Outcomes and prognostic factors of surgically treated thymic carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Runrun ¹ , CHEN Yeye ² , LI Li ² , HUANG Cheng ² , HE Jia ² ,  LI Shanqing ²

1. Department of Thoracic Surgery, Nanjing BenQ Hospital Affiliated to Nanjing Medical University, Nanjing, 210019, P.R.China;
2. Department of Thoracic Surgery, Peking Union Medical College Hospital Affiliated to Peking Union Medical College, Beijing, 100730, P.R.China;

Corresponding author：

LI Shanqing, Email: lidanqing@pumch.cn

Keywords：

Thymic carcinoma; surgical treatment; prognostic factor; Masaoka stage; resection status; radiotherapy

DOI：

10.7507/1007-4848.201709029

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Objective To evaluate the influence of resection status, pathological type, pathological stage and postoperative adjuvant therapy on prognosis of surgically treated thymic carcinoma. Methods In this retrospective study, 56 patients with surgically treated thymic carcinoma in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2005 to December 2015 were enrolled. There were 30 males and 26 females aged 52.1±11.5 years ranging from 22 to 81 years. The survival curve was performed by Kaplan-Meier method. The prognostic factors affecting overall survival (OS) and disease-free survival (DFS) were analyzed by one-way analysis of variance (ANOVA). Results R0 resection was performed in 37 patients (67.9%), and other resections in 19 (32.1%); 13 patients suffered thymic carcinoma with Masaoka stage Ⅰ-Ⅱ, 26 Ⅲ, and 17 Ⅳ. Low-grade thymic carcinoma was found in 42 patients, and high-grade in 14. Postoperative radiotherapy, chemotherapy and chemoradiotherapy were performed on 17, 12 and 18 patients respectively and 9 patients were untreated. Forty-one patients was followed up for 1 to 10 years, and the follow-up rate was 73%. The 1-, 3- and 5-year OS rates were 93%, 74% and 61%, respectively. Resection status and pathological stage affected OS. Postoperative radiotherapy after R0 resection affected DFS, but did not affect OS. Conclusion Most patients with thymic carcinoma after surgery can survive for a long period, and R0 resection is the most important prognostic factor of thymic carcinoma. Postoperative radiotherapy after R0 resection in patients with Masaoka stage Ⅱ-Ⅲ is recommended.

Citation： ZHAO Runrun, CHEN Yeye, LI Li, HUANG Cheng, HE Jia, LI Shanqing. Outcomes and prognostic factors of surgically treated thymic carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 762-766. doi: 10.7507/1007-4848.201709029 Copy

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2.	Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-884.
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5.	Zhao Y, Zhao H, Hu D, et al. Surgical treatment and prognosis of thymic squamous cell carcinoma: a retrospective analysis of 105 cases. Ann Thorac Surg, 2013, 96(3): 1019-1024.
6.	张志庸, 陈涛, 崔玉尚, 等. 胸腺癌的外科治疗与预后. 中国胸心血管外科临床杂志, 2005, 12(6): 377-380.
7.	王彬, 王波, 张连斌, 等. 58 例胸腺癌的外科治疗及临床分析. 解放军医学院学报, 2014, 35(6): 561-564.
8.	李晓, 夏奥, 王冲, 等. 41 例原发性胸腺癌的临床特点及手术效果分析. 中国微创外科杂志, 2016, 16(3): 201-204.
9.	Hishida T, Nomura S, Yano M, et al. Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese Nationwide Database Study. Eur J Cardiothorac Surg, 2016, 49(3): 835-841.
10.	Fu H, Gu ZT, Fang WT, et al. Long-term survival after surgical treatment of thymic carcinoma: A retrospective analysis from the Chinese Alliance for Research of Thymoma Database. Ann Surg Oncol, 2016, 23(2): 619-625.
11.	Weksler B, Dhupar R, Parikh V, et al. Thymic carcinoma: a multivariate analysis of factors predictive of survival in 290 patients. Ann Thorac Surg, 2013, 95(1): 299-303.
12.	Detterbeck F, Youssef S, Ruffini E, et al. A review of prognostic factors in thymic malignancies. J Thorac Oncol, 2011, 6(7 Suppl 3): S1698-S1704.
13.	Weissferdt A, Moran CA. Thymic carcinoma, part 1: a clinicopathologic and immunohistochemical study of 65 cases. Am J Clin Pathol, 2012, 138(1): 103-114.
14.	Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S65-S72.
15.	Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
16.	Korst RJ, Bezjak A, Blackmon S, et al. Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase Ⅱ, multi-institutional clinical trial. J Thorac Cardiovasc Surg, 2014, 147(1): 36-44.
17.	Ogawa K, UnoT, Toita T, et al. Postoperative radiotherapy for patients with completely resected thymoma: a multi-institutional, retrospective review of 103 patients. Cancer, 2002, 94(5): 1405-1413.
18.	Komaki R, Gomez DR. Radiotherapy for thymic carcinoma: adjuvant, inductive, and definitive. Front Oncol, 2014, 3: 330.
19.	Igawa S, Murakami H, Takahashi T, et al. Efficacy of chemotherapy with carboplatin and paclitaxel for unresectable thymic carcinoma. Lung Cancer, 2010, 67(2): 194-197.

1. 李鉴, 汪良骏, 张汝刚, 等. 胸腺瘤的临床病理特点和预后. 中华肿瘤杂志, 1999, 21(4): 272-274.
2. Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-884.
3. Marx A, Rieker R, Toker A, et al. Thymic carcinoma: is it a separate entity? From molecular to clinical evidence. Thorac Surg Clin, 2011, 21(1): 25-31.
4. Ruffini E, Detterbeck F, Van Raemdonck D, et al. Thymic carcinoma: a cohort study of patients from the European society of thoracic surgeons database. J Thorac Oncol, 2014, 9(4): 541-548.
5. Zhao Y, Zhao H, Hu D, et al. Surgical treatment and prognosis of thymic squamous cell carcinoma: a retrospective analysis of 105 cases. Ann Thorac Surg, 2013, 96(3): 1019-1024.
6. 张志庸, 陈涛, 崔玉尚, 等. 胸腺癌的外科治疗与预后. 中国胸心血管外科临床杂志, 2005, 12(6): 377-380.
7. 王彬, 王波, 张连斌, 等. 58 例胸腺癌的外科治疗及临床分析. 解放军医学院学报, 2014, 35(6): 561-564.
8. 李晓, 夏奥, 王冲, 等. 41 例原发性胸腺癌的临床特点及手术效果分析. 中国微创外科杂志, 2016, 16(3): 201-204.
9. Hishida T, Nomura S, Yano M, et al. Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese Nationwide Database Study. Eur J Cardiothorac Surg, 2016, 49(3): 835-841.
10. Fu H, Gu ZT, Fang WT, et al. Long-term survival after surgical treatment of thymic carcinoma: A retrospective analysis from the Chinese Alliance for Research of Thymoma Database. Ann Surg Oncol, 2016, 23(2): 619-625.
11. Weksler B, Dhupar R, Parikh V, et al. Thymic carcinoma: a multivariate analysis of factors predictive of survival in 290 patients. Ann Thorac Surg, 2013, 95(1): 299-303.
12. Detterbeck F, Youssef S, Ruffini E, et al. A review of prognostic factors in thymic malignancies. J Thorac Oncol, 2011, 6(7 Suppl 3): S1698-S1704.
13. Weissferdt A, Moran CA. Thymic carcinoma, part 1: a clinicopathologic and immunohistochemical study of 65 cases. Am J Clin Pathol, 2012, 138(1): 103-114.
14. Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S65-S72.
15. Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
16. Korst RJ, Bezjak A, Blackmon S, et al. Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase Ⅱ, multi-institutional clinical trial. J Thorac Cardiovasc Surg, 2014, 147(1): 36-44.
17. Ogawa K, UnoT, Toita T, et al. Postoperative radiotherapy for patients with completely resected thymoma: a multi-institutional, retrospective review of 103 patients. Cancer, 2002, 94(5): 1405-1413.
18. Komaki R, Gomez DR. Radiotherapy for thymic carcinoma: adjuvant, inductive, and definitive. Front Oncol, 2014, 3: 330.
19. Igawa S, Murakami H, Takahashi T, et al. Efficacy of chemotherapy with carboplatin and paclitaxel for unresectable thymic carcinoma. Lung Cancer, 2010, 67(2): 194-197.

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