da Nobrega Oliveira Rachid Eduardo Noleto, de Andrade Pontual Peres Clara, Oliveira Amanda Caroline, Onyeji Paul, Kemczenski Frederico
Departament of Thoracic Surgery, Barretos Cancer Hospital, Barretos, Brazil.
Faculty of Medical Sciences, University of Pernambuco, Recife, Brazil.
Ann Surg Oncol. 2025 Mar;32(3):1670-1678. doi: 10.1245/s10434-024-16547-4. Epub 2024 Nov 27.
The study was designed to evaluate the efficacy and safety of hyperthermic intrathoracic chemotherapy (HITHOC) as an adjuvant treatment for thymic epithelial tumors, including thymomas and thymic carcinomas.
A systematic review of PubMed, Embase, and Cochrane Library databases was conducted from inception to July 30, 2024. The analysis included retrospective studies and case series involving patients undergoing cytoreductive surgery combined with HITHOC for thymomas. The treatment effects for binary endpoints were assessed using proportion rates with 95% confidence intervals (CIs). Statistical analyses were performed using R software.
Fifteen studies comprising 248 patients were included. The mean age of patients was 56 years. Thymomas represented 92% of cases, thymic carcinomas 7%, and other thymic neoplasms 1%. Operative mortality was 2.42% (95% CI 1.09-5.28), and overall mortality was 8.32% (95% CI 4.25-15.65). The disease recurrence rate was 25.99% (95% CI 14.04-43.02). The incidence of pneumonia was 1.96% (95% CI 0.45-8.16), and acute kidney injury (AKI) was 2.83% (95% CI 0.94-8.20).
The combination of cytoreductive surgery with HITHOC in patients with thymomas resulted in low operative and overall mortality, as well as low rates of AKI. However, the high recurrence rate presents a challenge for long-term disease control. This study provides the most up-to-date evidence on the safety and efficacy of HITHOC for thymomas, contributing valuable insights for clinical practice.
International Prospective Register of Systematic Reviews; No.: CRD42024566953; URL: https://www.crd.york.ac.uk/prospero/ .
本研究旨在评估胸腔内热化疗（HITHOC）作为胸腺上皮肿瘤（包括胸腺瘤和胸腺癌）辅助治疗的疗效和安全性。
对PubMed、Embase和Cochrane图书馆数据库进行了从创建到2024年7月30日的系统综述。分析包括回顾性研究和病例系列，涉及接受减瘤手术联合HITHOC治疗胸腺瘤的患者。使用比例率及95%置信区间（CI）评估二元终点的治疗效果。使用R软件进行统计分析。
纳入了15项研究，共24名患者。患者的平均年龄为56岁。胸腺瘤占病例的92%，胸腺癌占7%，其他胸腺肿瘤占1%。手术死亡率为2.42%（95%CI 1.09 - 5.28），总死亡率为8.32%（95%CI 4.25 - 15.65）。疾病复发率为25.99%（95%CI 14.04 - 43.02）。肺炎发生率为1.96%（95%CI 0.45 - 8.16），急性肾损伤（AKI）发生率为2.83%（95%CI 0.94 - 8.20）。
胸腺瘤患者减瘤手术联合HITHOC导致手术和总死亡率较低，以及AKI发生率较低。然而，高复发率对长期疾病控制构成挑战。本研究提供了关于HITHOC治疗胸腺瘤安全性和疗效的最新证据，为临床实践提供了有价值的见解。
国际系统评价前瞻性注册库；编号：CRD42024566953；网址：https://www.crd.york.ac.uk/prospero/ 。
