251397322312314 Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA.
6566 Department of Surgery, Albert Einstein Healthcare Network, Philadelphia, PA, USA.
Innovations (Phila). 2020 Sep/Oct;15(5):468-474. doi: 10.1177/1556984520949287. Epub 2020 Sep 16.
Although rare, thymic neuroendocrine tumors (TNET) and thymic carcinoma (TC) are the most common thymic nonthymomatous malignancies; their survival outcomes have not been thoroughly compared. We analyzed the clinical, treatment, and survival characteristics of TNET and TC.
We retrospectively identified patients with a histologic diagnosis of TNET or TC in the National Cancer Database (2004 to 2015). Exclusion criteria were age <18 years and unstaged tumors. Descriptive statistics, survival analysis, and multivariable Cox regression analyses were used in elucidating associations.
One thousand four hundred eighty-nine patients were included (TNET: 19.8%). Patients with TNET were significantly younger (57 vs 62.5 years), more likely to be male (70.5% vs 60.0%), and have localized tumors (45.4% vs 32.3%). Patients with TC more frequently underwent chemotherapy (56.1% vs 34.9%), radiation (56.9% vs 39.3%), and trimodality therapy (21.3% vs 11.5%), while resection rates were similar (55.3% vs 58.3%). The 5-year survival was 62% for TNET and 52% for TC, but comparable following multivariable adjustment. Age, stage, and Charlson-Deyo score were negative predictors of survival, while surgery and trimodality therapy were positive predictors. On subanalysis, adjuvant radiation therapy (ART) improved the survival of margin-positive tumors and was an independent predictor of survival for both tumor types (hazard ratio = 0.5).
Our analysis of the largest series of TNET and TC showed a survival rate surpassing 50% at 5 years. These outcomes seem to be influenced by surgical resection and ART. Standardized staging and surgical protocols including lymph node sampling are still warranted to better elucidate the treatment algorithm of these tumors.
尽管胸腺神经内分泌肿瘤（TNET）和胸腺癌（TC）较为罕见，但它们是最常见的胸腺非胸腺瘤性恶性肿瘤；其生存结果尚未得到彻底比较。我们分析了 TNET 和 TC 的临床、治疗和生存特征。
我们在国家癌症数据库（2004 年至 2015 年）中回顾性地确定了组织学诊断为 TNET 或 TC 的患者。排除标准为年龄<18 岁和未分期肿瘤。使用描述性统计、生存分析和多变量 Cox 回归分析来阐明相关性。
共纳入 1489 例患者（TNET：19.8%）。TNET 患者明显更年轻（57 岁 vs. 62.5 岁），更可能为男性（70.5% vs. 60.0%），且肿瘤局限（45.4% vs. 32.3%）。TC 患者更常接受化疗（56.1% vs. 34.9%）、放疗（56.9% vs. 39.3%）和三联疗法（21.3% vs. 11.5%），而手术切除率相似（55.3% vs. 58.3%）。TNET 的 5 年生存率为 62%，TC 为 52%，但多变量调整后无差异。年龄、分期和 Charlson-Deyo 评分是生存的负预测因素，而手术和三联疗法是生存的正预测因素。亚组分析显示，辅助放疗（ART）改善了切缘阳性肿瘤的生存率，并且是两种肿瘤类型的独立生存预测因素（风险比=0.5）。
我们对最大系列的 TNET 和 TC 进行的分析显示，5 年生存率超过 50%。这些结果似乎受到手术切除和 ART 的影响。仍需要标准化分期和手术方案，包括淋巴结取样，以更好地阐明这些肿瘤的治疗方案。
