Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology, Clinical Laboratory, Kasugai Municipal Hospital, Kasugai, Japan.
Ann Surg Oncol. 2022 Mar;29(3):1829-1837. doi: 10.1245/s10434-021-10888-0. Epub 2021 Oct 17.
Thymoma patients with pleural dissemination are difficult to manage, and their treatment strategy remains undefined. This study aimed to investigate the clinicopathologic features of these patients, focusing on the association between the depth of pleural invasion and prognosis.
Between 2003 and 2019, the study identified 120 disseminated lesions in 20 thymoma patients. Seven patients had de novo stage IVa thymoma and 13 were recurrent cases. Extrapleural pneumonectomy was performed for 8 patients and debulking surgery for 12 patients. Invasion depth of pleural tumors was classified into two groups: when the disseminated tumors invaded the pleura beneath the elastic layer, the tumor was diagnosed as Da, and when the disseminated tumors invaded the pleura beyond the elastic layer, the tumor was diagnosed as Db.
Of 120 nodules, 31 (26%), found in eight patients with recurrent malignancies, were classified as Db. The pathologic status of the surgical margin (PSM) was positive in eight patients, seven of whom had Db nodules. The 5-year overall survival (OS) rate was 100% in the Da group and 75% in the Db group (P = 0.02). The 5-year progression-free survival (PFS) rate was 66.7% in the Da group and 25% in the Db group (P = 0.02). Cox univariate analysis showed that PFS was significantly influenced by the depth of invasion (P = 0.04) and PSM (P = 0.03).
Depth of pleural invasion may influence survival outcomes for thymoma patients with pleural dissemination. The patients in this study with Da-disseminated nodules had an increased probability of a longer OS and PFS and tended to achieve negative PSM compared with the patients with Db.
伴胸膜播散的胸腺瘤患者难以处理，其治疗策略仍不明确。本研究旨在探讨此类患者的临床病理特征，重点关注胸膜侵犯深度与预后的关系。
2003 年至 2019 年，研究共确定了 20 例胸腺瘤患者的 120 个播散病变。7 例患者为初诊 IVa 期胸腺瘤，13 例为复发性病例。8 例患者行胸膜外全肺切除术，12 例患者行肿瘤减灭术。胸膜肿瘤侵犯深度分为两组：当播散肿瘤侵犯弹性层下方的胸膜时，诊断为 Da；当播散肿瘤侵犯弹性层以外的胸膜时，诊断为 Db。
120 个结节中，31 个（26%）位于 8 例复发性恶性肿瘤患者中，被归类为 Db。8 例患者的手术切缘病理状态（PSM）阳性，其中 7 例为 Db 结节。Da 组的 5 年总生存率（OS）为 100%，Db 组为 75%（P = 0.02）。Da 组的 5 年无进展生存率（PFS）为 66.7%，Db 组为 25%（P = 0.02）。Cox 单因素分析显示，PFS 显著受侵犯深度（P = 0.04）和 PSM（P = 0.03）的影响。
胸膜侵犯深度可能影响伴胸膜播散的胸腺瘤患者的生存结局。与 Db 播散结节患者相比，本研究中 Da 播散结节患者的 OS 和 PFS 更长的可能性增加，并且更倾向于达到 PSM 阴性。
