Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Eur J Cardiothorac Surg. 2017 Jul 1;52(1):33-38. doi: 10.1093/ejcts/ezx037.
Thymic carcinoma (TC) and thymic carcinoid (TCD) are aggressive thymic epithelial neoplasms with a poor prognosis. Due to rarity, little is known about their comparative clinical characteristics, treatment outcomes and patterns of relapse.
A retrospective cohort study was performed on 287 patients with TC and 56 patients with TCD who were treated at the Shanghai Chest Hospital between February 2003 and April 2014. Patient demographics, tumour stage, treatment, pathologic findings and postoperative outcomes were compared between the two tumour types using both multivariable Cox regression analysis and propensity-matched analysis.
Compared to patients with TC, significantly more patients with TCD were male, had larger tumours, and displayed a greater proportion of lymph node metastases. However, overall survival was similar (60.7% 5-year survival for TC, 80.7% for TCD, P = 0.159), as was disease-free survival (41.1% 5-year survival for TC, 37.6% for TCD, P = 0.696) and patterns of relapse. Multiple Cox regression analysis identified younger patients [hazard ratio (HR) 1.018; 95% confidence interval (CI) 1.000-1.035; P = 0.047], more completeness of resection (HR 1.424; 95% CI 1.105-1.836; P = 0.006), adjuvant radiotherapy (HR 0.455; 95% CI 0.276-0.751; P = 0.002), and no adjuvant chemotherapy (HR 1.799; 95% CI 1.017-3.183; P = 0.044) as independent factors predicting better overall survival. Completeness of resection (HR 1.258; 95% CI 1.022-1.548; P = 0.031) and TNM stage (HR 1.479; 95% CI 1.107-1.977; P = 0.008) were independent predictors of disease-free survival. Propensity matching produced 46 patients in each group and no significant difference on overall survival or disease-free survival was found.
Patients with TCD have discrete features but share a similar clinical course to those with TC. The importance of complete resection in both of these thymic malignancies is emphasized. Further investigation at multiple centers with the longer follow-up data is required to substantiate our conclusion.
胸腺癌（TC）和胸类癌（TCD）是侵袭性胸上皮肿瘤，预后较差。由于其罕见性，对于其比较的临床特征、治疗结果和复发模式知之甚少。
对 2003 年 2 月至 2014 年 4 月在上海胸科医院接受治疗的 287 例 TC 患者和 56 例 TCD 患者进行了回顾性队列研究。使用多变量 Cox 回归分析和倾向匹配分析比较了两种肿瘤类型的患者人口统计学、肿瘤分期、治疗、病理发现和术后结果。
与 TC 患者相比，TCD 患者中男性更多，肿瘤更大，淋巴结转移比例更高。然而，总生存率相似（TC 为 60.7%，5 年生存率；TCD 为 80.7%，P=0.159），无病生存率也相似（TC 为 41.1%，5 年生存率；TCD 为 37.6%，P=0.696）和复发模式。多变量 Cox 回归分析确定了年龄较小的患者（风险比 [HR] 1.018；95%置信区间 [CI] 1.000-1.035；P=0.047）、更完整的切除（HR 1.424；95%CI 1.105-1.836；P=0.006）、辅助放疗（HR 0.455；95%CI 0.276-0.751；P=0.002）和无辅助化疗（HR 1.799；95%CI 1.017-3.183；P=0.044）是总生存率的独立预测因素。完全切除（HR 1.258；95%CI 1.022-1.548；P=0.031）和 TNM 分期（HR 1.479；95%CI 1.107-1.977；P=0.008）是无病生存率的独立预测因素。
TCD 患者具有不同的特征，但与 TC 患者的临床过程相似。强调了在这两种胸腺恶性肿瘤中完全切除的重要性。需要在多个中心进行进一步的研究，并结合更长的随访数据来证实我们的结论。
