Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
J Cardiothorac Surg. 2021 Nov 18;16(1):333. doi: 10.1186/s13019-021-01717-2.
Thymic tumors usually present with adjacent organ invasion or pleural dissemination, but very few studies have reported on occult pleural dissemination detected intraoperatively. This study aimed to investigate the risk factors that can predict pleural dissemination preoperatively.
Consecutive patients with thymic tumors who underwent surgery from January 2010 to January 2017 were reviewed. Only patients without pleural dissemination detected preoperatively were included in this study. Demographic, clinical, pathological, and survival data were collected for statistical analysis. Further analyses were performed to find the risk factors of occult pleural dissemination.
A total of 352 patients with thymic tumors were included in this study. Seven patients had pleural dissemination detected intraoperatively. All pleural dissemination cases were in clinical Masaoka-Koga stage III, and most underwent the video-assisted thoracoscopic surgery (VATS) approach (or VATS exploration). Univariate analysis showed that positive squamous cell carcinoma (SCC) antigen was the only predictor of pleural dissemination (p = 0.009). Tiny nodules close to the diaphragm were detected in the computed tomography scans of 1 case after reviewing the imaging data. Tumor recurrence occurred in 5 patients during follow-up. The disease-free survival rates were better in patients with a solitary nodule than those with multiple nodules (p = 0.019). No significant difference was detected in terms of disease-free survival rates between SCC antigen positive and SCC antigen negative patients.
Positive SCC antigen was the only detected risk factor for predicting pleural dissemination in thymic tumors preoperatively in this study. The VATS approach (including VATS exploration) is suggested for patients with clinical Masaoka-Koga stage III and SCC antigen positive thymic tumors, according to our experience.
胸腺瘤通常表现为邻近器官侵犯或胸膜播散，但很少有研究报道术中发现隐匿性胸膜播散。本研究旨在探讨术前可预测胸膜播散的危险因素。
回顾 2010 年 1 月至 2017 年 1 月期间行手术治疗的胸腺瘤连续患者。仅纳入术前未发现胸膜播散的患者。收集患者的人口统计学、临床、病理和生存数据进行统计分析。进一步分析以寻找隐匿性胸膜播散的危险因素。
本研究共纳入 352 例胸腺瘤患者，7 例术中发现胸膜播散。所有胸膜播散病例均为临床 Masaoka-Koga 分期 III 期，多数采用电视辅助胸腔镜手术（VATS）方法（或 VATS 探查）。单因素分析显示，鳞状细胞癌（SCC）抗原阳性是唯一预测胸膜播散的因素（p=0.009）。回顾影像学资料后发现，1 例 CT 扫描显示靠近膈肌的微小结节。5 例患者在随访期间肿瘤复发。单发结节患者的无病生存率优于多发结节患者（p=0.019）。SCC 抗原阳性和 SCC 抗原阴性患者的无病生存率无显著差异。
在本研究中，SCC 抗原阳性是预测胸腺瘤术前胸膜播散的唯一检测到的危险因素。根据我们的经验，对于临床 Masaoka-Koga 分期 III 期和 SCC 抗原阳性的胸腺瘤患者，建议采用 VATS 方法（包括 VATS 探查）。
