Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
J Thorac Oncol. 2024 Jul;19(7):1086-1094. doi: 10.1016/j.jtho.2024.04.004. Epub 2024 Apr 10.
The aim of this study is to describe characteristics and survival outcome of patients who underwent surgical treatment for distant thymoma relapse according to the definition of the International Thymic Malignancy Interest Group.
Data of patients affected by thymoma recurrence from four different institutions were collected and retrospectively reviewed. Patients with locoregional metastases who underwent nonsurgical therapies and with incomplete data on follow-up were excluded. According to the International Thymic Malignancy Interest Group distant recurrence definition, patients with recurrence due to hematogenic localization were included. Clinical and pathologic characteristics were described using descriptive statistics, whereas survival outcome was calculated using Kaplan-Meier curves and Cox regression analysis.
The analysis was conducted on 40 patients. A single localization was present in 13 patients, the relapse was intrathoracic in 28 cases (70%), and lung involvement was found in 26 cases. The liver was operated in seven cases, whereas other kinds of abdominal involvement were detected in eight cases. Adjuvant treatment was administered in 22 cases (55%).Five- and 10-year overall survival (OS) were 67% and 30%, respectively. Univariable analysis identified as significant favorable factor a low-grade histology (A, B1, B2): five-year OS at 92.3% versus 53.3% in high-grade (B3-C) (p = 0.035). Site of recurrence and number of localization did not influence the prognosis, but in patients with adjuvant therapy administration, there was a survival advantage also if not statistically significant: five-year OS 84.8% versus 54.5% in patients without adjuvant therapy (p = 0.101).Multivariable analysis confirmed as independent prognostic factor low-grade histology: hazard ratio = 0.176, 95% confidence interval 0.042-0.744, p = 0.018.
Our study revealed a good survival outcome in patients who underwent surgery for distant thymoma recurrence, independently from the number and site of the relapse localization. Patients with A, B1, or B2 histology presented a significantly better survival than patients with B3-C.
本研究旨在根据国际胸腺恶性肿瘤兴趣小组的定义，描述接受远处胸腺瘤复发手术治疗的患者的特征和生存结局。
收集了来自四个不同机构的胸腺瘤复发患者的数据，并进行回顾性分析。排除了局部区域转移且接受非手术治疗以及随访资料不完整的患者。根据国际胸腺恶性肿瘤兴趣小组远处复发的定义，包括因血行转移定位而复发的患者。使用描述性统计方法描述临床和病理特征，使用 Kaplan-Meier 曲线和 Cox 回归分析计算生存结局。
本分析纳入了 40 名患者。13 名患者存在单一转移部位，28 例（70%）为胸内复发，26 例为肺受累。7 例患者接受了肝脏手术，8 例患者发现其他类型的腹部受累。22 例（55%）患者接受了辅助治疗。5 年和 10 年总生存率（OS）分别为 67%和 30%。单变量分析显示，低级别组织学（A、B1、B2）为显著有利因素：5 年 OS 为 92.3%，而高级别（B3-C）为 53.3%（p=0.035）。复发部位和转移部位数量并未影响预后，但在接受辅助治疗的患者中，即使无统计学意义，也存在生存优势：5 年 OS 为 84.8%，而未接受辅助治疗的患者为 54.5%（p=0.101）。多变量分析证实低级别组织学为独立预后因素：风险比=0.176，95%置信区间 0.042-0.744，p=0.018。
本研究显示，接受远处胸腺瘤复发手术治疗的患者具有良好的生存结局，与复发部位的数量和位置无关。A、B1 或 B2 组织学的患者生存显著优于 B3-C 患者。
