Korasidis Stylianos, Rabazzi Giacomo, Bacchin Diana, Aprile Vittorio, Mastromarino Maria Giovanna, Ambrogi Marcello Carlo, Lucchi Marco
Division of Thoracic Surgery; Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
Updates Surg. 2025 Sep;77(5):1325-1333. doi: 10.1007/s13304-024-02006-y. Epub 2024 Oct 1.
Thymomas are rare, indolent tumors. Early stages (I-II) benefit from surgical treatment, while locally advanced diseases (stages III-IV) usually require a multidisciplinary approach. The role of postoperative radiotherapy (PORT) on anterior mediastinum for radically resected Masaoka-Koga stage II thymomas remains controversial. This study aims to determine the impact of PORT on the disease-free survival (DFS) of stage II thymomas. We retrospectively collected the clinical and oncologic data [age, sex, myasthenia gravis (MG) prevalence, Masaoka-Koga stage, World Health Organization (WHO) histologic subtype] of those patients who underwent radical exeresis in our Unit between January 2000 and December 2020. Kaplan-Meier estimates of DFS were then performed. Our study included 195 patients (M/F = 98/97). Almost all patients were affected by MG (90.7%) and most of them were operated by median sternotomy (93.3%). Thymoma stage was IIa in 87 cases (44.6%) and IIb in 108 cases (55.4%). The most represented histologic subtype was AB (27.7%), followed by B2 (24.6%), A (19%), B1 (14.9%) and B3 (13.8%). PORT was performed in 113 patients (58%, 39 stage IIa and 74 stage IIb). During the surveillance, 8 patients (4.1%) presented pleural recurrences and no local relapses. DFS was comparable in stage IIa and IIb patients, independently from PORT administration (p = .395 and p = .858, respectively). Moreover, PORT did not affect DFS considering the histologic subtypes (p = .304 for A and AB thymomas, p = .608 for B1, B2 and B3 thymomas). In our wide series, PORT administration didn't show any additional benefit on DFS. Therefore, based on our experience, patients with stage II thymoma who underwent radical surgery should not undergo any local adjuvant treatment.
胸腺瘤是罕见的惰性肿瘤。早期（I-II期）患者可从手术治疗中获益，而局部晚期疾病（III-IV期）通常需要多学科治疗方法。对于根治性切除的Masaoka-Koga II期胸腺瘤，术后放疗（PORT）在前纵隔的作用仍存在争议。本研究旨在确定PORT对II期胸腺瘤无病生存期（DFS）的影响。我们回顾性收集了2000年1月至2020年12月期间在本单位接受根治性切除的患者的临床和肿瘤学数据[年龄、性别、重症肌无力（MG）患病率、Masaoka-Koga分期、世界卫生组织（WHO）组织学亚型]。然后进行DFS的Kaplan-Meier估计。我们的研究包括195例患者（男/女=98/97）。几乎所有患者都患有MG（90.7%），大多数患者接受了正中胸骨切开术（93.3%）。胸腺瘤分期为IIa期87例（44.6%），IIb期108例（55.4%）。最常见的组织学亚型是AB型（27.7%），其次是B2型（24.6%）、A型（19%）、B1型（14.9%）和B3型（13.8%）。113例患者（58%，IIa期39例，IIb期74例）接受了PORT。在随访期间，8例患者（4.1%）出现胸膜复发，无局部复发。IIa期和IIb期患者的DFS相当，与是否接受PORT无关（分别为p = 0.395和p = 0.858）。此外，考虑组织学亚型时，PORT不影响DFS（A型和AB型胸腺瘤p = 0.304，B1、B2和B3型胸腺瘤p = 0.608）。在我们的大量病例中，PORT未显示对DFS有任何额外益处。因此，根据我们的经验，接受根治性手术的II期胸腺瘤患者不应接受任何局部辅助治疗。
