Katsuhiro Okuda1, Motoki Yano2, Ichiro Yoshino3, Meinoshin Okumura4, Masahiko Higashiyama5, Kenji Suzuki6, Masanori Tsuchida7, Jitsuo Usuda8, Hisashi Tateyama9. 1. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan. 2. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan. Electronic address: motoki@med.nagoya-cu.ac.jp. 3. Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 4. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Japan. 5. Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 6. Division of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 7. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 8. Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan. 9. Department of pathology, Kasugai Municipal Hospital, Kasugai, Japan.
Abstract
BACKGROUND: Thymoma is a rare mediastinal tumor with relatively slow growth. However, advanced-stage cases with pleural dissemination are occasionally encountered. The outcome of surgical resection for thymomas with pleural dissemination has not been clearly determined. METHODS: We retrospectively investigated the clinical records of 2,835 patients with thymic epithelial tumors that were treated from 1991 to 2010 in 32 institutions that participated in the Japanese Association for Research on the Thymus. In this study, we analyzed the clinicopathologic factors and prognosis of thymoma patients with pleural dissemination who underwent surgical resection. RESULTS: The thymomas with pleural disseminations numbered 148 cases (5.2% in the 2,835 thymic epithelial tumors). Surgical resection was performed in 136 cases. Pathologic Masaoka stages were classified as IVA (n=118) and IVB (n=18). In Masaoka stage IVA disease, the small number of disseminated pleural nodules (10 or fewer) was related to the curative resection. The prognosis was also better in these cases than in those with greater than 10 disseminated pleural nodules (certified during the operation; p=0.0057). Patients who underwent macroscopic total resection of disseminated nodules had a better prognosis than those with residual tumors (p=0.037). In stage IVA cases with complete resection (n=42), the efficacy of adjuvant chemotherapy, radiotherapy, or both was not demonstrated. CONCLUSIONS: Macroscopic total resection of tumors appears to be a promising prognostic factor in Masaoka stage IVA thymomas. The number of disseminated pleural nodules correlated with resectability.
BACKGROUND:Thymoma is a rare mediastinal tumor with relatively slow growth. However, advanced-stage cases with pleural dissemination are occasionally encountered. The outcome of surgical resection for thymomas with pleural dissemination has not been clearly determined. METHODS: We retrospectively investigated the clinical records of 2,835 patients with thymic epithelial tumors that were treated from 1991 to 2010 in 32 institutions that participated in the Japanese Association for Research on the Thymus. In this study, we analyzed the clinicopathologic factors and prognosis of thymomapatients with pleural dissemination who underwent surgical resection. RESULTS: The thymomas with pleural disseminations numbered 148 cases (5.2% in the 2,835 thymic epithelial tumors). Surgical resection was performed in 136 cases. Pathologic Masaoka stages were classified as IVA (n=118) and IVB (n=18). In Masaoka stage IVA disease, the small number of disseminated pleural nodules (10 or fewer) was related to the curative resection. The prognosis was also better in these cases than in those with greater than 10 disseminated pleural nodules (certified during the operation; p=0.0057). Patients who underwent macroscopic total resection of disseminated nodules had a better prognosis than those with residual tumors (p=0.037). In stage IVA cases with complete resection (n=42), the efficacy of adjuvant chemotherapy, radiotherapy, or both was not demonstrated. CONCLUSIONS: Macroscopic total resection of tumors appears to be a promising prognostic factor in Masaoka stage IVA thymomas. The number of disseminated pleural nodules correlated with resectability.
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