临床上巨大胸腺瘤案例罕见,对于IVa期巨大胸腺瘤治疗方法尚无共识,且可供选择的治疗方法又尤为缺乏。本文介绍一例35岁Masaoka IVa期巨大胸腺瘤的患者,行手术切除后联合化疗及免疫治疗,获得无复发生存时间(Recurrence Free Survival, RFS)为13个月,复发后又通过局部放疗联合化疗、免疫治疗后基本达到完全缓解(Complete Response, CR)。临床上对于Masaoka IVa期巨大胸腺瘤患者应采取多学科诊疗模式,即以手术为主,全身及局部治疗为辅的治疗模式下进行。随着免疫治疗在胸腺瘤中的机制及疗效正不断被披露,本例患者加用免疫治疗后取得不错的疗效,且未见明显副作用,这也提示我们免疫治疗的加入或可使难治性胸腺瘤从治疗中获益,或为临床决策提供了更多的选择。Giant thymoma cases are rare in clinical practice, and there remains a lack of consensus regarding treatment approaches for stage IVa giant thymomas. Furthermore, the available treatment options are limited. The present study reports on a case of a 35-year-old patient diagnosed with Masaoka stage IVa thymoma, who underwent surgical resection followed by combined chemotherapy and immunotherapy, achieving a recurrence-free survival time (RFS) of 13 months. Furthermore, upon relapse, the patient attained near-complete response (CR) through local radiotherapy in combination with chemotherapy and immunotherapy. In clinical practice, a multidisciplinary approach is recommended for patients with Masaoka stage IVa thymoma, wherein surgery serves as the primary treatment of giant thymoma treatment and systemic and local therapies are employed as adjunctive treatments. With an increasing comprehension of the mechanisms and efficacy of immunotherapy in thymomas, this case demonstrates favorable therapeutic effects without significant adverse reactions upon the addition of immunotherapy. This implies that incorporating immunotherapy may confer benefits to patients with refractory thymoma while offering additional options for clinical decision-making.
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