Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Division of Thoracic Surgery, Yale University, New Haven, CT, USA.
Eur J Cardiothorac Surg. 2017 Jul 1;52(1):26-32. doi: 10.1093/ejcts/ezx042.
Surgeons at different institutions worldwide choose different types of operations for thymic tumours. It is not known whether these differences affect the outcomes of the patients.
A total of 1430 patients with Masaoka-Koga pathological Stage I-II thymic tumours without myasthenia gravis or pre-treatment were identified from the International Thymic Malignancy Interest Group retrospective database. Outcomes of patients from 3 major continents (Europe, North America and Asia) were compared.
Patients from the 3 continents were comparable in gender and performance status. More European patients had more paraneoplastic syndromes; North American patients had the smallest tumour sizes and less adjuvant therapy; and Asian patients were younger and had more Stage I disease but higher grade tumours. Partial thymectomy was performed more often in Asian patients (31.7%) than in European (2.4%) and North American (5.4%; P < 0.001) patients. The median approach (sternotomy/clamshell) was the major approach in Europe (75.3%) and North America (76.6%). In contrast, the median approach was applied significantly less frequently in Asia (45.6%, P < 0.001); unilateral open (thoracotomy/hemi-clamshell, 23.3%) and minimally invasive approaches (video-assisted thoracoscopic surgery/robot, 31.1%) were used more often with similar rates of complete resection. The 10-year overall survival rate was 82% for Europe, 78% for North America and 90% for Asia ( P = 0.005), respectively. The 10-year cumulative recurrence rates were similar among the geographic groups (European 0.08, North American 0.07, and Asian 0.06, P = 0.61). Age was the only independent predictive factor for overall survival ( P < 0.001, HR = 1.089, 95% CI 1.056-1.123) in multivariable analysis. Types B3 and thymic carcinoma ( P = 0.003, HR = 3.932, 95% CI 1.615-9.576) were independent risk factors for increased recurrence.
This study shows that the selection of the surgical approach and the extent of resection for Stage I and II thymic tumours differ by geographic region. However, these differences seem to have little impact on outcomes.
全球不同医疗机构的外科医生会选择不同类型的胸腺肿瘤手术。目前尚不清楚这些差异是否会影响患者的结局。
从国际胸腺恶性肿瘤兴趣组的回顾性数据库中，共确定了 1430 例无重症肌无力或预处理的 Masaoka-Koga 病理分期 I-II 胸腺肿瘤患者。比较了来自三大洲（欧洲、北美和亚洲）的患者的结局。
三大洲的患者在性别和功能状态方面具有可比性。欧洲患者更多伴有副肿瘤综合征；北美患者肿瘤体积最小，辅助治疗更少；亚洲患者更年轻，更多为 I 期疾病，但肿瘤分级更高。亚洲患者行胸腺部分切除术（31.7%）的比例高于欧洲（2.4%）和北美（5.4%；P<0.001）患者。胸骨正中劈开/双瓣式入路是欧洲（75.3%）和北美（76.6%）的主要入路。相比之下，亚洲采用该入路的比例明显更低（45.6%，P<0.001）；单侧开胸（剖胸/半开胸）和微创入路（电视辅助胸腔镜手术/机器人）的使用率更高，且完全切除率相似。欧洲、北美和亚洲的 10 年总生存率分别为 82%、78%和 90%（P=0.005）。各组的 10 年累积复发率相似（欧洲 0.08、北美 0.07、亚洲 0.06，P=0.61）。多变量分析显示，年龄是总生存的唯一独立预测因素（P<0.001，HR=1.089，95%CI 1.056-1.123）。B3 型和胸腺癌（P=0.003，HR=3.932，95%CI 1.615-9.576）是复发的独立危险因素。
本研究表明，Ⅰ期和Ⅱ期胸腺瘤的手术入路选择和切除范围因地理位置不同而存在差异。然而，这些差异似乎对结局影响不大。
