Song Seung Hwan, Suh Jee Won, Yu Woo Sik, Byun Go Eun, Park Seong Yong, Lee Chang Young, Kim Dae Joon, Paik Hyo Chae, Chung Kyung Young, Lee Geun Dong, Choi Sehoon, Kim Hyeong Ryul, Kim Yong-Hee, Kim Dong Kwan, Park Seung-Il, Cho Jong Ho, Kim Hong Kwan, Choi Yong Soo, Kim Jhingook, Zo Jae Il, Shim Young Mog, Hwang Yoohwa, Park Samina, Park In Kyu, Kang Chang Hyun, Kim Young Tae, Lee Jin Gu
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
J Thorac Dis. 2020 Nov;12(11):6680-6689. doi: 10.21037/jtd-20-1713.
Complete resection is a standard treatment for patients with Masaoka-Koga stages II and III thymoma, however the role of postoperative radiotherapy (PORT) is controversial. We analyzed data collected from 4 Korean hospitals to determine the effectiveness of PORT in stage II and III thymoma patients.
Between January 2000 and December 2013, 1,663 patients underwent surgery for thymic tumors at the 4 hospitals. Among them, 668 patients (527 with stage II and 141 with stage III) were investigated, among whom, 443 received PORT (335 with stage II and 108 with stage III). Propensity score matching (PSM) was performed, and 404 patients (346 with stage II and 58 with stage III) were selected.
Perioperative characteristics were similar in the PORT and non-PORT groups after PSM. On survival analysis of stage II patients, the PORT and non-PORT groups showed no difference in either 5-year recurrence-free survival (RFS) (96.3% 96.6%, P=0.622) or 5-year overall survival (OS) (94.6% 93.8%, P=0.839). However, among stage III patients, the PORT group showed significantly better 5-year RFS (75.7% 50.1%, P=0.040) and 5-year OS (86.5% 54.7%, P=0.001). On multivariate Cox regression analysis, PORT was a significant positive prognostic factor in terms of both RFS (P=0.005) and OS (P=0.004) in patients with stage III thymomas, but not in those with stage II disease (P=0.987 and 0.968, respectively).
PORT improved the RFS and OS in stage III thymoma patients, but showed no survival benefit in stage II patients.
完整切除是Masaoka-Koga分期II期和III期胸腺瘤患者的标准治疗方法，然而术后放疗（PORT）的作用仍存在争议。我们分析了从4家韩国医院收集的数据，以确定PORT在II期和III期胸腺瘤患者中的有效性。
2000年1月至2013年12月期间，4家医院的1663例患者接受了胸腺肿瘤手术。其中，对668例患者（II期527例，III期141例）进行了调查，其中443例接受了PORT（II期335例，III期108例）。进行了倾向评分匹配（PSM），选择了404例患者（II期346例，III期58例）。
PSM后，PORT组和非PORT组的围手术期特征相似。在II期患者的生存分析中，PORT组和非PORT组在5年无复发生存率（RFS）（96.3%对96.6%，P = 0.622）或5年总生存率（OS）（94.6%对93.8%，P = 0.839）方面均无差异。然而，在III期患者中，PORT组的5年RFS（75.7%对50.1%，P = 0.040）和5年OS（86.5%对54.7%，P = 0.001）明显更好。在多因素Cox回归分析中，PORT是III期胸腺瘤患者RFS（P = 0.005）和OS（P = 0.004）的显著阳性预后因素，但在II期患者中并非如此（分别为P = 0.987和0.968）。
PORT改善了III期胸腺瘤患者的RFS和OS，但对II期患者未显示出生存获益。
