Division of Thoracic Surgery; Cardiac, Thoracic and Vascular Department; Pisa University Hospital, via Paradisa 2, Pisa 56124, Italy.
Division of Thoracic Surgery; Cardiac, Thoracic and Vascular Department; Pisa University Hospital, via Paradisa 2, Pisa 56124, Italy.
Lung Cancer. 2023 Jun;180:107214. doi: 10.1016/j.lungcan.2023.107214. Epub 2023 Apr 22.
Nearly-one-third of thymomas are locally-advanced at diagnosis. The traditional dogma that surgery is justified in case a complete resection can be achieved has remained unmovable until today. This study aimed to investigate feasibility and oncologic efficacy of incomplete resection for locally-advanced thymomas in a contest of multimodality therapy.
A retrospective analysis was conducted using data of prospectively maintained thymomas database in a single high-volume centre. Data on 285 consecutive patients undergoing surgery for stage III and IVa thymomas between 1995 and 2019 were reviewed. Patients who underwent incomplete resection with curative-intent (removal of at least 90% of tumour burden) were included. Long-term outcomes and predictors of cancer-specific survival (CSS) and progression-free survival (PFS) were analyzed. Secondary endpoint was to assess adjuvant therapy efficacy.
The study included 79 patients, 60 with microscopic residual tumour (76%, R1) and 19 with macroscopic residual disease (24%, R2). Masaoka-Koga stage was: III in 41 patients (52%) and IVa in 38 (48%). Histology was B2-thymomas (n = 31, 39.2%) followed by B3 (n = 27, 34.2%). Five- and 10-years CSS was 88% and 80%. Seventy patients (90%) underwent adjuvant treatment; they showed CSS comparable to radical resected patients (5-years: 89.1% vs 98.9%, respectively; 10-years: 81.8% vs 92.7%, respectively, p = 0.43). The site of residual disease, Masaoka-Koga stage and WHO histology did not affect prognosis. Stepwise multivariable analysis confirmed adjuvant therapy as a favourable CSS prognostic factor (HR, 0.51; 95% CI, 0.33-0.79, p = 0.003). Stratifying by subgroups, R2-patients who received postoperative chemo(radio)therapy (pCRT) showed a significantly better prognosis than R2-patients treated by consolidation radiotherapy alone (10-years CSS: 60%, p < 0.001).
In locally-advanced thymomas, whenever a radical surgery cannot be achieved, incomplete resection has proved to be effective in a contest of multimodality strategy, independently of WHO histology, Masaoka-Koga stage and site of residual disease.
近三分之一的胸腺瘤在诊断时已局部进展。传统观点认为，只要能够实现完全切除，手术就是合理的，这一观点至今仍然没有改变。本研究旨在探讨在多模式治疗背景下，对局部晚期胸腺瘤进行不完全切除的可行性和肿瘤学疗效。
对单一大容量中心前瞻性维持的胸腺瘤数据库中的数据进行回顾性分析。回顾了 1995 年至 2019 年间接受 III 期和 IVa 期胸腺瘤手术的 285 例连续患者的数据。纳入了接受根治性不完全切除（至少切除 90%肿瘤负担）的患者。分析了癌症特异性生存率（CSS）和无进展生存率（PFS）的长期结果和预测因素。次要终点是评估辅助治疗的疗效。
该研究纳入了 79 例患者，其中 60 例为显微镜下残留肿瘤（76%，R1），19 例为肉眼残留肿瘤（24%，R2）。Masaoka-Koga 分期为：41 例（52%）为 III 期，38 例（48%）为 IVa 期。组织学为 B2 胸腺瘤（n=31，39.2%），其次是 B3（n=27，34.2%）。5 年和 10 年 CSS 分别为 88%和 80%。70 例（90%）患者接受了辅助治疗；他们的 CSS 与根治性切除患者相当（5 年：89.1% vs 98.9%，分别；10 年：81.8% vs 92.7%，分别，p=0.43）。残留病灶的部位、Masaoka-Koga 分期和 WHO 组织学均未影响预后。逐步多变量分析证实辅助治疗是 CSS 的有利预后因素（HR，0.51；95%CI，0.33-0.79，p=0.003）。按亚组分层，接受术后化疗（放）疗（pCRT）的 R2 患者的预后明显优于仅接受巩固性放疗的 R2 患者（10 年 CSS：60%，p<0.001）。
在局部晚期胸腺瘤中，只要不能进行根治性手术，不完全切除在多模式治疗策略中已被证明是有效的，而与 WHO 组织学、Masaoka-Koga 分期和残留病灶部位无关。
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