Giovanni Leuzzi1, Gaetano Rocco2, Enrico Ruffini3, Isabella Sperduti4, Frank Detterbeck5, Walter Weder6, Federico Venuta7, Dirk Van Raemdonck8, Pascal Thomas9, Francesco Facciolo10. 1. Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy. Electronic address: gio.leuzzi@yahoo.it. 2. Department of Thoracic Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy. 3. Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy. 4. Scientific Direction, Regina Elena National Cancer Institute-IFO, Rome, Italy. 5. Department of Surgery, Section of Thoracic Surgery, Yale University, New Haven, Conn. 6. Department of Thoracic Surgery, University Hospital, Zurich, Switzerland. 7. Department of Thoracic Surgery, University of Rome SAPIENZA, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy. 8. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. 9. Department of Thoracic Surgery, Aix-Marseille University, Marseille, France. 10. Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy.
Abstract
OBJECTIVE: This study investigated the prognostic impact of multimodality therapies in locally advanced thymomas. METHODS: From January 1990 to January 2010, clinicopathological, surgical, and oncological features were retrospectively reviewed in a cohort of 370 Masaoka-Koga stage III thymomas (World Health Organization classification A to B3) collected from 37 institutions. A multivariate Cox proportional hazard model was created to identify independent predictors of overall, cancer-specific (CSS), and relapse-free survivals. Furthermore, a propensity score-matching analysis for exposure to adjuvant (AT) therapy was generated. RESULTS: Induction therapy and AT were administered to 88 (24.9%) and 245 (69.4%) patients, respectively. Overall, 5- and 10-year overall survival, CSS, and relapse-free survivals were 82.8%, 88.4%, and 80.0%, and 68.9%, 83.3%, and 71.5%, respectively. At multivariable analysis performed in the matched cohort, AT was confirmed as the strongest predictive factor for overall survival (hazard ratio, 2.83; 95% confidence interval, 0.88-9.12; P = .08) and CSS (hazard ratio, 4.70; 95% confidence interval, 1.00-22.2; P = .05). Pathologic T classification (according to International Association for the Study of Lung Cancer and International Thymic Malignancy Interest Group TNM staging proposal) was an independent factor for relapse (hazard ratio, 8.69; 95% confidence interval, 1.08-70.04; P = .04). When CSS was adjusted for T classification, AT confirmed a significant survival advantage for pT3 tumors (P = .04). On the other hand, for thymomas larger than 5 cm, stratifying for tumor size and AT did not affect 5-year CSS (P = .17). CONCLUSIONS: Our results indicate that AT is beneficial for locally advanced thymomas, mainly for specific pathologic features (pT3 or tumor size smaller than 5 cm). Further larger studies are needed to confirm these data.
OBJECTIVE: This study investigated the prognostic impact of multimodality therapies in locally advanced thymomas. METHODS: From January 1990 to January 2010, clinicopathological, surgical, and oncological features were retrospectively reviewed in a cohort of 370 Masaoka-Koga stage III thymomas (World Health Organization classification A to B3) collected from 37 institutions. A multivariate Cox proportional hazard model was created to identify independent predictors of overall, cancer-specific (CSS), and relapse-free survivals. Furthermore, a propensity score-matching analysis for exposure to adjuvant (AT) therapy was generated. RESULTS: Induction therapy and AT were administered to 88 (24.9%) and 245 (69.4%) patients, respectively. Overall, 5- and 10-year overall survival, CSS, and relapse-free survivals were 82.8%, 88.4%, and 80.0%, and 68.9%, 83.3%, and 71.5%, respectively. At multivariable analysis performed in the matched cohort, AT was confirmed as the strongest predictive factor for overall survival (hazard ratio, 2.83; 95% confidence interval, 0.88-9.12; P = .08) and CSS (hazard ratio, 4.70; 95% confidence interval, 1.00-22.2; P = .05). Pathologic T classification (according to International Association for the Study of Lung Cancer and International Thymic Malignancy Interest Group TNM staging proposal) was an independent factor for relapse (hazard ratio, 8.69; 95% confidence interval, 1.08-70.04; P = .04). When CSS was adjusted for T classification, AT confirmed a significant survival advantage for pT3tumors (P = .04). On the other hand, for thymomas larger than 5 cm, stratifying for tumor size and AT did not affect 5-year CSS (P = .17). CONCLUSIONS: Our results indicate that AT is beneficial for locally advanced thymomas, mainly for specific pathologic features (pT3 or tumor size smaller than 5 cm). Further larger studies are needed to confirm these data.