Background: To evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors (TETs) using the Chinese Alliance for Research in Thymomas (ChART) retrospective database.
Methods: Patients without preoperative therapy, who underwent surgery for early-stage (Masaoka-Koga stage I and II) tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups.
Results: A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomectomy group. Improvement rate of myasthenia gravis (MG) was higher after thymectomy than after thymomectomy (91.6% vs 50.0%, P<0.001). Ten-year overall survival was similar between the two groups (90.9% after thymectomy and 89.4% after thymomectomy, P=0.732). Overall, recurrence rate was 3.1% after thymectomy and 5.4% after thymomectomy, with no significant difference between the two groups (P=0.149). Stratified analysis revealed no significant difference in recurrence rates in Masaoka-Koga stage I tumors (3.2% vs 1.4%, P=0.259). However in patients with Masaoka-Koga stage II tumors, recurrence was significantly less after thymectomy group than after thymomectomy (2.9% vs 14.5%, P=0.001).
Conclusions: Thymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.
背景与目的 探采用中国胸腺肿瘤协作组胸腺肿瘤多中心回顾性数据库，探讨胸腺切除范围对早期胸腺上皮肿瘤预后的影响。方法 选择Masaoka-Koga分期I期、II期且术前没有接受新辅助治疗的患者，根据术中胸腺切除程度，分为胸腺切除组及胸腺瘤切除组。对比分析两组患者的临床特点及预后差异。结果 共有1,047例患者纳入研究，其中胸腺切除组入组796例患者、胸腺瘤切除组入组251例患者。对于术前合并重症肌无力（myasthenia gravis, MG）的患者，胸腺切除组术后的MG的缓解率明显优于胸腺瘤切除组（91.6% vs 50.0%, P<0.001）。胸腺切除组的10年总体生存率（overall survival, OS）为90.9%，胸腺瘤切除组的10年OS为89.4%，两者之间没有统计学差异（P=0.732）。胸腺切除组术后复发率为3.7%，胸腺瘤切除组术后复发率为6.2%，两组之间无统计学差异（P=0.149）。进一步分层分析显示，对于Masaoka-Koga I期患者，胸腺切除组和胸腺瘤切除组在复发率上没有差异（3.2% vs 1.4%, P=0.259）；然而在Masaoka-Koga II期患者中，胸腺切除组的复发率明显低于胸腺瘤切除组的复发率（2.9% vs 14.5%, P=0.001）。结论 胸腺切除是治疗胸腺上皮肿瘤的标准手术方式，特别是对于Masaoka-Koga II期及合并MG的患者。.