Choe Giye, Elmadhun Nassrene
Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Mediastinum. 2025 Jun 25;9:18. doi: 10.21037/med-25-20. eCollection 2025.
Surveillance after thymic epithelial tumors (TETs) is widely recommended yet poorly studied. While this is not a situation unique to TETs, we seek to evaluate the rational of surveillance after treatment of TETs and summarize current available guidelines.
A literature review was conducted in PubMed/MEDLINE and Google Scholar databases. Articles were included if they discussed the following: (I) the epidemiology and natural history of TETs; (II) the diagnosis of recurrent TETs; (III) the treatment and outcomes of recurrent TETs; (IV) current available guidelines for surveillance or follow-up after treatment of TETs.
TETs are rare group of neoplasms that include thymoma, thymic carcinoma and neuroendocrine neoplasms. Thymomas have excellent overall survival but can recur over longer periods of time compared to other malignancies. Thymic carcinoma and neuroendocrine neoplasms have less favorable outcomes but still have prolonged survival even at advanced stages. Moreover, recurrence tends to be asymptomatic and localized to the chest and pleura, making it amenable to local treatments such as surgery and/or radiation. As such, TETs may be positioned to benefit from surveillance but also present unique challenges regarding surveillance. There are no prospective studies addressing surveillance in TETs, but at least 5 guidelines have made recommendations that mostly recommend computed tomography (CT) of the chest in variable frequencies and durations. Most agree that the duration for thymoma surveillance should be 10 years or longer. Thymic malignancies are frequently associated with paraneoplastic syndromes which can be a symptom of recurrence, and knowledge of these disorders should be a component of surveillance.
Surveillance after treatment for TETs is felt to be beneficial, but there is a paucity of evidence directly studying this. Currently available guidelines do offer some direction based on expert opinion. Given the rare occurrence of TETs and recurrences after treatment, pooling of data such as the International Thymic Malignancy Interest Group (ITMIG) database to study follow up will be necessary to develop more effective surveillance strategies.
胸腺上皮肿瘤（TETs）治疗后的监测虽被广泛推荐，但相关研究较少。尽管这并非TETs独有的情况，但我们旨在评估TETs治疗后监测的合理性，并总结当前可用的指南。
在PubMed/MEDLINE和谷歌学术数据库中进行文献综述。纳入的文章需讨论以下内容：（I）TETs的流行病学和自然史；（II）复发性TETs的诊断；（III）复发性TETs的治疗及结果；（IV）TETs治疗后当前可用的监测或随访指南。
TETs是一组罕见的肿瘤，包括胸腺瘤、胸腺癌和神经内分泌肿瘤。胸腺瘤总体生存率良好，但与其他恶性肿瘤相比，其复发时间可能更长。胸腺癌和神经内分泌肿瘤的预后较差，但即使在晚期仍有较长生存期。此外，复发往往无症状，且局限于胸部和胸膜，适合进行手术和/或放疗等局部治疗。因此，TETs可能从监测中获益，但在监测方面也存在独特挑战。目前尚无针对TETs监测的前瞻性研究，但至少有5项指南给出了建议，大多建议以不同频率和时长进行胸部计算机断层扫描（CT）。多数人认为胸腺瘤监测的时长应为10年或更长。胸腺恶性肿瘤常与副肿瘤综合征相关，这可能是复发的症状，对这些疾病的了解应作为监测的一部分。
TETs治疗后的监测被认为是有益的，但直接研究这方面的证据较少。当前可用的指南确实基于专家意见提供了一些指导。鉴于TETs及其治疗后复发的罕见性，有必要汇总国际胸腺恶性肿瘤兴趣小组（ITMIG）数据库等数据来研究随访情况，以制定更有效的监测策略。
