Ke Ma1, Zhitao Gu1, Yongtao Han1, Jianhua Fu1, Yi Shen1, Yucheng Wei1, Lijie Tan1, Peng Zhang1, 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, Sichuan Cancer Hospital, Chengdu 610041, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 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 ; 4 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 5 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 6 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, 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 study the role of postoperative chemotherapy and its prognostic effect in Masaoka-Koga stage III and IV thymic tumors. METHODS: Between 1994 and 2012, 1,700 patients with thymic tumors who underwent surgery without neoadjuvant therapy were enrolled for the study. Among them, 665 patients in Masaoka-Koga stage III and IV were further analyzed to evaluate the clinical value of postoperative chemotherapy. The Kaplan-Meier method was used to obtain the survival curve of the patients divided into different subgroups, and the Cox regression analysis was used to make multivariate analysis on the factors affecting prognosis. A Propensity-Matched Study was used to evaluate the clinical value of chemotherapy. RESULTS: Two-hundred and twenty-one patients were treated with postoperative chemotherapy, while the rest 444 cases were not. The two groups showed significant differences (P<0.05) regarding the incidence of myasthenia gravis, World Health Organization (WHO) histological subtypes, pathological staging, resection status and the use of postoperative radiotherapy. WHO type C tumors, incomplete resection, and postoperative radiotherapy were significantly related to increased recurrence and worse survival (P<0.05). Five-year and 10-year disease free survivals (DFS) and recurrence rates in patients who underwent surgery followed by postoperative chemotherapy were 51% and 30%, 46% and 68%, comparing with 73% and 58%, 26% and 40% in patients who had no adjuvant chemotherapy after surgery (P=0.001, P=0.001, respectively). In propensity-matched study, 158 pairs of patients with or without postoperative chemotherapy (316 patients in total) were selected and compared accordingly. Similar 5-year survival rates were detected between the two groups (P=0.332). CONCLUSIONS: Pathologically higher grade histology, incomplete resection, and postoperative radiotherapy were found to be associated with worse outcomes in advanced stage thymic tumors. At present, there is no evidence to show that postoperative chemotherapy may help improve prognosis in patients with Masaoka-Koga stage III and IV thymic tumors.
BACKGROUND: To study the role of postoperative chemotherapy and its prognostic effect in Masaoka-Koga stage III and IV thymic tumors. METHODS: Between 1994 and 2012, 1,700 patients with thymic tumors who underwent surgery without neoadjuvant therapy were enrolled for the study. Among them, 665 patients in Masaoka-Koga stage III and IV were further analyzed to evaluate the clinical value of postoperative chemotherapy. The Kaplan-Meier method was used to obtain the survival curve of the patients divided into different subgroups, and the Cox regression analysis was used to make multivariate analysis on the factors affecting prognosis. A Propensity-Matched Study was used to evaluate the clinical value of chemotherapy. RESULTS: Two-hundred and twenty-one patients were treated with postoperative chemotherapy, while the rest 444 cases were not. The two groups showed significant differences (P<0.05) regarding the incidence of myasthenia gravis, World Health Organization (WHO) histological subtypes, pathological staging, resection status and the use of postoperative radiotherapy. WHO type C tumors, incomplete resection, and postoperative radiotherapy were significantly related to increased recurrence and worse survival (P<0.05). Five-year and 10-year disease free survivals (DFS) and recurrence rates in patients who underwent surgery followed by postoperative chemotherapy were 51% and 30%, 46% and 68%, comparing with 73% and 58%, 26% and 40% in patients who had no adjuvant chemotherapy after surgery (P=0.001, P=0.001, respectively). In propensity-matched study, 158 pairs of patients with or without postoperative chemotherapy (316 patients in total) were selected and compared accordingly. Similar 5-year survival rates were detected between the two groups (P=0.332). CONCLUSIONS: Pathologically higher grade histology, incomplete resection, and postoperative radiotherapy were found to be associated with worse outcomes in advanced stage thymic tumors. At present, there is no evidence to show that postoperative chemotherapy may help improve prognosis in patients with Masaoka-Koga stage III and IV thymic tumors.
Entities:
Keywords:
Thymic tumors; chemotherapy; prognosis; surgery
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