Hashinokuchi Asato, Takamori Shinkichi, Zhu Junjia, Abe Miyuki, Ozono Keigo, Takenaka Tomoyoshi, Osoegawa Atsushi, Yoshizumi Tomoharu, Komiya Takefumi
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Oita, Japan.
Ann Surg Oncol. 2025 Mar;32(3):1662-1669. doi: 10.1245/s10434-024-16732-5. Epub 2024 Dec 27.
Thymic epithelial tumor (TET) staging has been based on Masaoka-Koga systems or the 8th edition of the TNM classification, which do not use tumor size as a T descriptor. The 9th edition of the TNM classification incorporates tumor size; however, the study on which this classification is based included only 4.4% of patients from North America. This study investigated the prognostic impact of primary tumor size in TET patients in the US population.
Using data from the National Cancer Database (NCDB), we analyzed patients with surgically resected TETs diagnosed in 2004-2020. Survival analysis was performed by using the Kaplan-Meier method and multivariate Cox regression analyses; propensity score matching (PSM) analyses were performed. Thymoma data from our facilities (n = 166) were used for validation.
Of 4,151 and 647 thymoma and thymic-carcinoma patients, respectively, we classified 1,618 and 268 patients into small-tumor (primary tumor size ≤ 5 cm) and large-tumor groups, respectively. Thymoma patients in the small-tumor group had a significantly longer overall survival (OS) than those in the large-tumor group (>5 cm) (median OS 193.2 vs. 161.4 months, respectively; log-rank P < 0.0001; hazard ratio 0.72; 95% confidence interval 0.64-0.82). After PSM, multivariate analysis showed that tumor size was an independent prognostic factor for OS (P < 0.0001). Validation cohort analysis supported these results. Tumor size did not have a significant impact on OS (P = 0.0994) in thymic-carcinoma patients.
Tumor size in thymoma, but not in thymic carcinoma, was an important prognostic factor in the U.S.
胸腺瘤上皮性肿瘤（TET）分期一直基于Masaoka-Koga系统或第8版TNM分类，这些分类未将肿瘤大小用作T描述符。第9版TNM分类纳入了肿瘤大小；然而，该分类所依据的研究仅纳入了4.4%的北美患者。本研究调查了美国人群中TET患者原发肿瘤大小对预后的影响。
利用国家癌症数据库（NCDB）的数据，我们分析了2004年至2020年诊断为手术切除TET的患者。采用Kaplan-Meier法和多变量Cox回归分析进行生存分析；进行倾向评分匹配（PSM）分析。来自我们机构的胸腺瘤数据（n = 166）用于验证。
在4151例胸腺瘤患者和647例胸腺癌患者中，我们分别将1618例和268例患者分为小肿瘤组（原发肿瘤大小≤5 cm）和大肿瘤组。小肿瘤组的胸腺瘤患者总生存期（OS）明显长于大肿瘤组（>5 cm）（中位OS分别为193.2个月和161.4个月；对数秩检验P<0.0001；风险比0.72；95%置信区间0.64 - 0.82）。PSM后，多变量分析显示肿瘤大小是OS的独立预后因素（P<0.0001）。验证队列分析支持了这些结果。肿瘤大小对胸腺癌患者的OS没有显著影响（P = 0.0994）。
在美国，胸腺瘤的肿瘤大小是一个重要的预后因素，而胸腺癌并非如此。
