Background: The prognostic factors and the efficacy of first-line chemotherapy remain unclear in patients with advanced thymic carcinoma.
Materials and methods: We conducted a multi-institutional retrospective study named NEJ023 for patients with advanced thymic carcinoma. All patients without any indication of curative treatment were treated with chemotherapy from 1995 to 2014 at 40 institutions of the North East Japan Study Group.
Results: A total of 286 patients with advanced thymic carcinoma were analyzed. First-line chemotherapy included platinum-based doublets in 62.2% of the patients, monotherapy in 3.5%, and other multidrug chemotherapy (e.g., cisplatin, doxorubicin, vincristine, and cyclophosphamide [ADOC]) in 34.3%. The median follow-up period was 55.5 months, and the median overall survival (OS) from the start of first-line chemotherapy was 30.7 months (95% confidence interval, 25.9-35.9 months). There was no significant difference in OS among different first-line chemotherapy regimens (e.g., between carboplatin/paclitaxel and ADOC, median OS: 27.8 vs. 29.9 months). Masaoka-Koga stage IVa and volume reduction surgery were favorable prognostic factors for OS in the multivariate analysis using the Cox proportional hazards model.
Conclusion: The efficacy of each first-line chemotherapy regimen for advanced thymic carcinoma did not vary significantly. Our results might support the adequacy of the use of carboplatin/paclitaxel as first-line chemotherapy for these patients.
Implications for practice: Because of its rarity, there is limited information about prognostic factors and efficacy of chemotherapy in patients with advanced thymic carcinoma. This is the largest data set for those patients treated with chemotherapy. This study suggests there is no significant difference in efficacy between carboplatin/paclitaxel and cisplatin/doxorubicin/vincristine/cyclophosphamide for advanced thymic carcinoma. This result can support the adequacy of the selection of platinum doublets as treatment for those patients, rather than anthracycline-based multidrug regimen.
摘要
背景。晚期胸腺癌患者的预后因素和一线化疗的疗效尚不清楚。
材料与方法。我们对晚期胸腺癌患者进行了一项名为 NEJ023 的多机构回顾性研究。1995‐2014 年间,所有无根治性治疗指征的患者在日本东北部研究小组的40个机构中接受了化疗。
结果。本文对286例晚期胸腺癌患者的临床资料进行分析。一线化疗包括铂类双药62.2%、单药治疗3.5%和其他多药化疗34.3% [如顺铂、阿霉素、长春新碱和环磷酰胺 (ADOC)] 。中位随访期为55.5个月,一线化疗开始后的中位总生存期(OS)为30.7个月(95% 置信区间,25.9–35.9月)。不同一线化疗方案的OS无显着差异(如卡铂/紫杉醇与ADOC,中位OS为27.8 vs. 29.9个月)。采用Cox比例风险模型进行多因素分析,Masaoka‐Koga分期IVa期和减容术是有利于OS的预后因素。
结论。各一线化疗方案对晚期胸腺癌的疗效无显着差异。我们的结果也许能支持卡铂/紫杉醇作为这些患者的一线化疗药物。
Keywords: Chemotherapy; Masaoka‐Koga stage; Thymic carcinoma; Volume reduction surgery.
© AlphaMed Press 2018.