Mizuno Tetsuya, Chen-Yoshikawa Toyofumi Fengshi, Yoshino Ichiro, Okumura Meinoshin, Ikeda Norihiko, Kuroda Koji, Maniwa Yoshimasa, Kanzaki Masato, Suzuki Makoto
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Jun 5;38(6). doi: 10.1093/icvts/ivae064.
This study aimed to analyse the surgical outcomes for recurrent thymic epithelial tumours and identify the factors associated with post-recurrence survival, using an updated Japanese nationwide database.
The cohort that developed recurrence after the initial resection was extracted from an updated database of patients whose thymic epithelial tumours were treated surgically between 1991 and 2010. Furthermore, we reviewed clinicopathological and prognostic factors of re-resected cases. Post-recurrence survival outcomes and cause-specific deaths in non-re-resected cases were also reviewed.
We enrolled 191 patients who underwent re-resection and 259 patients who did not. In the surgery group, more patients with early stage disease, less aggressive World Health Organization (WHO) histological classification, initial complete resection and shorter recurrence-free intervals were included. Non-thymic carcinoma, absence of preoperative treatment, longer recurrent-free interval, single-site recurrence and R0-1 re-resection were all significantly favourable prognostic factors for post-recurrence survival in the surgery group, according to univariable analyses. Non-thymic carcinoma histology, longer recurrence-free interval and R0-1 re-resection were identified as independent prognostic factors according to multivariable analysis. The post-recurrence survival of the entire cohort with R2 re-resection was significantly better than that of the non-surgery group, although it was not demonstrated that patients with thymoma who underwent R2 re-resection had significantly better post-recurrence and lower cause-specific death.
R0-1 re-resection was newly identified as a prognostic factor after re-resection, in addition to non-thymic carcinoma histological classification and longer recurrence-free intervals, as documented in the initial report.
本研究旨在利用更新后的日本全国性数据库，分析复发性胸腺上皮肿瘤的手术结果，并确定与复发后生存相关的因素。
从1991年至2010年接受胸腺上皮肿瘤手术治疗患者的更新数据库中提取初次切除后出现复发的队列。此外，我们回顾了再次切除病例的临床病理和预后因素。还回顾了未再次切除病例的复发后生存结果和特定原因死亡情况。
我们纳入了191例行再次切除的患者和259例未行再次切除的患者。手术组纳入了更多早期疾病患者、世界卫生组织（WHO）组织学分类侵袭性较低的患者、初次完全切除的患者以及无复发生存期较短的患者。单因素分析显示，非胸腺癌、无术前治疗、无复发生存期较长、单部位复发和R0-1再次切除均是手术组复发后生存的显著有利预后因素。多因素分析确定非胸腺癌组织学、无复发生存期较长和R0-1再次切除为独立预后因素。尽管未证明行R2再次切除的胸腺瘤患者复发后生存显著更好且特定原因死亡更低，但R2再次切除的整个队列的复发后生存明显优于非手术组。
除了初次报告中记录的非胸腺癌组织学分类和无复发生存期较长外，R0-1再次切除被新确定为再次切除后的预后因素。
