| BACKGROUND:At present, the main treatment for lymphoma is radiation and chemotherapy, surgical treatment is limited. Surgical treatment is mainly used for laparotomy or biopsy of staging; early appropriate surgical resection should be used for primary lymphoma in the stomach, kidney, bladder, testis, ovary, uterus, skin, breast, etc., postoperative supplemented by chemotherapy and radiotherapy. Primary thymic lymphoma refers to the lymphoma is located in the thymus on clinical and radiological study, there is no similar lesions in addition to the mediastinum , with a rare clinical manifestation of the systemic symptoms of lymphoma in general, not specific performance, many tumor symptoms resulting from oppression based on a lack of signs at lymphoma often local lymph nodes, the emergence of signs can be seen under pressure or organ involvement, so it is difficult to identificate from thymic carcinoma or thymoma phase. Primary thymic large B-cell lymphoma structure as the large cell similar to those the mother cells at the center or immune cells, can be accompanied by fibrosis, sclerosis;manypatients are young people,women, as happened from the thymus induced the regular respiratory pressure or superior vena cava syndrome . The most common primary lymphoma of the thymus as the nodular sclerosis type of the CHL and diffuse large B-cell lymphoma (DLBCL) of NHL.Surgery at the role of primary thymic lymphoma divergent views, it was suggested that the primary role of surgery for a clear diagnosis, generally through the forceps and needle biopsy specimens to obtain a very small, making pathological diagnosis difficult, and too few organizations can not be carried out immunohistochemical analysis, as to the mass lesion have a clear scope by imaging examinations, clear diagnosis can be get througth taking appropriate surgical method to get enough material , intraoperative frozen pathology is particularly necessary, unnecessary removal and to expand the scope of resection can be avoid by a clear diagnosis. In generally ,such methods as mediastinoscopy, video-assisted thoracoscopic biopsy, or through the upper sternal incision, median sternotomy incision, the standard posterolateral thoracotomy incision tumor excision are used. Surgery can also know the structure of mediastinal involvement in the situation, is able to carry out suspicious circumstances surrounding the surgical field within the biopsy, can help select the best treatment methods, and can help determine the location and extent of radiotherapy without increasing complications, not only resectable tumor, reducing tumor burden, but also through the right way of surgery so that patients get better postoperative survival. Surgical resection with postoperative radiotherapy and chemotherapy are the combination therapy of radical treatment, the current radiotherapy united chemotherapy is very effective; early cases (I, II period) after surgery often available on the largest clinical mitigation by postoperative radiotherapy and chemotherapy; for the result of some life-threatening primary mediastinal lymphoma is not satisfactory after radiotherapy and chemotherapy, the vital organs such as trachea, superior vena cava burdened on tumor suppression, feasible partial or radical subtotal tumor surgery in order to alleviate the symptoms and prolong life. Surgery is not only an important means of definitive diagnosis, but can also lift the tumor in a short time on the surrounding organs of repression, to alleviate symptoms, on the other hand, because of incomplete or subtotal tumor, can reduce the scope of and side effects of radiotherapy. Someone will think the treatment of mediastinal lymphoma should be based on radiotherapy and chemotherapy as a first choice, it is necessary identificated with other mediastinal malignant phase, in order to avoid unnecessary surgical trauma. for the result of some life-threatening primary mediastinal lymphoma is not satisfactory after radiotherapy and chemotherapy, the vital organs such as trachea, superior vena cava burdened on tumor suppression, feasible partial or radical subtotal tumor surgery in order to alleviate the symptoms and prolong life.Currently, the status of surgery has been affirmed in some other parts of the comprehensive treatment of lymphoma. According to the literature: the majority treatment of primary gastric malignant lymphoma should be the surgical treatment, surgical treatment of primary gastric malignant lymphoma are essential treatment, surgery will be the exact efficacy to prevent emerging perforation, bleeding and other complications after radiotherapy and chemotherapy at the same time, while surgery is the principal means to obtain pathological type and immunohistochemical classification in order to determine the clinical stage and provide a basis for selecting a reasonable and appropriate treatment program in the next step. Primary Breast Lymphoma is a kind of high degree of malignancy, surgical treatment can not be completely radical, most scholars advocate to be supplemented by post-operative chemotherapy and radiotherapy. Mediastinal lymphoma after complete resection in patients have short-term efficacy of satisfaction ,as to those patients without preoperative superficial lymphadenopathy, abnormal hematological examination, , and abnormal liver and spleen enlarged retroperitoneal lymph nodes after abdominal ultrasound, confined to mediastinum or with pathological lung nodules not specific cases, such as patients can tolerate, surgical tumor resectability not only to reduce the tumor load, but also helps clarify the diagnosis,give based on pathology for follow-up treatment, surgical intervention on the mediastinal lymph diagnosis and treatment of tumors is of positive significance. early detection, as far as possible complete tumor resection, postoperative adjuvant radiotherapy, chemotherapy and biological formal immunotherapy would be beneficial to control the disease .It appears from the current, the combined treatment modalities with surgery, radiotherapy and chemotherapy have achieved remarkable results in the treatment confined to the gastrointestinal tract and breast lymphoma, whether same applies this model to primary thymic lymphoma and achieved the effect of treatment is not yet to be seen. The topics to be evidence-based medical research on the topic of discussion in order to determine the primary surgical treatment of thymic lymphoma general role and status, while clear a variety of treatment modalities and age, tumor size, tumor stage, pathological type and other factors in the study.OBJECTIVES:1. To surgery, radiotherapy and chemotherapy and the united targeted therapy treatment modalities has achieved the remarkable results on the treatment of gastrointestinal tract and breast lymphoma lymphoma , whether applies to this model on the treatment of of primary thymic lymphoma and achieved the effect yet to be seen. This paper summarizes clinical data treated patients with primary thymic lymphoma in Nanfang Hospital,the Southern Medical University and Guangzhou Medical College affiliated tumor hospital . conduct a preliminary analysis on the clinicopathological characteristics and treatment methods of primary lymphoma of the thymus , and to investigate its rational treatment.2. At the same time, based on the preliminary study, a variety of patterns and age, tumor size, tumor stage, pathological type and other factors is analysis in order to help evaluating the prognosis and formulating appropriate treatment Ways. Some studies now show that primary lymphoma in some parts such as gastrointestinal and breast , staging, treatment and modalities are clearly related to prognosis. Other factors such as pathology and prognosis are still controversial. The relations with these factors and prognosis of primary thymic lymphoma, will be elaborated in this study .3. Access to domestic literature, about reports of primary thymic lymphoma Retrieval from January 1, 1980 - December 31,2008 in Chinese Biomedical Database and PUBMED Database, remove duplicate reports and incomplete data, and determine the integrity of the final data with clinical significance of Primary thymic lymphoma in all patients, comprehensive analysis, and clinical study in contrast.METHODS:Part one1. 142 cases of primary thymic lymphoma treated in Nanfang Hospital ,Southern Medical University,and Guangzhou Medical College affiliated Cancer hospital were collected since 1, 1978 -1,2004 , 85 cases of male, 57 cases of female, male to female ratio to 1.49:1.2. Diagnostic criteria of Primary thymic lymphoma: (1) enough to obtain the pathological specimen; (2) pathologically confirmed thymic lymphoma infiltrating organizations and close; (3) not evidence of systemic spread of disease in the same period ; (4) Not outside the site of a history of thymic lymphoma. Clinical staging according to Ann Arbor staging criteria and medical examination, chest X-ray, CT and bone marrow puncture, such as inspection.3. Follow-up of 142 cases, follow-up of the termination date of 1,2009 . Survive Record by feedback, as well as cause of death ,all patients does not appear lost.4. In this study, an analysis of all data using statistical software SPSS12.0 treatment, single-variable analysis to Kpalna-Meier method for analysis, application testing Lgo-rakn Act survival rate differences. Statistically significant difference defined as P <.005. Based on age, tumor size, Ann Arbor stage, histology type, treatment modalities were calculated cumulative survival rate. Using COX model analysis of many factors, and test it, discovered and to evaluate the prognostic indicators of survival.Part twoPUBMED Database and Chinese Biomedical Database were retrieved, a total of 172 cases of article 64 were reported in the domestic from January 1, 1980 to December 31,2008, the majority of reported cases; remove 86 cases of duplicate and incomplete data ,determine the integrity of the final data with clinical significance of all primary thymic lymphoma patients, for a total of 94 cases, a comprehensive analysis in prograss.RESULTS:Part one1. 142 cases of patients with 5 or 10 years survival rates were 59.05%, 45.77%,.2. according to Ann Arbor staging method in phases, the period of 5 years, 10-year survival rates were I a view to 89.06%, 79.09%, II period of 81.09 %, 58.02% III 56.09%, 32.09%, IV Phase 0.3. Surgical treatment of 116 cases (81.7%), 84 cases of radical resection (72.4%), palliative resection in 9 cases (7.8%), only 23 cases from the pathological (19.8%). Radiotherapy for 89 cases (6.27%), 55 cases of postoperative radiotherapy (61.8%).4. Univariate analysis of Ann Arbor stage, histology type, treatment modalities are prognostic indicators of survival. At multivariate analysis finally reached Ann Arbor staging, treatment modalities are prognostic indicators of survival.Part two1. 94 cases searched from the literature, 60 cases (63.8%) line surgery, 31 cases (33.0%) no chemotherapy after surgery, 25 cases (26.6%) CHOP (Cyclophosphamide acid amines, doxorubicin, vincristine, prednisone) or COP (Cyclophosphamide, vincristine, prednisone) chemotherapy after surgery, 4 cases (4.3%) postoperative chemotherapy and radiotherapy at the same time; 18 cases of non-surgical in 21 cases (19.1%) received chemotherapy, 3 cases (3.2%) chemotherapy and radiotherapy. 13 cases (13.8%) refused treatment or information is available.2. 49 cases (52.1%) have complete follow-up data, with an average follow-up time is 30 months, range 6 months to 13 years, 40 cases alive, nine cases of death, an average of 2.5-year survival rate of 81.6%. In complete follow-up data at 49 cases, no chemotherapy after surgery were 19 cases, 16 cases of survival; 10 cases of survival in 11 cases of postoperative chemotherapy , postoperative radiotherapy and chemotherapy simultaneously from all four cases of survival, , 9 cases of survival in 13 cases of non-surgical chemotherapy,1 cases of survival in two cases of radiotherapy and chemotherapy .DISCUSSIONS:The study found Ann Arbor staging, pathological type, treatment modalities and prognosis are closely related and found a precise correlation between them. However, existing data are based on limited information from the two hospitals, and want to build a more precise prognosis of the survival models still need to be based on more extensive and large-scale data analysis. Our research confirmed the value of tumor radical mastectomy and postoperative radiotherapy and chemotherapy in primary thymic lymphoma therapeutic. Therefore tumor radical surgery and radiotherapy combined with chemotherapy after adical surgery must be affirmed for the treatment of primary thymic lymphoma. In this study, the greatest factor impact on the prognosis are Ann Arbor stage, therefore early detection, early diagnosis and early treatment of primary thymic lymphoma is very importment. In short, through the prognostic factor analysis of the primary thymic lymphoma, can help us to understand disease progression and prognosis ,can help us formulate a reasonable treatment plan, there is finally conducive to the extension of survival time of patients.In this study, the greatest another factor impact on prognosis is the methods of treatment, many scholars consider complete surgical resection be the most important prognostic factors for the prediction of tumor recurrence. Complete surgical resection benefit the prognosis is better than any other treatment, including subtotal or auxiliary united neoadjuvant radiotherapy and chemotherapy. Surgery is the preferred treatment of primary thymic lymphoma. I period of thymic lymphoma for postoperative radiotherapy and chemotherapy can improve efficacy, reduce the relapse rate , therefore postoperative radiotherapy and chemotherapy should be the conventional therapy. Try radical surgery to improve survival rates on the patients of Phase II, but even though patients with stage II or more , postoperative radiotherapy and chemotherapy remains conventional. The total 5-year survival rate of Stage III patients improve not significantly over the past 20 years, IV period patients not be completely removed, the prognosis is still not ideal even if postoperative radiotherapy or radiotherapy and chemotherapy were put out, pre-operative radiotherapy or radiotherapy and chemotherapy can improve complete resection rates, reduce partial and improve the survival rate of pleural recurrence. The survival rate of primary thymic lymphomas are the adoption of a new adjuvant therapy and increasing the rate of radical surgical resection increased. Preoperative radiation enhancing the integrity of the resection rate and increase survival rate of in the total. Because this group of cases can not be analyzed statistically for without preoperative radiotherapy, results pending further analysis. Literature search found, even though primary thymic lymphoma is a rare disease, lack of specificity of symptoms and easily misdiagnosed, but the summing up of this set of data revealed that the disease and pathological study of the images have a certain degree of specificity in the diagnosis of the technical side, CT-guided percutaneous tumor puncture the chest and surgical biopsy are the effective means of diagnosis, surgical treatment is more important for primary lymphoma in the thymus, it should be preferred to surgery-based General treatment modalities.
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