Chiappetta Marco, Grossi Ugo, Sperduti Isabella, Margaritora Stefano, Marulli Giuseppe, Fiorelli Alfonso, Sandri Alberto, Mizuno Tetsuya, Cusumano Giacomo, Hamaji Masatsugu, Cesario Alfredo, Lococo Filippo
Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Cancers (Basel). 2021 Mar 29;13(7):1559. doi: 10.3390/cancers13071559.
Optimal recurrent thymoma management remains arguable because of limited patient numbers, and relatively late and variable recurrence patterns. Given the absence of high-quality evidence and relatively small study cohorts, we performed a quantitative meta-analysis to determine the outcome of surgical and non-surgical approaches assessing the five-year overall survival (5y overall survival (OS)) in patients with recurrent thymoma.
We performed a comprehensive literature search and analysis according to PRISMA guidelines of studies published from 1 January 1980 until 18 June 2020 from PubMed/MEDLINE, EMBASE, and Scopus. We included studies with the cohorts' superior to 30 patients describing recurrent thymoma treatment, comparing surgical and non-surgical approaches reporting survival data.
Literature search revealed 3017 articles. Nine studies met all inclusion criteria and were selected for the meta-analysis. The recurrences were local/regional in 73-98% of cases and multiple in 49-72%. After treatment, 5y OS ranged from 48-77% and 10y OS from 37-51%. The quantitative meta-analysis showed a better outcome comparing surgical vs other treatments. Two studies showed statistically significant risk differences in the 5y OS favoring complete resection. After pooling results of seven studies using the random model, the combined 5y OS risk difference was 0.39, with lower and upper limits of 0.16 and 0.62, respectively ( = 0.001), and a moderate heterogeneity among studies ( = 0.098, I2 = 43.9%). Definitive conclusions could not be drawn regarding the prognostic impact of myasthenia gravis, histology, and patterns of relapse reported in literature.
Surgical treatment after thymoma recurrence is associated with a significant better 5y OS; therefore, surgical resection should be preferred in all technically feasible cases.
由于患者数量有限，以及复发模式相对较晚且多变，复发性胸腺瘤的最佳治疗方案仍存在争议。鉴于缺乏高质量证据且研究队列相对较小，我们进行了一项定量荟萃分析，以确定评估复发性胸腺瘤患者五年总生存率（5年总生存率（OS））的手术和非手术方法的疗效。
我们根据PRISMA指南，对1980年1月1日至2020年6月18日发表在PubMed/MEDLINE、EMBASE和Scopus上的研究进行了全面的文献检索和分析。我们纳入了队列超过30例患者的研究，这些研究描述了复发性胸腺瘤的治疗，比较了报告生存数据的手术和非手术方法。
文献检索共找到3017篇文章。9项研究符合所有纳入标准，并被选入荟萃分析。73% - 98%的病例复发为局部/区域复发，49% - 72%为多发复发。治疗后，5年总生存率为48% - 77%，10年总生存率为37% - 51%。定量荟萃分析显示，与其他治疗方法相比，手术治疗效果更好。两项研究显示，5年总生存率在完全切除方面存在统计学上的显著风险差异。使用随机模型汇总七项研究的结果后，合并的5年总生存率风险差异为0.39，下限和上限分别为0.16和0.62（P = 0.001），研究间存在中度异质性（P = 0.098，I² = 43.9%）。关于文献中报道的重症肌无力、组织学和复发模式的预后影响，无法得出明确结论。
胸腺瘤复发后进行手术治疗与显著更好的5年总生存率相关；因此，在所有技术可行的情况下，应首选手术切除。
