Ma Ke, Gu Zhitao, Han Yongtao, Fu Jianhua, Shen Yi, Wei Yucheng, Tan Lijie, Zhang Peng, Chen Chun, Zhang Renquan, Li Yin, Chen Ke-Neng, Chen Hezhong, Liu Yongyu, Cui Youbing, Wang Yun, Pang Liewen, Yu Zhentao, Zhou Xinming, Liu Yangchun, Liu Yuan, Fang Wentao
Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Zhongguo Fei Ai Za Zhi. 2016 Jul 20;19(7):473-82. doi: 10.3779/j.issn.1009-3419.2016.07.10.
To study the role of postoperative chemotherapy and its prognostic effect in Masaoka-Koga stage III and IV thymic tumors.
Between 1994 and 2012, 1,700 patients with thymic tumors who underwent surgery without neoajuvant therapy were enrolled for the study. Among them, 665 patients in Masaoka-Koga stage III and IV were further analyzed to evaluate the clinical value of postoperative chemotherapy. The Kaplan-Meier method was used to obtain the survival curve of the patients divided into different subgroups, and the Cox regression analysis was used to make multivariate analysis on the factors affecting prognosis. A Propensity-Matched Study was used to evaluate the clinical value of chemotherapy.
Two-hundred-twenty-one patients were treated with postoperative chemotherapy, while the rest 444 cases were not. The two groups showed significant differences (P<0.05) regarding the incidence of myasthenia gravis, World Health Organization (WHO) histological subtypes, pathological staging, resection status and the use of postoperative radiotherapy. WHO type C tumors, incomplete resection, and postoperative radiotherapy were significantly related to increased recurrence and worse survival (P<0.05). Five-year and 10-year disease free survivals (DFS) and recurrence rates in patients who underwent surgery followed by postoperative chemotherapy were 51% and 30%, 46% and 68%, comparing with 73% and 58%, 26% and 40% in patients who had no adjuvant chemotherapy after surgery (P=0.001, P=0.001, respectively). In propensity-matched study, 158 pairs of patients with or without postoperative chemotherapy (316 patients in total) were selected and compared accordingly. Similar 5-year survival rates were detected between the two groups (P=0.332).
Pathologically higher grade histology, incomplete resection, and postoperative radiotherapy were found to be associated with worse outcomes in advanced stage thymic tumors. At present, there is no evidence to show that postoperative chemotherapy may help improve prognosis in patients with Masaoka-Koga-Koga stage III and IV thymic tumors.
研究术后化疗在Masaoka-KogaⅢ期和Ⅳ期胸腺瘤中的作用及其预后效果。
1994年至2012年间，纳入1700例未接受新辅助治疗而行手术的胸腺瘤患者。其中，对665例Masaoka-KogaⅢ期和Ⅳ期患者进行进一步分析，以评估术后化疗的临床价值。采用Kaplan-Meier法获取不同亚组患者的生存曲线，并用Cox回归分析对影响预后的因素进行多因素分析。采用倾向匹配研究评估化疗的临床价值。
221例患者接受了术后化疗，其余444例未接受。两组在重症肌无力发生率、世界卫生组织（WHO）组织学亚型、病理分期、切除情况及术后放疗使用方面存在显著差异（P<0.05）。WHO C型肿瘤、不完全切除及术后放疗与复发增加和生存较差显著相关（P<0.05）。术后接受化疗的患者5年和10年无病生存率（DFS）及复发率分别为51%和30%、46%和68%，而术后未接受辅助化疗的患者分别为73%和58%、26%和40%（P分别为0.001、0.001）。在倾向匹配研究中，选取158对接受或未接受术后化疗的患者（共316例）进行相应比较。两组5年生存率相似（P=0.332）。
病理组织学分级较高、不完全切除及术后放疗与晚期胸腺瘤预后较差相关。目前，尚无证据表明术后化疗有助于改善Masaoka-KogaⅢ期和Ⅳ期胸腺瘤患者的预后。
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