术前病理学诊断在胸腺肿瘤诊疗中的应用

背景与目的探讨术前病理学诊断在胸腺肿瘤诊断和治疗中的价值及其对胸腺肿瘤治疗的影响。方法对中国胸腺肿瘤协作组（Chinese Alliance for Research in hTymomas, ChART）收集的1994年-2012年的多中心且具有明确活检状态的胸腺肿瘤患者的临床病理资料进行回顾性分析，探讨术前病理学诊断的应用趋势及其对胸腺肿瘤患者预后的影响。结果1,902例胸腺肿瘤患者中，术前病理学诊断患者336例（17.1%）。近年来术前病理学诊断的比例较前明显增加（P=0.008），胸腔镜/纵隔镜/超声内镜下经支气管活检（endobronchial ultrasound, E-BUS）比例较前升高（P=0.029）。术前行病理学诊断患者的生存明显差于无病理学诊断患者（P<0.001），术前病理学诊断后的目的与肿瘤的Masaoka分期（P<0.001）、切除程度（P=0.025）、病理类型（P<0.001）具有相关性。术前病理学诊断后直接手术患者的生存要明显优于诱导治疗后再手术患者（P<0.001）。结论胸腺瘤诊断主要依靠临床及组织学判断，近年来术前病理学诊断在胸腺肿瘤的诊断和治疗中起重要作用；根治性手术切除是胸腺肿瘤的首先治疗手段；术前病理学诊断后直接手术患者的预后要明显优于诱导治疗后患者。

Pretreatment Biopsy for Histological Diagnosis and Induction Therapy in Thymic Tumors

Background and objectiveThe aim of this study is to investigate the value of pretreatment biopsy for histological diagnosis and induction therapies in the management of locally advanced thymic malignancies.MethodsThe clinical pathological data of patients with thymic tumors in the Chinese Alliance for Research in Thymomas (ChART) who underwent biopsy before treatment from 1994 to December 2012 were retrospectively reviewed. The application trend of preoperative histological diagnosis and its inlfuence on treatment outcome were analyzed.Results Of 1,902 cases of thymic tumors, 336 (17.1%) had undergone biopsy for histological diagnosis before therapeutic decision was decided. In recent years, percentage of pretreatment histological diagnosis signiifcantly increased in the later ten years than the former during the study period (P=0.008). There was also a signiifcant increase in thoracoscopy/mediastinoscopy/endobronchial ultrasound (E-BUS) biopsy as compared to open biopsy (P=0.029). Survival in Patients with preoperative biopsy for histology had signiifcantly higher stage lesions (P<0.001) and higher grade malignancy (P<0.001), thus a significantly lower complete resection rate (P<0.001) and therefore a significantly worse survival than those without preoperative biopsy (P=0.001). In the biopsied 336 patients, those who received upfront surgery had signiifcantly better survival than those received surgery atfer induction therapy (P=0.001). In stage III and IVa diseases, the R0 resection rate atfer induction therapies increased signiifcantly as com-pared to the surgery upfront cases (65.5%vs 46.2%,P=0.025). Tumors downstaged atfer induction had similar outcomes as those having upfront surgery (92.3%vs 84.2%,P=0.51). However, tumors not downstaged by induction had signiifcantly worse prognosis than those downstaged (P=0.004), and fared even worse than those having deifnitive chemoradiation without sur-gery (37.2%vs 62.4%,P=0.216).ConclusionIt is crucial to get histological diagnosis for thymoma before surgery or adjuvant
treatment and minimally invasive biopsy should be undertaken. Although in our study we could not ifnd the beneift of induc-tion chemotherapy before surgery in survival and recurrence rate, it could increase the R0 resection rate compared with direct surgery in late stage (III and IVa).