Hui Liu1, ZhiTao Gu2, Bo Qiu1, Frank C Detterbeck3, Anja C Roden4, Enrico Ruffini5, Meinoshin Okumura6, Nicolas Girard7, YangWei Xiang8, Yuan Liu2, ZhiCheng Du9, YuanTao Hao9, JianHua Fu10, Peng Zhang11, LieWen Pang12, KeNeng Chen13, Yun Wang14, ZhenTao Yu15, Teng Mao2, WenTao Fang16. 1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China. 2. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China. 3. Department of Thoracic Surgery, Yale Cancer Center, New Haven, Connecticut. 4. Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota. 5. Department of Thoracic Surgery, University of Torino, Turin, Italy. 6. Department of General Thoracic Surgery, Osaka University, Osaka, Japan. 7. Thorax Institute Curie Montsouris, Institut Curie, Paris, France. 8. Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China. 9. School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. 10. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China. 11. Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China. 12. Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China. 13. Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, People's Republic of China. 14. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China. 15. Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin, People's Republic of China. 16. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China. Electronic address: vwtfang@hotmail.com.
Abstract
OBJECTIVE: Our aim was to investigate appropriate postoperative management based on the risk of disease recurrence in thymic epithelial tumors after complete resection. METHODS: The Chinese Alliance for Research in Thymomas retrospective database was reviewed. Patients having stage I to IIIa tumors without pretreatment and with complete resection were included. Clinicopathologic variables with statistical significance in the multivariate Cox regression were incorporated into a nomogram for building a recurrence predictive model. RESULTS: A total of 907 cases, including 802 thymomas, 88 thymic carcinomas, and 17 neuroendocrine tumors, were retrieved between 1994 and 2012. With a median follow-up of 52 months, the 10-year overall survival rate was 89.5%. Distant and/or locoregional recurrences were noted in 53 patients (5.8%). The nomogram model revealed histologic type and T stage as independent predictive factors for recurrence, with a bootstrap-corrected C-index of 0.86. On the basis of this model, patients with T1 thymomas or T2 or T3 type A, AB, or B1 thymomas had a significantly lower incidence of recurrence (low-risk group) than those with T2 or T3 type B2 or B3 thymomas and all thymic carcinomas and neuroendocrine tumors (high-risk group) (2.7% versus 20.1% [p < 0.001]). In the high-risk group, more than half of the recurrences (55.2% [16 of 29]) were seen within the first 3 postoperative years, whereas all recurrences but one were recorded within 6 years after surgery. Recurrence occurred quite evenly over 10 postoperative years in the low-risk group. CONCLUSIONS: A 6-year active surveillance should be considered in high-risk patients regardless of adjuvant therapy. For low-risk patients, annual follow-up may be sufficient. Studies examining postoperative adjuvant therapies would be plausible in high-risk patients.
OBJECTIVE: Our aim was to investigate appropriate postoperative management based on the risk of disease recurrence in thymic epithelial tumors after complete resection. METHODS: The Chinese Alliance for Research in Thymomas retrospective database was reviewed. Patients having stage I to IIIa tumors without pretreatment and with complete resection were included. Clinicopathologic variables with statistical significance in the multivariate Cox regression were incorporated into a nomogram for building a recurrence predictive model. RESULTS: A total of 907 cases, including 802 thymomas, 88 thymic carcinomas, and 17 neuroendocrine tumors, were retrieved between 1994 and 2012. With a median follow-up of 52 months, the 10-year overall survival rate was 89.5%. Distant and/or locoregional recurrences were noted in 53 patients (5.8%). The nomogram model revealed histologic type and T stage as independent predictive factors for recurrence, with a bootstrap-corrected C-index of 0.86. On the basis of this model, patients with T1 thymomas or T2 or T3 type A, AB, or B1 thymomas had a significantly lower incidence of recurrence (low-risk group) than those with T2 or T3 type B2 or B3 thymomas and all thymic carcinomas and neuroendocrine tumors (high-risk group) (2.7% versus 20.1% [p < 0.001]). In the high-risk group, more than half of the recurrences (55.2% [16 of 29]) were seen within the first 3 postoperative years, whereas all recurrences but one were recorded within 6 years after surgery. Recurrence occurred quite evenly over 10 postoperative years in the low-risk group. CONCLUSIONS: A 6-year active surveillance should be considered in high-risk patients regardless of adjuvant therapy. For low-risk patients, annual follow-up may be sufficient. Studies examining postoperative adjuvant therapies would be plausible in high-risk patients.