Surgical treatment and prognostic analysis of thymic carcinoma: a report of 38 cases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Chengxiang ^1,2 , WANG Wei ¹ , HUANG Chenjun ¹ , LI Qifan ¹ , ZHUANG Yu ¹ ,  YU Yue ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P.R. China;
2. Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, 210001, P.R. China;

Corresponding author：

YU Yue, Email: yuyue2014@njmu.edu.cn

Keywords：

Thymic carcinoma; prognosis; surgery; radical resection

DOI：

10.7507/1007-4848.201904041

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Objective To evaluate the influence of clinical, pathological and treatment factors on the prognosis of thymic carcinoma patient accepted surgical treatment.Methods Retrospective analysis was performed on 38 patients with thymic carcinoma undergoing surgical treatment between January 2008 and December 2017. The association between the prognostic factors including age, sex, thymectomy, radical resection, pathological type, TNM stage, Masaoka-Koga stage, tumor size, and survival was assessed using the Kaplan-Meier method.Results The 5-year overall survival rate of our cohort was 51.9%. Kaplan-Meier univariate survival analysis showed that radical resection (P=0.003), TNM stage (P=0.038), Masaoka-Koga stage (P=0.033), and tumor size (P=0.030) were related to the prognosis of patients with thymic carcinoma. Radical resection was also validated as an independent prognostic factor in multivariate Cox analysis (P=0.009, hazard ratio 2.31, 95%CI 1.23-4.33).Conclusion Radical surgical treatment could improve the prognosis of patients with resectable thymic carcinoma.

Citation： ZHU Chengxiang, WANG Wei, HUANG Chenjun, LI Qifan, ZHUANG Yu, YU Yue. Surgical treatment and prognostic analysis of thymic carcinoma: a report of 38 cases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(11): 1092-1097. doi: 10.7507/1007-4848.201904041 Copy

1.	Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 99: 332-350.
2.	赵润润, 陈野野, 李力, 等. 胸腺癌患者的手术预后及其影响因素. 中国胸心血管外科临床杂志, 2018, 25(9): 762-766.
3.	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.
4.	Hayes SA, Huang J, Golia PJ, et al. Radiographic predictors of resectability in thymic carcinoma. Ann Thorac Surg, 2018, 106(1): 242-248.
5.	Hamanaka K, Koyama T, Matsuoka S, et al. Analysis of surgical treatment of Masaoka stage Ⅲ-Ⅳ thymic epithelial tumors. Gen Thorac Cardiovasc Surg, 2018, 66(12): 731-735.
6.	Fujiwara A, Funaki S, Ose N, et al. Surgical resection for advanced thymic malignancy with pulmonary hilar invasion using hemi-clamshell approach. J Thorac Dis, 2018, 10(12): 6475-6481.
7.	Miyata R, Hamaji M, Omasa M, et al. Survival outcomes after minimally invasive thymectomy for early-stage thymic carcinoma. Surg Today, 2019, 49(4): 357-360.
8.	汪灏, 谷志涛, 丁建勇, 等. 胸腔镜与开放手术治疗临床早期胸腺恶性肿瘤的围手术期效果及长期生存率的比较. 中国肺癌杂志, 2016, 19(7): 453-458.
9.	Ried M, Eicher MM, Neu R, et al. Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival. World J Surg Oncol, 2017, 15(1): 214.
10.	Masaoka A, Monden Y, Nakahara K, et al. Follow-up study of thymomas with special reference to their clinical stages. Cancer, 1981, 48(11): 2485-2492.
11.	Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int, 1994, 44(5): 359-367.
12.	Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epi-thelial 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): S65-72.
13.	梁光辉, 谷志涛, 李印, 等. 基于中国胸腺瘤协作组回顾性数据库对比Masaoka-Koga分期和国际肺癌协会/国际胸腺肿瘤协作组提出的TNM分期系统. 中国肺癌杂志, 2016, 19(7): 425-436.
14.	Fukui T, Fukumoto K, Okasaka T, et al. Clinical evaluation of a new tumour-node-metastasis staging system for thymic malignancies proposed by the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and the International Thymic Malignancy Interest Group. Eur J Cardiothorac Surg, 2016, 49(2): 574-579.
15.	Hwang Y, Kang CH, Park S, et al. Impact of lymph node dissection on thymic malignancies: multi-institutional propensity score matched analysis. J Thorac Oncol, 2018, 13(12): 1949-1957.
16.	Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignan-cies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
17.	Sato Y, Yanagawa M, Hata A, et al. Volumetric analysis of the thymic epithelial tumors: correlation of tumor volume with the WHO classification and Masaoka staging. J Thorac Dis, 2018, 10(10): 5822-5832.
18.	徐凌, 艾星浩, 顾康生. 71 例胸腺癌的临床预后因素分析. 安徽医科大学学报, 2015, 50(9): 1319-1322.
19.	Willmann J, Rimner A. The expanding role of radiation therapy for thymic malignancies. J Thorac Dis, 2018, 10(Suppl 21): S2555-S2564.

1. Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 99: 332-350.
2. 赵润润, 陈野野, 李力, 等. 胸腺癌患者的手术预后及其影响因素. 中国胸心血管外科临床杂志, 2018, 25(9): 762-766.
3. 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.
4. Hayes SA, Huang J, Golia PJ, et al. Radiographic predictors of resectability in thymic carcinoma. Ann Thorac Surg, 2018, 106(1): 242-248.
5. Hamanaka K, Koyama T, Matsuoka S, et al. Analysis of surgical treatment of Masaoka stage Ⅲ-Ⅳ thymic epithelial tumors. Gen Thorac Cardiovasc Surg, 2018, 66(12): 731-735.
6. Fujiwara A, Funaki S, Ose N, et al. Surgical resection for advanced thymic malignancy with pulmonary hilar invasion using hemi-clamshell approach. J Thorac Dis, 2018, 10(12): 6475-6481.
7. Miyata R, Hamaji M, Omasa M, et al. Survival outcomes after minimally invasive thymectomy for early-stage thymic carcinoma. Surg Today, 2019, 49(4): 357-360.
8. 汪灏, 谷志涛, 丁建勇, 等. 胸腔镜与开放手术治疗临床早期胸腺恶性肿瘤的围手术期效果及长期生存率的比较. 中国肺癌杂志, 2016, 19(7): 453-458.
9. Ried M, Eicher MM, Neu R, et al. Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival. World J Surg Oncol, 2017, 15(1): 214.
10. Masaoka A, Monden Y, Nakahara K, et al. Follow-up study of thymomas with special reference to their clinical stages. Cancer, 1981, 48(11): 2485-2492.
11. Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int, 1994, 44(5): 359-367.
12. Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epi-thelial 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): S65-72.
13. 梁光辉, 谷志涛, 李印, 等. 基于中国胸腺瘤协作组回顾性数据库对比Masaoka-Koga分期和国际肺癌协会/国际胸腺肿瘤协作组提出的TNM分期系统. 中国肺癌杂志, 2016, 19(7): 425-436.
14. Fukui T, Fukumoto K, Okasaka T, et al. Clinical evaluation of a new tumour-node-metastasis staging system for thymic malignancies proposed by the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and the International Thymic Malignancy Interest Group. Eur J Cardiothorac Surg, 2016, 49(2): 574-579.
15. Hwang Y, Kang CH, Park S, et al. Impact of lymph node dissection on thymic malignancies: multi-institutional propensity score matched analysis. J Thorac Oncol, 2018, 13(12): 1949-1957.
16. Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignan-cies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
17. Sato Y, Yanagawa M, Hata A, et al. Volumetric analysis of the thymic epithelial tumors: correlation of tumor volume with the WHO classification and Masaoka staging. J Thorac Dis, 2018, 10(10): 5822-5832.
18. 徐凌, 艾星浩, 顾康生. 71 例胸腺癌的临床预后因素分析. 安徽医科大学学报, 2015, 50(9): 1319-1322.
19. Willmann J, Rimner A. The expanding role of radiation therapy for thymic malignancies. J Thorac Dis, 2018, 10(Suppl 21): S2555-S2564.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment and prognostic analysis of thymic carcinoma: a report of 38 cases

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