Efficacy of adjuvant radiotherapy after thymoma resection: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QUE Changhao ¹ , WANG Yaping ¹ , YE Zhibo ¹ , LI Keyong ¹ , JIN Dacheng ² , GOU Yunjiu ^1,2 ,  WANG Chengfeng ²

1. The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Gansu Clinical Center for Chest Diseases, Lanzhou, 730000, P. R. China;

Corresponding author：

WANG Chengfeng, Email: 15002664360@163.com

Keywords：

Thymoma; postoperative radiation therapy; thymoma resection; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202312027

Video：

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Objective To systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. Results A total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. Conclusion PORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.

Citation： QUE Changhao, WANG Yaping, YE Zhibo, LI Keyong, JIN Dacheng, GOU Yunjiu, WANG Chengfeng. Efficacy of adjuvant radiotherapy after thymoma resection: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1522-1530. doi: 10.7507/1007-4848.202312027 Copy

1.	Lombe DC, Jeremic B. A review of the place and role of radiotherapy in thymoma. Clin Lung Cancer, 2015, 16(6): 406-412.
2.	Marx A, Weis CA, Ströbel P. Thymomas. Der Pathologe, 2016, 37(5): 412-424.
3.	Carillo C, Diso D, Mantovani S, et al. Multimodality treatment of stageⅡthymic tumours. J Thorac Dis, 2017, 9(8): 2369-2374.
4.	Lalani N, Brade AM. Radiation dose for thymic tumours. Mediastinum, 2020, 4: 35.
5.	Liao J, Liu T, Zhang H, et al. The role of postoperative radiation therapy for completely resected stageⅢthymoma and effect of higher heart radiation dose on risk of cardiovascular disease: A retrospective cohort study. Int J Surg, 2018, 53: 345-349.
6.	Zhou D, Liu QX, Zheng H, et al. Postoperative radiotherapy for completely resected thymoma: Differing roles in masaoka stageⅡand stageⅢdisease. Asian J Surg, 2022, 45(12): 2670-2675.
7.	Chang JH, Kim HJ, Wu HG, et al. Postoperative radiotherapy for completely resected stageⅡorⅢthymoma. J Thorac Oncol, 2011, 6(7): 1282-1286.
8.	Chen L, Li Y, Dong X, et al. The value of postoperative radiotherapy in thymoma patients with myasthenia gravis. Radiother Oncol, 2023, 183: 109644.
9.	Chen YD, Feng QF, Lu HZ, et al. Role of adjuvant radiotherapy for stageⅡthymoma after complete tumor resection. Int J Radiat Oncol Biol Phys, 2010, 78(5): 1400-1406.
10.	Fan C, Feng Q, Chen Y, et al. Postoperative radiotherapy for completely resected Masaoka stageⅢthymoma: A retrospective study of 65 cases from a single institution. Radiat Oncol, 2013, 8: 199.
11.	Fernandes AT, Shinohara ET, Guo M, et al. The role of radiation therapy in malignant thymoma: A Surveillance, Epidemiology, and End Results Database analysis. J Thorac Oncol, 2010, 5(9): 1454-1460.
12.	Jackson MW, Palma DA, Camidge DR, et al. The impact of postoperative radiotherapy for thymoma and thymic carcinoma. J Thorac Oncol, 2017, 12(4): 734-744.
13.	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.
14.	Lim YJ, Kim HJ, Wu HG. Role of postoperative radiotherapy in nonlocalized thymoma: Propensity-matched analysis of Surveillance, Epidemiology, and End Results Database. J Thorac Oncol, 2015, 10(9): 1357-1363.
15.	Lin LM, Li YM, Huang YX, et al. Evaluation of the role of postoperative radiotherapy in locally invasive thymoma: A propensity-matched study based on the SEER Database. PLoS One, 2023, 18(4): e0283192.
16.	Lu CF, Yu L, Jing Y, et al. Value of adjuvant radiotherapy for thymoma with myasthenia gravis after extended thymectomy. Chin Med J (Engl), 2018, 131(8): 927-932.
17.	Mou H, Kong Y, Wu Y, et al. Effect of postoperative radiotherapy in thymoma patients: A SEER-based study. Oncol Res Treat, 2021, 44(1-2): 28-35.
18.	Omasa M, Date H, Sozu T, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stageⅡandⅢthymic epithelial tumors: The Japanese Association for Research on the Thymus Database Study. Cancer, 2015, 121(7): 1008-1016.
19.	Rena O, Papalia E, Oliaro A, et al. Does adjuvant radiation therapy improve disease-free survival in completely resected Masaoka stageⅡthymoma? Eur J Cardiothorac Surg, 2007, 31(1): 109-113.
20.	Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stageⅡandⅢthymoma: An analysis of the International Thymic Malignancies Interest Group Retrospective Database. J Thorac Oncol, 2016, 11(10): 1785-1792.
21.	Singhal S, Shrager JB, Rosenthal DI, et al. Comparison of stages Ⅰ-Ⅱthymoma treated by complete resection with or without adjuvant radiation. Ann Thorac Surg, 2003, 76(5): 1635-1641.
22.	Song SH, Suh JW, Yu WS, et al. The role of postoperative radiotherapy in stageⅡandⅢthymoma: A Korean multicenter database study. J Thorac Dis, 2020, 12(11): 6680-6689.
23.	Wen J, Chen J, Chen D, et al. Evaluation of the prognostic value of surgery and postoperative radiotherapy for patients with thymic neuroendocrine tumors: A propensity-matched study based on the SEER database. Thorac Cancer, 2018, 9(12): 1603-1613.
24.	Yan J, Liu Q, Moseley JN, et al. Adjuvant radiotherapy for stagesⅡandⅢresected thymoma: A single-institutional experience. Am J Clin Oncol, 2016, 39(3): 223-227.
25.	Yang F, Dai J, Lou X, et al. Prognostic factors and role of postoperative radiotherapy in surgically resected thymomas. JTCVS Open, 2023, 14: 561-580.
26.	Yuan D, Gu Z, Liang G, et al. Clinical study on the prognosis of patients with thymoma with myasthenia gravis. Chin J Lung Cancer, 2018, 21(1): 1-7.
27.	Zhang C, Wang Q, Hu L, et al. The prognostic value of postoperative radiotherapy for thymoma and thymic carcinoma: A propensity-matched study based on SEER Database. Cancers (Basel), 2022, 14(19): 4938.
28.	Xu C, Zhang Y, Wang W, et al. Chinese expert consensus on the diagnosis and treatment of thymic epithelial tumors. Thorac Cancer, 2023, 14(12): 1102-1117.
29.	Tateishi Y, Horita N, Namkoong H, et al. Postoperative radiotherapy for completely resected Masaoka/Masaoka-Koga stage Ⅱ/Ⅲthymoma improves overall survival: An updated meta-analysis of 4746 patients. J Thorac Oncol, 2021, 16(4): 677-685.
30.	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
31.	Hamaji M, Shah RM, Ali SO, et al. A meta-analysis of postoperative radiotherapy for thymic carcinoma. Ann Thorac Surg, 2017, 103(5): 1668-1675.
32.	Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: Differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys, 2010, 76(2): 440-445.
33.	Harnath T, Marx A, Ströbel P, et al. Thymoma: A clinico-pathological long-term study with emphasis on histology and adjuvant radiotherapy dose. J Thorac Oncol, 2012, 7(12): 1867-1871.
34.	Mariano C, Ionescu DN, Cheung WY, et al. Thymoma: A population-based study of the management and outcomes for the province of British Columbia. J Thorac Oncol, 2013, 8(1): 109-117.
35.	Utsumi T, Shiono H, Kadota Y, et al. Postoperative radiation therapy after complete resection of thymoma has little impact on survival. Cancer, 2009, 115(23): 5413-5420.
36.	Süveg K, Putora PM, Joerger M, et al. Radiotherapy for thymic epithelial tumours: A review. Transl Lung Cancer Res, 2021, 10(4): 2088-2100.
37.	Berman AT, Litzky L, Livolsi V, et al. Adjuvant radiotherapy for completely resected stage 2 thymoma. Cancer, 2011, 117(15): 3502-3508.

1. Lombe DC, Jeremic B. A review of the place and role of radiotherapy in thymoma. Clin Lung Cancer, 2015, 16(6): 406-412.
2. Marx A, Weis CA, Ströbel P. Thymomas. Der Pathologe, 2016, 37(5): 412-424.
3. Carillo C, Diso D, Mantovani S, et al. Multimodality treatment of stageⅡthymic tumours. J Thorac Dis, 2017, 9(8): 2369-2374.
4. Lalani N, Brade AM. Radiation dose for thymic tumours. Mediastinum, 2020, 4: 35.
5. Liao J, Liu T, Zhang H, et al. The role of postoperative radiation therapy for completely resected stageⅢthymoma and effect of higher heart radiation dose on risk of cardiovascular disease: A retrospective cohort study. Int J Surg, 2018, 53: 345-349.
6. Zhou D, Liu QX, Zheng H, et al. Postoperative radiotherapy for completely resected thymoma: Differing roles in masaoka stageⅡand stageⅢdisease. Asian J Surg, 2022, 45(12): 2670-2675.
7. Chang JH, Kim HJ, Wu HG, et al. Postoperative radiotherapy for completely resected stageⅡorⅢthymoma. J Thorac Oncol, 2011, 6(7): 1282-1286.
8. Chen L, Li Y, Dong X, et al. The value of postoperative radiotherapy in thymoma patients with myasthenia gravis. Radiother Oncol, 2023, 183: 109644.
9. Chen YD, Feng QF, Lu HZ, et al. Role of adjuvant radiotherapy for stageⅡthymoma after complete tumor resection. Int J Radiat Oncol Biol Phys, 2010, 78(5): 1400-1406.
10. Fan C, Feng Q, Chen Y, et al. Postoperative radiotherapy for completely resected Masaoka stageⅢthymoma: A retrospective study of 65 cases from a single institution. Radiat Oncol, 2013, 8: 199.
11. Fernandes AT, Shinohara ET, Guo M, et al. The role of radiation therapy in malignant thymoma: A Surveillance, Epidemiology, and End Results Database analysis. J Thorac Oncol, 2010, 5(9): 1454-1460.
12. Jackson MW, Palma DA, Camidge DR, et al. The impact of postoperative radiotherapy for thymoma and thymic carcinoma. J Thorac Oncol, 2017, 12(4): 734-744.
13. 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.
14. Lim YJ, Kim HJ, Wu HG. Role of postoperative radiotherapy in nonlocalized thymoma: Propensity-matched analysis of Surveillance, Epidemiology, and End Results Database. J Thorac Oncol, 2015, 10(9): 1357-1363.
15. Lin LM, Li YM, Huang YX, et al. Evaluation of the role of postoperative radiotherapy in locally invasive thymoma: A propensity-matched study based on the SEER Database. PLoS One, 2023, 18(4): e0283192.
16. Lu CF, Yu L, Jing Y, et al. Value of adjuvant radiotherapy for thymoma with myasthenia gravis after extended thymectomy. Chin Med J (Engl), 2018, 131(8): 927-932.
17. Mou H, Kong Y, Wu Y, et al. Effect of postoperative radiotherapy in thymoma patients: A SEER-based study. Oncol Res Treat, 2021, 44(1-2): 28-35.
18. Omasa M, Date H, Sozu T, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stageⅡandⅢthymic epithelial tumors: The Japanese Association for Research on the Thymus Database Study. Cancer, 2015, 121(7): 1008-1016.
19. Rena O, Papalia E, Oliaro A, et al. Does adjuvant radiation therapy improve disease-free survival in completely resected Masaoka stageⅡthymoma? Eur J Cardiothorac Surg, 2007, 31(1): 109-113.
20. Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stageⅡandⅢthymoma: An analysis of the International Thymic Malignancies Interest Group Retrospective Database. J Thorac Oncol, 2016, 11(10): 1785-1792.
21. Singhal S, Shrager JB, Rosenthal DI, et al. Comparison of stages Ⅰ-Ⅱthymoma treated by complete resection with or without adjuvant radiation. Ann Thorac Surg, 2003, 76(5): 1635-1641.
22. Song SH, Suh JW, Yu WS, et al. The role of postoperative radiotherapy in stageⅡandⅢthymoma: A Korean multicenter database study. J Thorac Dis, 2020, 12(11): 6680-6689.
23. Wen J, Chen J, Chen D, et al. Evaluation of the prognostic value of surgery and postoperative radiotherapy for patients with thymic neuroendocrine tumors: A propensity-matched study based on the SEER database. Thorac Cancer, 2018, 9(12): 1603-1613.
24. Yan J, Liu Q, Moseley JN, et al. Adjuvant radiotherapy for stagesⅡandⅢresected thymoma: A single-institutional experience. Am J Clin Oncol, 2016, 39(3): 223-227.
25. Yang F, Dai J, Lou X, et al. Prognostic factors and role of postoperative radiotherapy in surgically resected thymomas. JTCVS Open, 2023, 14: 561-580.
26. Yuan D, Gu Z, Liang G, et al. Clinical study on the prognosis of patients with thymoma with myasthenia gravis. Chin J Lung Cancer, 2018, 21(1): 1-7.
27. Zhang C, Wang Q, Hu L, et al. The prognostic value of postoperative radiotherapy for thymoma and thymic carcinoma: A propensity-matched study based on SEER Database. Cancers (Basel), 2022, 14(19): 4938.
28. Xu C, Zhang Y, Wang W, et al. Chinese expert consensus on the diagnosis and treatment of thymic epithelial tumors. Thorac Cancer, 2023, 14(12): 1102-1117.
29. Tateishi Y, Horita N, Namkoong H, et al. Postoperative radiotherapy for completely resected Masaoka/Masaoka-Koga stage Ⅱ/Ⅲthymoma improves overall survival: An updated meta-analysis of 4746 patients. J Thorac Oncol, 2021, 16(4): 677-685.
30. Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
31. Hamaji M, Shah RM, Ali SO, et al. A meta-analysis of postoperative radiotherapy for thymic carcinoma. Ann Thorac Surg, 2017, 103(5): 1668-1675.
32. Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: Differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys, 2010, 76(2): 440-445.
33. Harnath T, Marx A, Ströbel P, et al. Thymoma: A clinico-pathological long-term study with emphasis on histology and adjuvant radiotherapy dose. J Thorac Oncol, 2012, 7(12): 1867-1871.
34. Mariano C, Ionescu DN, Cheung WY, et al. Thymoma: A population-based study of the management and outcomes for the province of British Columbia. J Thorac Oncol, 2013, 8(1): 109-117.
35. Utsumi T, Shiono H, Kadota Y, et al. Postoperative radiation therapy after complete resection of thymoma has little impact on survival. Cancer, 2009, 115(23): 5413-5420.
36. Süveg K, Putora PM, Joerger M, et al. Radiotherapy for thymic epithelial tumours: A review. Transl Lung Cancer Res, 2021, 10(4): 2088-2100.
37. Berman AT, Litzky L, Livolsi V, et al. Adjuvant radiotherapy for completely resected stage 2 thymoma. Cancer, 2011, 117(15): 3502-3508.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of adjuvant radiotherapy after thymoma resection: A systematic review and meta-analysis

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