White Darin B, Hora Megan J, Jenkins Sarah M, Marks Randolph S, Garces Yolanda I, Cassivi Stephen D, Roden Anja C
Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic Rochester, Rochester, MN, USA.
Eur J Cardiothorac Surg. 2019 Feb 11. doi: 10.1093/ejcts/ezz013.
The aim of this study is to evaluate the efficacy of chest computed tomography (CT) to predict the pathological stage of thymic epithelial tumours (TET) using the recently introduced tumour, node and metastasis (TNM) staging with comparison to the modified Masaoka staging.
Preoperative chest CT examinations in cases of resected TET with sampled lymph nodes (2006-2016) were retrospectively reviewed by 2 thoracic radiologists and radiologically (r) staged using both staging systems. A thoracic pathologist reviewed all cases for the pathological (p) stage. Concordance between r-staging and p-staging was assessed by % agreement and unweighted kappa statistics. Associations between r-stage and p-stage with outcomes were assessed using the Cox proportional hazards regression.
Sixty patients with TET were included (47 thymomas, 12 thymic carcinomas and 1 atypical carcinoid tumour). Sixteen patients (26.7%) had received neoadjuvant therapy. Fifty-four patients (90.0%) had complete resection. The overall agreement between the r-stage and p-stage was 66.7% (κ = 0.46) for TNM staging and 46.7% (κ = 0.30) for modified Masaoka staging. Agreement between r-assessment and p-assessment of the T, N and M components of the TNM stage was 61.7% (κ = 0.28), 86.7% (κ = 0.48) and 98.3% (κ = 0.88), respectively. CT overstaged 12 patients (20.0%) for TNM staging and 12 patients (20.0%) for modified Masaoka staging and understaged 8 (13.3%) and 20 (33.3%) patients for TNM staging modified Masaoka staging, respectively. The r-TNM staging accuracy was lower for patients with neoadjuvant therapy (50.0% with vs 72.7% without). During a median follow-up of 2.6 years (range 0.1-10.5 years), 12 patients had metastases and/or recurrence; 11 patients died (4 of disease). The r-TNM stage and modified Masaoka stage were associated with overall survival and progression-free survival (P < 0.001).
Preoperative chest CT is able to accurately predict p-TNM stage in two-thirds of surgically resected TET, with an agreement between radiological staging and pathological staging superior to the modified Masaoka staging.
本研究旨在评估胸部计算机断层扫描（CT）使用最近引入的肿瘤、淋巴结和转移（TNM）分期系统预测胸腺上皮肿瘤（TET）病理分期的效能，并与改良的Masaoka分期进行比较。
两名胸放射科医生对2006年至2016年期间切除的伴有淋巴结采样的TET病例的术前胸部CT检查进行回顾性分析，并使用两种分期系统进行放射学（r）分期。一名胸病理科医生对所有病例进行病理（p）分期评估。通过一致性百分比和非加权kappa统计评估r分期与p分期之间的一致性。使用Cox比例风险回归评估r分期和p分期与预后之间的关联。
纳入60例TET患者（47例胸腺瘤、12例胸腺癌和1例非典型类癌肿瘤）。16例患者（26.7%）接受了新辅助治疗。54例患者（90.0%）实现了完全切除。TNM分期的r分期与p分期之间的总体一致性为66.7%（κ = 0.46），改良Masaoka分期为46.7%（κ = 0.30）。TNM分期中T、N和M成分的r评估与p评估之间的一致性分别为61.7%（κ = 0.28）、86.7%（κ = 0.48）和98.3%（κ = 0.88）。CT对TNM分期高估了12例患者（20.0%），对改良Masaoka分期高估了12例患者（20.0%）；对TNM分期低估了8例患者（13.3%），对改良Masaoka分期低估了20例患者（33.3%）。接受新辅助治疗的患者r-TNM分期准确性较低（接受新辅助治疗的患者为50.0%，未接受新辅助治疗的患者为72.7%）。在中位随访2.6年（范围0.1 - 10.5年）期间，12例患者发生转移和/或复发；11例患者死亡（4例死于疾病）。r-TNM分期和改良Masaoka分期与总生存期和无进展生存期相关（P < 0.001）。
术前胸部CT能够在三分之二的手术切除TET病例中准确预测p-TNM分期，放射学分期与病理分期之间的一致性优于改良Masaoka分期。
