Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
J Thorac Oncol. 2015 Nov;10(11):1642-7. doi: 10.1097/JTO.0000000000000660.
Thymic carcinomas and thymic neuroendocrine tumors are rare diseases often treated with surgical resection. Currently, there are no guidelines regarding nodal dissection at the time of tumor resection. Moreover, the prognostic significance of nodal metastases is unclear. The goal of this study was to define the incidence and prognostic relevance of nodal metastases in patients with thymic carcinoma and thymic neuroendocrine tumors.
The Surveillance, Epidemiology and End Results database was queried for patients who underwent surgical resection of thymic carcinoma or a thymic neuroendocrine tumor with documented pathological examination of lymph nodes. The incidence of nodal metastases and the impact on survival were examined.
We identified 176 patients with thymic carcinoma and 53 with thymic neuroendocrine tumors. A median of three lymph nodes was sampled per patient. Positive metastasis to at least one lymph node was identified in 92 patients (40.2%). Nodal metastasis was more common in patients with thymic neuroendocrine tumors than in patients with thymic carcinoma (62.3% versus 33.5%). In multivariate analysis, nodal metastasis was more likely in patients with thymic neuroendocrine tumors and with more advanced tumors. The presence of nodal metastases had significant, independent, adverse impact on survival (hazard ratio, 2.933, 95% confidence interval, 1.903-4.521, p = 0.001). Median survival was 47 months in patients with nodal metastasis and 124 months in patients without nodal metastases (p < 0.001).
Nodal status seems to be an important prognostic factor in patients with thymic carcinoma and thymic neuroendocrine tumors. Nodal sampling should be performed during resection of these thymic malignancies.
胸腺癌和胸腺神经内分泌肿瘤是罕见疾病，常采用手术切除进行治疗。目前，在肿瘤切除时行淋巴结清扫术并无指南可循。此外，淋巴结转移的预后意义尚不清楚。本研究旨在明确胸腺癌和胸腺神经内分泌肿瘤患者中淋巴结转移的发生率和预后相关性。
通过监测、流行病学和最终结果数据库，检索接受过胸腺腺癌或胸腺神经内分泌肿瘤切除术且淋巴结病理检查结果明确的患者。分析淋巴结转移的发生率及其对生存的影响。
共纳入 176 例胸腺癌患者和 53 例胸腺神经内分泌肿瘤患者。每位患者的平均淋巴结取样数为 3 个。92 例（40.2%）患者至少有一个淋巴结发生转移。与胸腺癌患者相比，胸腺神经内分泌肿瘤患者的淋巴结转移更为常见（62.3%比 33.5%）。多变量分析显示，胸腺神经内分泌肿瘤和肿瘤分期较高的患者更易发生淋巴结转移。淋巴结转移的存在对生存有显著的独立不利影响（风险比 2.933，95%置信区间 1.903-4.521，p = 0.001）。有淋巴结转移患者的中位生存时间为 47 个月，无淋巴结转移患者的中位生存时间为 124 个月（p < 0.001）。
淋巴结状态似乎是胸腺癌和胸腺神经内分泌肿瘤患者的一个重要预后因素。在这些胸腺恶性肿瘤的切除术中应进行淋巴结取样。
