Samina Park1, In Kyu Park1, Young Tae Kim1, Geun Dong Lee2, Dong Kwan Kim2, Jong Ho Cho3, Yong Soo Choi3, Chang Young Lee4, Jin Gu Lee4, Chang Hyun Kang5. 1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 3. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. 5. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: chkang@snu.ac.kr.
Abstract
BACKGROUND: The oncologic benefit of neoadjuvant chemotherapy in thymic malignancies remains unclear. Postoperative oncologic outcomes of curative resection after neoadjuvant chemotherapy were compared with those of upfront surgery. METHODS: Based on records from a multicenter database, 1,486 patients with surgically resected thymic malignancies between 2000 and 2013 were included in the final study cohort. Of these, 110 patients (7.4%) underwent surgical resection after neoadjuvant chemotherapy, and 1,376 patients (92.6%) underwent upfront surgery. A propensity score-matched analysis was performed to minimize differences in preoperative and intraoperative variables. Postoperative outcomes and survivals were compared between the two groups. RESULTS: In the matched cohort, there were no significant differences in postoperative mortality (p value not calculated), postoperative complications (p = 0.405), and hospital length of stay (p = 0.821) between the two groups. However, the neoadjuvant chemotherapy group showed significantly higher transfusion rates (p = 0.003) and longer operation times (p < 0.001) than the upfront surgery group. Pathologically complete resection rates (p = 0.382) and tumor sizes (p = 0.286) were similar between the two groups. The 5-year overall survival rates were 77.4% and 76.7%, respectively (p = 0.596). The 3-year recurrence-free survival rates were 62.9% and 71.5%, respectively (p = 0.070). CONCLUSIONS: Neoadjuvant chemotherapy, followed by resection, obtained similar resectability and long-term survival rates to those of upfront surgery. Therefore, the role of neoadjuvant chemotherapy should be refined in randomized controlled trials.
BACKGROUND: The oncologic benefit of neoadjuvant chemotherapy in thymic malignancies remains unclear. Postoperative oncologic outcomes of curative resection after neoadjuvant chemotherapy were compared with those of upfront surgery. METHODS: Based on records from a multicenter database, 1,486 patients with surgically resected thymic malignancies between 2000 and 2013 were included in the final study cohort. Of these, 110 patients (7.4%) underwent surgical resection after neoadjuvant chemotherapy, and 1,376 patients (92.6%) underwent upfront surgery. A propensity score-matched analysis was performed to minimize differences in preoperative and intraoperative variables. Postoperative outcomes and survivals were compared between the two groups. RESULTS: In the matched cohort, there were no significant differences in postoperative mortality (p value not calculated), postoperative complications (p = 0.405), and hospital length of stay (p = 0.821) between the two groups. However, the neoadjuvant chemotherapy group showed significantly higher transfusion rates (p = 0.003) and longer operation times (p < 0.001) than the upfront surgery group. Pathologically complete resection rates (p = 0.382) and tumor sizes (p = 0.286) were similar between the two groups. The 5-year overall survival rates were 77.4% and 76.7%, respectively (p = 0.596). The 3-year recurrence-free survival rates were 62.9% and 71.5%, respectively (p = 0.070). CONCLUSIONS: Neoadjuvant chemotherapy, followed by resection, obtained similar resectability and long-term survival rates to those of upfront surgery. Therefore, the role of neoadjuvant chemotherapy should be refined in randomized controlled trials.
Authors: Jose Arimateia Batista Araujo-Filho; Maria Mayoral; Junting Zheng; Kay See Tan; Peter Gibbs; Annemarie Fernandes Shepherd; Andreas Rimner; Charles B Simone; Gregory Riely; James Huang; Michelle S Ginsberg Journal: Ann Thorac Surg Date: 2021-04-09 Impact factor: 5.102