Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
J Surg Oncol. 2020 Sep;122(3):515-522. doi: 10.1002/jso.25981. Epub 2020 May 28.
It is unclear if a specific strategy for simultaneous treatment of primary thymic neoplasms and pleural metastases confers benefit for Masaoka stage IVA disease. We reviewed our experience with thymic neoplasms with concurrent pleural metastases to identify factors influencing outcomes.
Records of patients who presented with stage IVA thymic neoplasms from 2000 to 2018 were assessed. Multivariate Cox proportional hazards analyses were completed to determine predictors of progression-free and overall survival.
Forty-eight patients were identified, including 34 (71%) who underwent surgery. Median overall and progression-free survival were 123 and 21 months, respectively. The extent of resection varied, and was most commonly thymectomy plus partial pleurectomy (22, 65%). Median progression-free survival for patients who underwent surgical resection versus those who had not was 24 versus 12 months (P = .018). Following surgical resection, mediastinal recurrence was uncommon (2, 6%, vs 7, 50% nonoperatively). Five-year survival rates in these groups were suggestive of possible benefit to surgery (87% vs 68%).
Thymic neoplasms with pleural dissemination represents a treatment challenge. As part of a multidisciplinary approach, surgery appears to be associated with more favorable long-term results, although selection bias may account for some of the survival differences observed.
目前尚不清楚同时治疗胸腺原发性肿瘤和胸膜转移瘤的特定策略是否对 Masaoka 分期 IVA 疾病有益。我们回顾了我们对同时伴有胸膜转移的胸腺肿瘤的经验，以确定影响预后的因素。
评估了 2000 年至 2018 年间患有 IVA 期胸腺肿瘤的患者的记录。完成了多变量 Cox 比例风险分析，以确定无进展生存和总生存的预测因素。
共确定了 48 例患者，其中 34 例（71%）接受了手术。中位总生存和无进展生存分别为 123 个月和 21 个月。切除范围不同，最常见的是胸腺切除术加部分胸膜切除术（22 例，65%）。接受手术切除的患者与未接受手术切除的患者的无进展生存中位时间分别为 24 个月和 12 个月（P = .018）。手术后纵隔复发少见（2 例，6%，而非手术者为 7 例，50%）。这两组的 5 年生存率表明手术可能有获益（87% vs 68%）。
伴胸膜播散的胸腺肿瘤是一种治疗挑战。作为多学科治疗方法的一部分，手术似乎与更有利的长期结果相关，尽管选择偏倚可能解释了观察到的一些生存差异。
