Marco Chiappetta1, Edoardo Zanfrini2, Luca Giraldi3, Maria Giovanna Mastromarino2, Leonardo Petracca-Ciavarella2, Dania Nachira2, Maria Teresa Congedo2, Vittorio Aprile4, Marcello Carlo Ambrogi4, Marco Lucchi4, Pier Luigi Filosso5, Enrico Ruffini5, Francesco Guerrera5, Antonino Mulè6, Greta Alì7, Luca Molinaro8, Filippo Lococo2, Elisa Meacci2, Stefano Margaritora2. 1. Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: marcokiaps@hotmail.it. 2. Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy. 3. Università Cattolica del Sacro Cuore, Roma, Italy; Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy. 4. Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy. 5. Unit of Thoracic Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy. 6. Università Cattolica del Sacro Cuore, Roma, Italy; Gineco-patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 7. Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, AOU Pisana, Pisa, Italy. 8. Anatomia Patologica 1, Città della salute e delle scienze di Torino - Presidio San Giovanni Battista Molinette, Turin, Italy.
Abstract
OBJECTIVES: Thymomas are rare neoplasms with a low recurrence rate, which are preferably surgically treated. Iterative thymoma surgery has not been well investigated yet. Study aim is to analyse prognostic factors after iterative recurrence treatment. METHODS: Clinical, pathological and surgical findings of 155 patients, treated for thymoma recurrence in three high-volume centres from 01/01/1990 to 1/07/2017, were retrospectively reviewed. Recurrence patterns/treatment types (surgery or chemotherapy, radiotherapy or combined) were correlated to overall (OS) and disease free survival (DFS). RESULTS: Myasthenia Gravis was present in 135 (87%) patients. Surgery was performed in 135/155 (87%) patients with 109 (80.7%) complete resections. Sixty (55%)patients experienced a second recurrence surgically treated in 31/60 (52%) cases with 18 (58%) complete resections. Eleven (61%) patients experienced a third recurrence and nine underwent complete resection. Myastenia Gravis (HR: 0.45; 95% CI: 0.20-0.98, p = 0.046), DFS after the initial thymectomy >36 months (HR: 0.9; 95% CI: 0.96-0.99, p = 0.006) and complete second recurrence resection (HR: 1.45; 95% CI 2.07-10.01, p = 0.010) resulted as independent favorable prognostic survival factor. Despite patient selection bias, rewarding long-term survivals was predictable after iterative thymoma surgery (5 and 10 years survival of 79.6% and 64.6%) while a poor prognosis was observed after CT/RT (5 and 10 years OS of 56.7% and 21.5%), Masaoka stage and DFS > 36 months were risk factor for iterative recurrences. CONCLUSIONS: Myasthenia Gravis and long DFS after thymectomy are favorable survival factors for multiple thymoma recurrences. Iterative surgical treatment is a viable therapeutic option associated to long-term survival if technically and clinically feasible.
OBJECTIVES: Thymomas are rare neoplasms with a low recurrence rate, which are preferably surgically treated. Iterative thymoma surgery has not been well investigated yet. Study aim is to analyse prognostic factors after iterative recurrence treatment. METHODS: Clinical, pathological and surgical findings of 155 patients, treated for thymoma recurrence in three high-volume centres from 01/01/1990 to 1/07/2017, were retrospectively reviewed. Recurrence patterns/treatment types (surgery or chemotherapy, radiotherapy or combined) were correlated to overall (OS) and disease free survival (DFS). RESULTS:Myasthenia Gravis was present in 135 (87%) patients. Surgery was performed in 135/155 (87%) patients with 109 (80.7%) complete resections. Sixty (55%)patients experienced a second recurrence surgically treated in 31/60 (52%) cases with 18 (58%) complete resections. Eleven (61%) patients experienced a third recurrence and nine underwent complete resection. Myastenia Gravis (HR: 0.45; 95% CI: 0.20-0.98, p = 0.046), DFS after the initial thymectomy >36 months (HR: 0.9; 95% CI: 0.96-0.99, p = 0.006) and complete second recurrence resection (HR: 1.45; 95% CI 2.07-10.01, p = 0.010) resulted as independent favorable prognostic survival factor. Despite patient selection bias, rewarding long-term survivals was predictable after iterative thymoma surgery (5 and 10 years survival of 79.6% and 64.6%) while a poor prognosis was observed after CT/RT (5 and 10 years OS of 56.7% and 21.5%), Masaoka stage and DFS > 36 months were risk factor for iterative recurrences. CONCLUSIONS:Myasthenia Gravis and long DFS after thymectomy are favorable survival factors for multiple thymoma recurrences. Iterative surgical treatment is a viable therapeutic option associated to long-term survival if technically and clinically feasible.
Authors: Vittorio Aprile; Diana Bacchin; Stylianos Korasidis; Roberta Ricciardi; Iacopo Petrini; Marcello Carlo Ambrogi; Marco Lucchi Journal: Ann Transl Med Date: 2021-06