Advertisement
JTCVS Open
Advanced searchSave search
Research Article|Articles in Press

Prognostic factors and role of postoperative radiotherapy in surgically resected thymomas

Open AccessPublished:March 02, 2023DOI:https://doi.org/10.1016/j.xjon.2023.02.013
Prognostic factors and role of postoperative radiotherapy in surgically resected thymomas
Previous ArticleThe state of cardiac surgery in Ethiopia
Next ArticleEffect of venoarterial extracorporeal membrane oxygenation initiation timing on tricuspid valve surgery outcomes
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective

      To investigate the prognostic factors and role of postoperative radiotherapy (PORT) for surgically-resected thymomas.

      Methods

      A total of 1,540 patients with pathologically-confirmed thymomas undergoing resection between 2000 and 2018 were retrospectively identified from the Surveillance, Epidemiology, and End Results database. Tumor was re-staged as local (limited to thymus), regional (invasion to mediastinal fat and other neighboring structures), or distant stage. Disease-specific survival (DSS) and overall survival (OS) were estimated by the Kaplan-Meier method and Log-rank test. Adjusted hazard ratios with 95% confidence intervals (HR, 95%CI) were calculated by cox proportional hazards modeling.

      Results

      Tumor stage and histology were independent predictors of both DSS (regional: HR, 3.711, 95%CI, 2.006-6.864; distant: HR, 7.920, 95%CI, 4.061-15.446; type B2/B3: HR, 1.435, 95%CI, 1.008-2.044) and OS (regional: HR, 1.461, 95%CI, 1.139-1.875; distant: HR, 2.551, 95%CI, 1.855-3.509; type B2/B3: HR, 1.409, 95%CI, 1.153-1.723). For patients with regional stage and type B2/B3 thymomas, PORT was associated with better DSS after thymectomy/thymomectomy (HR, 0.268, 95%CI, 0.099-0.727), but the association was not significant after an extended thymectomy (HR, 1.514, 95%CI, 0.516-4.44). In patients with lymph nodal metastases, those who received PORT (HR, 0.372, 95%CI, 0.146-0.949), chemotherapy (HR, 0.843, 95%CI, 0.303-2.346), or both (HR, 0.296, 95%CI, 0.071-1.236) had a better OS.

      Conclusions

      Extent of invasion and tumor histology were independent predictors of worse survival following surgical resection of thymoma. Patients with regional invasion and type B2/B3 thymoma who undergo thymectomy/thymomectomy may benefit from PORT, while patients with nodal metastases may benefit from multi-modality treatment including PORT and chemotherapy.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

      Abbreviations:

      (TETs) (Thymic epithelial tumors), (SEER) (Surveillance, Epidemiology, and End Results), (NCI) (National Cancer Institute), (OS) (Overall survival), (DSS) (Disease-specific survival), (PORT) (postoperative radiotherapy), (TNM) (tumor-node-metastasis), (ICD) (International Classification of Diseases), (IASLC) (International Association for the Study of Lung Cancer), (ITMIG) (International Thymic Malignancy Interest Group), (NCCN) (National Comprehensive Cancer Network), (ESMO) (European Society for Medical Oncology), (NOS) (not otherwise specified), (HR) (Hazard ratio), (CI) (Confidence intervals)

      Article info

      Publication history

      Accepted: February 7, 2023
      Received: October 18, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflict of interest statement: Authors have nothing to disclose.

      Funding statement: This research was supported by the National Natural Science Foundation of China (Grant Nos. 82172848), Shanghai Rising-Star Program (Grant No. 19QA1407400), Shanghai Municipal Education Commission “Chen Guang” project (19CG19), Shanghai "Rising Stars of Medical Talent" Youth Development Program Youth Medical Talents - Specialist Program, Shanghai Pulmonary Hospital Fund for Excellent Young Scholars (No. fkyq1908), Shanghai Pulmonary Hospital Fund (fkzr2105 and fkyq1908).

      Central Message: Postoperative radiotherapy for patients with regional invasion and type B2/B3 thymoma who undergo thymectomy/thymomectomy could significantly improve the disease-specific survival.

      Perspective Statement: PORT should be considered in tumors with advanced stage using NCCN guidelines or aggressive histology per ESMO recommendations. Extent of resection should also be considered as PORT was associated with better survival in thymoma with regional invasion and type B2/B3. Additionally, multi-modality therapy should be given in thymoma with lymphogenous metastases.

      Abbreviated legend for our Central Picture: The comparison between clinical guidelines and our study.

      Ultramini-abstract

      In light of different criteria for recommending PORT after thymoma resection, our study found that extent of resection, stage, and histology should be considered in the decision to administer PORT. Multi-modality therapy should be considered in patients with lymphogenous metastases.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.02.013

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

      User license

      Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) |
      How you can reuse Information Icon
      Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)

      Permitted

      For non-commercial purposes:

      • Read, print & download
      • Redistribute or republish the final article
      • Text & data mine
      • Translate the article (private use only, not for distribution)
      • Reuse portions or extracts from the article in other works

      Not Permitted

      • Sell or re-use for commercial purposes
      • Distribute translations or adaptations of the article

      Elsevier's open access license policy

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX