目的 探讨胸腺鳞状细胞癌(thymic squamous cell carcinoma,TSCC)的临床特征和无进展生存(progression-free survival,PFS)的影响因素.方法 回顾性分析在2018年3月15日至2023年3月15日期间于青岛大学附属医院初次确诊的78例TSCC患者的临床资料,并随访至2024年3月15日,生存分析采用Kaplan-Meier法,预后影响因素分析采用Log rank检验以及Cox单因素和多因素回归模型.结果 78例患者的中位PFS为66个月,1年、3年、5年PFS率分别为91.0%、69.0%、54.3%.全组单因素分析显示,肿瘤长径(χ2=7.43,P=0.006)、N分期(χ2=6.00,P=0.050)、M分期(χ2=8.18,P=0.004)、TNM分期(χ2=4.91,P=0.027)、手术(χ2=4.10,P=0.043)、治疗方式(χ2=10.19,P=0.017)与患者的PFS相关;多因素分析显示,肿瘤长径(HR=1.30,95%CI:1.08～1.58,P=0.007)、化疗(HR=0.22,95%CI:0.06～0.77,P=0.018)、单纯手术(HR=0.04,95%CI:0.01～0.29,P=0.001)、手术加辅助治疗(HR=0.23,95%CI:0.06～0.86,P=0.029)是患者PFS的独立影响因素.亚组多因素分析显示,单纯手术(HR=0.06,95%CI:0～0.74,P=0.028)和手术加辅助治疗(HR=0.08,95%CI:0.01～0.79,P=0.031)是Ⅰ/Ⅱ期患者PFS的独立影响因素;肿瘤长径(HR=1.35,95%CI:1.03～1.78,P=0.031)和放疗(HR=0.21,95%CI:0.05～0.92,P=0.039)是Ⅲ/Ⅳ期患者PFS的独立影响因素.结论 TSCC患者预后较差,肿瘤长径和肿瘤分期与患者的PFS相关,分期尽量选择国际抗癌联盟(Union for International Cancer Control,UICC)/美国癌症联合会(American Joint Committee on Cancer,AJCC)第九版TNM分期.手术、放疗和化疗可以降低患者的进展风险,建议Ⅰ/Ⅱ期患者尽量进行手术治疗,术后可进行辅助治疗,Ⅲ/Ⅳ期患者的治疗尽量加入放疗,化疗也可加入综合治疗.
Analysis of clinical characteristics and factors influencing progression-free survival of 78 cases thymic squamous cell carcinoma
Objective:To investigate the clinical characteristics and factors influencing progression-free survival(PFS)of 78 cases thymic squamous cell carcinoma(TSCC).Methods:We retrospectively analyzed the clinical data of 78 patients with TSCC diagnosed for the first time in the Affiliated Hospital of Qingdao University from March 15th,2018 to March 15th,2023 and followed them until March 15,2024.Kaplan-Meier(KM)curve was used for survival analysis.Log rank test and Cox univariate and multivariate regression were used for the analysis of factors influencing prognosis.Results:The median PFS of the 78 patients were 66.0 months.The 1-year,3-year,and 5-year PFS rates were 91.0%,69.0%,and 54.3%,respectively.In the overall patient cohort,Univariate analysis showed that the tumor diameter(χ2=7.43,P=0.006),N stage(χ2=6.00,P=0.050),M stage(χ2=8.18,P=0.004),TNM stage(χ2=4.91,P=0.027),surgery(χ2=4.10,P=0.043),and treatment method(χ2=10.19,P=0.017)were associated with PFS;Multivariate analysis showed that tumor diameter(HR=1.30,95%CI:1.08-1.58,P=0.007),chemotherapy(HR=0.22,95%CI:0.06-0.77,P=0.018),surgery alone(HR=0.04,95%CI:0.01-0.29,P=0.001),and surgery with adjuvant therapy(HR=0.23,95%CI:0.06-0.86,P=0.029)were independent influencing factors of PFS.As for patient subgroups stratified according to the TNM stage,Multivariate analysis showed that surgery alone(HR=0.06,95%CI:0-0.74,P=0.028)and surgery with adjuvant therapy(HR=0.08,95%CI:0.01-0.79,P=0.031)were independent influencing factors of PFS in stage Ⅰ/Ⅱ patients;Tumor diameter(HR=1.35,95%CI:1.03-1.78,P=0.031)and radiotherapy(HR=0.21,95%CI:0.05-0.92,P=0.039)are independent influencing factors of PFS in stage Ⅲ/Ⅳ patients.Conclusion:TSCC is a malignancy with a poor prognosis.Both tumor diameter and tumor stage are associated with PFS.It is recommended to choose the UICC/AJCC 9th TNM staging as the staging method.Patients who undergo surgery,radiotherapy,or chemotherapy have a lower risk of progression.It is recommended that stage Ⅰ/Ⅱ patients should undergo surgical treatment,and postoperative adjuvant therapy would be feasible.Stage Ⅲ/Ⅳ patients are recommended to try to add radiotherapy,and chemotherapy should be considered for selected patients.
万方数据
维普
