Fiorelli Alfonso, Natale Giovanni, Freda Chiara, Santini Mario
Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy.
Interact Cardiovasc Thorac Surg. 2019 Mar 1;28(3):399-403. doi: 10.1093/icvts/ivy270.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed is whether thymomectomy can be equivalent to thymectomy for non-myasthenic early-stage thymoma in terms of recurrence and survival. Ten papers were chosen to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. All studies included in this analysis are retrospective; most of them are small and from single-institution experiences, and only 3 used propensity-matched analysis to minimize the patients' selection bias. The choice of performing thymectomy or thymomectomy was based on surgeons' preference rather than on a standardized surgical approach. Most papers found that thymectomy was equivalent to thymomectomy in terms of outcomes, but these results could be affected by the intergroup differences in terms of follow-up length, administration of induction or adjuvant therapy, histological subtypes distribution and tumour size. Conversely, the studies of the Japanese Association for Research on the Thymus and the Chinese Alliance for Research in Thymoma found a higher rate of local recurrence in the thymomectomy group than in the thymectomy group. The National Comprehensive Cancer Network, National Cancer Institute and International Thymic Malignancy Interest Group recommend complete thymectomy in non-myasthenic patients with early thymoma; therefore, the identified studies in this review are not strong enough to change this recommendation.
根据结构化方案撰写了一篇胸外科最佳证据主题文章。所探讨的问题是，对于非重症肌无力的早期胸腺瘤患者，胸腺肿瘤切除术在复发率和生存率方面是否等同于胸腺切除术。选择了10篇论文来回答该问题。将这些论文的作者、期刊、发表日期、国家、研究的患者群体、研究类型、相关结局和结果制成表格。本分析纳入的所有研究均为回顾性研究；其中大多数规模较小，来自单一机构经验，只有3项研究采用倾向匹配分析以尽量减少患者选择偏倚。进行胸腺切除术或胸腺肿瘤切除术的选择基于外科医生的偏好，而非标准化手术方法。大多数论文发现，胸腺切除术和胸腺肿瘤切除术在结局方面相当，但这些结果可能受到组间随访时间长度、诱导或辅助治疗的使用、组织学亚型分布和肿瘤大小差异的影响。相反，日本胸腺研究协会和中国胸腺瘤研究联盟的研究发现，胸腺肿瘤切除术组的局部复发率高于胸腺切除术组。美国国立综合癌症网络、美国国立癌症研究所和国际胸腺恶性肿瘤兴趣小组建议对非重症肌无力的早期胸腺瘤患者进行完整的胸腺切除术；因此，本综述中确定的研究不足以改变这一建议。
