Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
Lung Cancer. 2019 Dec;138:27-34. doi: 10.1016/j.lungcan.2019.09.024. Epub 2019 Sep 30.
Thymomas are rare neoplasms with a low recurrence rate, which are preferably surgically treated. Iterative thymoma surgery has not been well investigated yet. Study aim is to analyse prognostic factors after iterative recurrence treatment.
Clinical, pathological and surgical findings of 155 patients, treated for thymoma recurrence in three high-volume centres from 01/01/1990 to 1/07/2017, were retrospectively reviewed. Recurrence patterns/treatment types (surgery or chemotherapy, radiotherapy or combined) were correlated to overall (OS) and disease free survival (DFS).
Myasthenia Gravis was present in 135 (87%) patients. Surgery was performed in 135/155 (87%) patients with 109 (80.7%) complete resections. Sixty (55%)patients experienced a second recurrence surgically treated in 31/60 (52%) cases with 18 (58%) complete resections. Eleven (61%) patients experienced a third recurrence and nine underwent complete resection. Myastenia Gravis (HR: 0.45; 95% CI: 0.20-0.98, p = 0.046), DFS after the initial thymectomy >36 months (HR: 0.9; 95% CI: 0.96-0.99, p = 0.006) and complete second recurrence resection (HR: 1.45; 95% CI 2.07-10.01, p = 0.010) resulted as independent favorable prognostic survival factor. Despite patient selection bias, rewarding long-term survivals was predictable after iterative thymoma surgery (5 and 10 years survival of 79.6% and 64.6%) while a poor prognosis was observed after CT/RT (5 and 10 years OS of 56.7% and 21.5%), Masaoka stage and DFS > 36 months were risk factor for iterative recurrences.
Myasthenia Gravis and long DFS after thymectomy are favorable survival factors for multiple thymoma recurrences. Iterative surgical treatment is a viable therapeutic option associated to long-term survival if technically and clinically feasible.
胸腺瘤是一种罕见的肿瘤，复发率低，最好通过手术治疗。迭代性胸腺瘤手术尚未得到充分研究。本研究旨在分析多次复发治疗后的预后因素。
回顾性分析了 2017 年 1 月 1 日至 2017 年 7 月 1 日期间，3 家高容量中心对 155 例胸腺瘤复发患者的临床、病理和手术资料。分析复发模式/治疗类型（手术或化疗、放疗或联合治疗）与总生存（OS）和无病生存（DFS）的关系。
135 例（87%）患者存在重症肌无力。135/155 例（87%）患者接受了手术治疗，其中 109 例（80.7%）为完全切除。60 例（55%）患者经历了第二次手术复发，其中 31 例（52%）为完全切除。11 例（61%）患者经历了第三次复发，其中 9 例为完全切除。重症肌无力（HR：0.45；95%CI：0.20-0.98，p=0.046）、初始胸腺切除术 DFS 超过 36 个月（HR：0.9；95%CI：0.96-0.99，p=0.006）和完全第二次复发切除（HR：1.45；95%CI 2.07-10.01，p=0.010）是独立的有利预后生存因素。尽管存在患者选择偏倚，但迭代性胸腺瘤手术后仍可预测长期生存获益（5 年和 10 年生存率分别为 79.6%和 64.6%），而 CT/RT 后预后较差（5 年和 10 年 OS 分别为 56.7%和 21.5%），Masaoka 分期和 DFS>36 个月是复发的危险因素。
重症肌无力和胸腺切除后 DFS 较长是多发性胸腺瘤复发的有利生存因素。如果在技术和临床可行的情况下，迭代性手术治疗是一种可行的治疗选择，可与长期生存相关。
