Zhitao Gu1, Chun Chen2, Yun Wang3, Yucheng Wei4, Jianhua Fu5, Peng Zhang6, Yongyu Liu7, Renquan Zhang8, Keneng Chen9, Zhentao Yu10, Liewen Pang11, Yangchun Liu12, Yin Li13, Yongtao Han14, Hezhong Chen15, Xinming Zhou16, Youbin Cui17, Lijie Tan18, Jianyong Ding18, Yi Shen4, Yuan Liu1, Wentao Fang1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 2. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China. 3. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China. 4. Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China. 5. 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, China. 6. Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin, China. 7. Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang, China. 8. Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China. 9. Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, China. 10. Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China. 11. Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China. 12. Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang, China. 13. Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. 14. Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China. 15. Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China. 16. Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, China. 17. Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun, China. 18. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Abstract
OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) has been increasingly used in the management of thymic epithelial tumours. However, its oncological efficacy remains to be proved. The purpose of this study is to compare the oncological outcomes following thoracoscopic versus open surgery in the case-matched groups of patients with early-stage thymic tumours from the Chinese Alliance for Research in Thymomas (ChART) retrospective database. METHODS: Between 1994 and 2012, a total of 1087 patients who underwent surgery for UICC (Union for International Cancer Control) pathological Stage I tumours from the ChART retrospective database were recruited for this study. A propensity score-matched analysis was used to compare the long-term outcomes in patients who received VATS or open surgery. RESULTS: VATS resection was performed in 271 patients (24.9%) and open surgery in 816 patients (75.1%). Before propensity score matching, the VATS group had a smaller tumour size (P = 0.002), lower grade histology (P = 0.034), lower T stage (P < 0.001) and less adjuvant therapy (P < 0.001). Propensity score matching by gender, myasthenia gravis, tumour size, histological classification, pathological T stage, extent of thymectomy, adjuvant radiotherapy and adjuvant chemotherapy identified 110 patients in each group. After matching, there was no significant difference in patient demographics, tumour characteristics or adjuvant therapy. All matched patients had R0 resection. Overall survival, disease-free survival and cumulative incidence of recurrence were only predicted by WHO histology, but not by surgical approach, in both univariable and multivariable analyses. There was no significant difference in the overall survival (85.7% vs 93.1%, P = 0.539), disease-free survival (92.5% vs 91.9%, P = 0.773), cumulative incidence of recurrence (7.1% vs 5.8%, P = 0.522) and improvement rate of myasthenia gravis (83.3% vs 88.2%, P = 0.589) between the 2 groups. CONCLUSIONS: This propensity score-matched study suggests that VATS and open surgeries are associated with similar oncological outcomes for Stage I thymic epithelial tumours. Minimally invasive surgery might be an acceptable surgical approach for early-stage thymic malignancies.
OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) has been increasingly used in the management of thymic epithelial tumours. However, its oncological efficacy remains to be proved. The purpose of this study is to compare the oncological outcomes following thoracoscopic versus open surgery in the case-matched groups of patients with early-stage thymic tumours from the Chinese Alliance for Research in Thymomas (ChART) retrospective database. METHODS: Between 1994 and 2012, a total of 1087 patients who underwent surgery for UICC (Union for International Cancer Control) pathological Stage I tumours from the ChART retrospective database were recruited for this study. A propensity score-matched analysis was used to compare the long-term outcomes in patients who received VATS or open surgery. RESULTS: VATS resection was performed in 271 patients (24.9%) and open surgery in 816 patients (75.1%). Before propensity score matching, the VATS group had a smaller tumour size (P = 0.002), lower grade histology (P = 0.034), lower T stage (P < 0.001) and less adjuvant therapy (P < 0.001). Propensity score matching by gender, myasthenia gravis, tumour size, histological classification, pathological T stage, extent of thymectomy, adjuvant radiotherapy and adjuvant chemotherapy identified 110 patients in each group. After matching, there was no significant difference in patient demographics, tumour characteristics or adjuvant therapy. All matched patients had R0 resection. Overall survival, disease-free survival and cumulative incidence of recurrence were only predicted by WHO histology, but not by surgical approach, in both univariable and multivariable analyses. There was no significant difference in the overall survival (85.7% vs 93.1%, P = 0.539), disease-free survival (92.5% vs 91.9%, P = 0.773), cumulative incidence of recurrence (7.1% vs 5.8%, P = 0.522) and improvement rate of myasthenia gravis (83.3% vs 88.2%, P = 0.589) between the 2 groups. CONCLUSIONS: This propensity score-matched study suggests that VATS and open surgeries are associated with similar oncological outcomes for Stage I thymic epithelial tumours. Minimally invasive surgery might be an acceptable surgical approach for early-stage thymic malignancies.
Authors: Stevan S Pupovac; Joshua Newman; Paul C Lee; Miguel Alexis; Julissa Jurado; Kevin Hyman; Lawrence Glassman; David Zeltsman Journal: J Thorac Dis Date: 2020-08 Impact factor: 3.005