Zhitao Gu1, Jianhua Fu1, Yi Shen1, Yucheng Wei1, Lijie Tan1, Peng Zhang1, Yongtao Han1, Chun Chen1, Renquan Zhang1, Yin Li1, Keneng Chen1, Hezhong Chen1, Yongyu Liu1, Youbing Cui1, Yun Wang1, Liewen Pang1, Zhentao Yu1, Xinming Zhou1, Yangchun Liu1, Yuan Liu1, Wentao Fang1. 1. 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China.
Abstract
BACKGROUND: To evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors (TETs) using the Chinese Alliance for Research in Thymomas (ChART) retrospective database. METHODS: Patients without preoperative therapy, who underwent surgery for early-stage (Masaoka-Koga stage I and II) tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups. RESULTS: A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomectomy group. Improvement rate of myasthenia gravis (MG) was higher after thymectomy than after thymomectomy (91.6% vs. 50.0%, P<0.001). Ten-year overall survival was similar between the two groups (90.9% after thymectomy and 89.4% after thymomectomy, P=0.732). Overall, recurrence rate was 3.1% after thymectomy and 5.4% after thymomectomy, with no significant difference between the two groups (P=0.149). Stratified analysis revealed no significant difference in recurrence rates in Masaoka-Koga stage I tumors (3.2% vs. 1.4%, P=0.259). However in patients with Masaoka-Koga stage II tumors, recurrence was significantly less after thymectomy group than after thymomectomy (2.9% vs. 14.5%, P=0.001). CONCLUSIONS: Thymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.
BACKGROUND: To evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors (TETs) using the Chinese Alliance for Research in Thymomas (ChART) retrospective database. METHODS:Patients without preoperative therapy, who underwent surgery for early-stage (Masaoka-Koga stage I and II) tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups. RESULTS: A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomectomy group. Improvement rate of myasthenia gravis (MG) was higher after thymectomy than after thymomectomy (91.6% vs. 50.0%, P<0.001). Ten-year overall survival was similar between the two groups (90.9% after thymectomy and 89.4% after thymomectomy, P=0.732). Overall, recurrence rate was 3.1% after thymectomy and 5.4% after thymomectomy, with no significant difference between the two groups (P=0.149). Stratified analysis revealed no significant difference in recurrence rates in Masaoka-Koga stage I tumors (3.2% vs. 1.4%, P=0.259). However in patients with Masaoka-Koga stage II tumors, recurrence was significantly less after thymectomy group than after thymomectomy (2.9% vs. 14.5%, P=0.001). CONCLUSIONS: Thymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.
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