胸腺癌患者临床病理特点和预后

目的 分析胸腺癌患者的临床病理特点,探讨影响预后的因素。方法 整理54例胸腺癌患者的临床资料和生存资料,按Masaoka标准分期。其中根治切除18例(其中类癌9例),姑息切除17例,探查10例。运用寿命表法计算累积生存率,采用Log rank检验和Cox多因素分析模型进行回顾性预后研究。结果 全组术后5年生存率为44．4％。肿瘤位于前纵隔和无钙化是其特点,在鉴别诊断中起重要作用。肿瘤大小、病理类型、手术方式、是否外侵和术后复发是影响预后的重要因素。类癌与其他胸腺癌相比,病变较早,切除率较高,预后较好。结论 肿瘤大小、病理类型、手术方式、是否外侵和术后复发是影响胸腺癌预后的主要因素,分期指标的选择应参照该结果。胸腺癌的治疗应首先考虑完整切除,并根据病理类型辅以放化疗。     

Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients (13 Stage IVA patients and 3 Stage IVB patients).According to the World Heath Organization Histological Criteria (2004), 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed and approximately 1-2 cm2 surrounding the tumor (according to preoperative imaging). Expanded irradiation volume covered the full mediastinal and pericardium areas (with or without prophylactic irradiation in the supraclavicular area). Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.     

Treatment and prognosis of thymic carcinoma: a retrospective analysis of 40 cases

BACKGROUND: Thymic carcinomas are rare neoplasms, and information regarding the results of treatment and possible prognostic factors in patients with these tumors is limited. METHODS: The records of 40 patients with histologically confirmed thymic carcinoma who were treated between 1984 and 1998 were reviewed. Twenty-seven patients were treated with surgical resection followed by radiotherapy with or without chemotherapy, and the remaining 13 patients were treated with radiotherapy with or without chemotherapy. The median follow-up time for the 13 surviving patients was 87 months (range, 44-193 months). RESULTS: The 5-year and 10-year actuarial overall survival rates in all patients were 38% and 28%, respectively. On univariate analysis, complete resection, Karnofsky performance status (KPS), histology, and Masaoka stage at the time of diagnosis were found to have a significant impact on overall survival, whereas on multivariate analysis, complete resection, KPS, and histology were found to be significant prognostic factors. With regard to the degree of resection, 12 of 16 patients (75%) treated with complete resection were alive and free of disease at the time of last follow-up whereas 1 of 24 patients (4%) treated with incomplete resection or biopsy still was alive. Among 12 surviving patients treated with complete resection, 8 with resectable tumors at the time of presentation all had low-grade histology (squamous cell carcinoma) and were treated successfully with complete resection and postoperative radiotherapy with or without adjuvant chemotherapy. The remaining four patients with unresectable tumors at the time of presentation were treated successfully with neoadjuvant chemotherapy, complete resection, and postoperative radiotherapy. CONCLUSIONS: The results of the current study indicate that multimodal treatment, especially complete resection and postoperative radiotherapy with or without chemotherapy, is a curative therapy for thymic carcinomas.     

Postoperative radiotherapy in thymic carcinoma: treatment results and prognostic factors

PURPOSE: To analyze the treatment results and prognostic factors of patients with primary thymic carcinoma treated by total or subtotal tumor resection followed by radiotherapy alone. METHODS AND MATERIALS: Between October 1987 and October 1997, 26 patients with thymic carcinoma were treated with complete or incomplete surgical resection and postoperative adjuvant irradiation without chemotherapy. The radiation was delivered with 10-MV X-ray given 5 days per week at 1.8 to 2 Gy per fraction. Total doses ranged from 40 to 70 Gy. All patients had at least 40 months of follow-up. RESULTS: The 5-year overall survival rate, local control rate, and distant metastasis-free rate were 77%, 91%, and 57%, respectively. Several prognostic factors, including sex, age, extent of resection (total resection vs. subtotal resection), Masaoka staging (early Stage I + II vs. advanced Stage III + IV), pathology (low-grade vs. high-grade), and postoperative radiation dose (> or =60 Gy vs. <60 Gy), were evaluated in univariate analysis. The Masaoka staging system was the only statistically significant predictor in overall survival rate (p = 0.0482) and distant metastasis-free rate (p = 0.0193). CONCLUSIONS: The Masaoka staging system is the most important prognostic factor in primary thymic carcinoma patients receiving postoperative radiotherapy alone. For resectable tumors, surgery and postoperative radiotherapy can achieve good local control, but the distant metastatic rate is still high. Further investigation of more effective chemotherapy is needed.     

Clinical analysis of 45 patients with thymic carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma. METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients （13 Stage ⅣA patients and 3 Stage ⅣB patients）. According to the World Heath Organization Histological Criteria （2004）, 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21 patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation. Local irradiation volume covered the primary tumor bed and approximately 1-2 cm^2 surrounding the tumor （according to preoperative imaging）. Expanded irradiation volume covered the full mediastinal and pericardium areas （with or without prophylactic irradiation in the supraclavicular area）. Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16, Endoxan, 5-FU and taxol. RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors. The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9% in patients treated without simultaneous chemotherapy （P 〉 0.05）. Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy （P 〈 0.05）.
CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma, chemotherapy is necessary.     

头颈部唾液腺腺样囊性癌术后调强放疗预后分析

目的:探讨头颈部唾液腺腺样囊性癌(ACC)的综合治疗模式及预后因素。方法:收集2016—2018年间上海交通大学医学院附属第九人民医院放疗科收治的头颈部唾液腺ACC完成术后放疗患者资料进行回顾性分析。 Kaplan- Meier法生存分析, log- rank检验单因素预...     

原发鼻腔鼻窦腺癌临床病理特征分析(附3例)

目的:探讨原发性鼻腔鼻窦腺癌临床病理特征、诊断与鉴别诊断、治疗与预后。方法:回顾性分析2015-2022年我院确诊的3例原发鼻腔鼻窦腺癌的临床、影像学和免疫组织化学、分子病理学特点,并复习国内外相关文献。结果:3例患者均为男性,平均年龄68岁,均无木屑、皮革类长期接触史,组织学类型分别为肠型腺癌、高级别非肠型腺癌、低级别非肠型腺癌。临床表现均为鼻阻伴鼻出血,影像学检查无特异性,均未考虑癌。镜下肠型腺癌排列呈小管-腺样,部分呈乳头状、筛状,可见坏死,高级别非肠型腺癌呈明显的侵袭性生长,以实性增生为主,可见明显的核多形性和坏死,低级别非肠型腺癌呈特征性的复杂腺样生长模式并可见背靠背腺体,肿瘤细胞一致,核圆形。分子病理检测：均未检测到BRAF基因突变。治疗方案为手术或手术+放/化疗,均随访17～36月,肠型腺癌和高级别非肠型腺癌患者术后均死亡,低级别非肠型腺癌患者无复发或转移。结论:原发鼻腔鼻窦腺癌罕见,无特异临床表现及影像学表现,诊断主要依赖病理组织学检查,免疫组化及分子病理可协助诊断,并对治疗和预后监测有指导作用。     

Prognostic significance of CT contrast enhancement within histological subgroups of intracranial glioma

We report the prognostic significance of tumor CT contrast enhancement within histological subgroups in 831 consecutive adult glioma patients of high-grade (n=516) and low-grade (n=315) histology. In the present report, a negative prognostic factor is associated with shortened survival. Methods: Survival analysis including Kaplan-Meier plots, log-rank tests, Cox analysis, and Aalen's linear model as implemented in SPSS and S-PLUS. Results: Sensitivity and specificity of contrast enhancement as a test for high-grade glioma was 0.87 and 0.79, respectively. Enhancement was a strong negative prognostic factor comparable to high-grade histology in the total patient population. Enhancement was also a negative prognostic factor within the subgroups adult high-grade (Grade 3–4), anaplastic (Grade 3), and low-grade (Grade 1–2) gliomas (p < 0.001). The prognostic implications of initial enhancement declined in high-grade patients surviving beyond 36 months. Tumor contrast enhancement or calcifications (in parentheses) were present in 96% (3.6%) of glioblastomas, in 87% (7.4%) of high-grade gliomas, in 56.5% of anaplastic gliomas, and in 21% (16.2%) of low-grade gliomas. Calcification was a positive prognostic factor within the high-grade group of patients (p < 0.0001). Conclusion: Enhancement was a major prognostic factor comparable to high-grade histology in this glioma patient population. Enhancement was a negative prognostic factor within each of the adult subgroups high-grade, anaplastic (grade 3), and low-grade gliomas. Enhancement was strongly associated with but not pathognomonic for high-grade histology.     

食管癌术后区域性淋巴结转移三维适形放射治疗的预后分析

目的:探讨食管癌术后区域性淋巴结转移患者三维适形放射治疗的预后,并分析影响预后的相关因素。方法:回顾性分析河北医科大学第四医院放疗科2001年1 月至2005年12月收治的食管癌根治术后因区域性淋巴结复发和/或转移而接受根治性三维适形放疗的患者90例,其中79例全程适形放疗处方剂量为50~72Gy/25~36次,11例后程适形放疗的剂量为50~76Gy/25~38次。结果:自手术之日起计算的术后1、3、5 年生存率分别为85.71% 、34.34% 、14.92% ,自复发和（或）淋巴结转移放疗之日起计算的放疗后1、2、3 年生存率分别为43.41% 、18.09% 、7.81% 。单因素分析显示术中测量原发食管病变长度、钡餐造影病变长度、T分期、TNM分期、转移淋巴结个数、淋巴结转移度、术后出现区域性淋巴结转移的时间对术后生存均有显著影响。多因素分析显示双肺V35、放疗后近期疗效和淋巴结缩小率是影响食管癌术后区域性淋巴结转移放疗疗效的独立性预后因素。结论:双肺V35越小、放疗后近期疗效越好;淋巴结缩小率越大,食管癌术后区域性淋巴结复发和（或）转移者放疗后的生存率越高。      

术后化疗胸腺肿瘤中的应用及对其预后的影响

背景与目的探讨术后化疗在胸腺肿瘤中的应用及术后化疗对Masaoka III期/IV期预后的影响。方法1994年3月至2012年12月,中国胸腺瘤研究协作组（Chinese Alliance of Research for hTymomas, ChART）数据库共纳入2,306例胸腺肿瘤病例,资料相对完整1,700例患者纳入本研究,对其中Masaoka III期/IV期665例患者进行进一步分析,初步评估术后化疗的临床价值,采用Kaplan-Meier法绘制不同亚组患者生存曲线,Cox回归进行多因素分析影响预后的因素。采用倾向值匹配研究（propensity-matched study, PSM）,评估化疗的临床价值。结果1,700例患者中未行术后化疗1,406例（82.7%）,术后化疗294例（17.3%）,随着Masaoka分期的增加,术后化疗患者的比例也随之增高,差异有统计学意义（P<0.001）。对Masaoka III期/IV期患者665例进行进一步分析,其中未术后化疗组444例,术后化疗组221例。两组患者在有无重症肌无力、WHO病理类型、病理分期、手术根治性、有无术后放疗等方面分布有差异（P<0.05）。其中C型胸腺瘤、不完全切除和术后放疗明显影响患者术后复发和生存（P<0.05）。术后化疗组5年和10年无病生存率分别为51%、30%,5年和10年复发率分别为46%、68%,而未术后化疗组5年和10年无病生存率分别为73%、58%。5年和10年复发率分别为26%、40%,两组无病生存率和复发率均有明显统计学差异（P=0.001, P=0.001）。对有无重症肌无力,病理类型,病理分期,手术根治性状态,术后放疗等因素进行倾向值匹配筛选出其中158例未术后化疗和158例术后化疗共316例患者,生存分析显示：未术后化疗组和术后化疗组两组5年生存率并无明显统计学差异（P=0.332）。结论病理学类型、手术的根治性和术后放疗是影响进展期胸腺肿瘤患者术后生存和复发的主要因素。术后化疗并未给Masaoka-Koga III期/IV期胸腺瘤患者带来生存获益。     

89例术后高度恶性脑胶质瘤预后影响因素分析

  目的  探讨高度恶性脑胶质瘤的预后以及预后影响因素。   方法  回顾分析江西省肿瘤医院2005年4月至2011年2月收治的89例高度恶性脑胶质瘤的临床资料, 其中手术全切43例, 部分切除46例; WHO3级45例, 4级44例。   结果  全组中位生存期13个月, 2年总生存率(OS)及无进展生存率(PFS)分别为43.2%和36.9%;单因素分析显示切除程度、病理分级、年龄是OS的影响因素(P < 0.05), 切除程度、脑室系统受侵、术后放疗是PFS的影响因素(P < 0.05), 多因素分析结果显示切除程度、年龄是OS的独立影响因素(P < 0.05);切除程度、术后放疗是PFS的独立影响因素(P < 0.05);全组共41例复发, 其中原位复发65.9%, 远隔部位复发34.1%;46例脑室系统受侵者, 11例出现远隔部位复发; 其余43例, 仅3例出现远隔部位复发。   结论  手术切除程度、年龄是影响OS的独立预后因素, 术后放疗能改善PFS; 原位复发是主要复发模式, 脑室受侵增加了远处播散概率。      

Postoperative radiotherapy in carcinoma of the cervix with microscopically positive resection margin

Background Patients with cervical cancer who have positive surgical resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with microscopically positive surgical resection margins were analyzed to evaluate the role of radiotherapy. Methods Between 1979 and 1992, 60 patients with cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of microscopic positive vaginal (48 patients), or parametrial (12 patients) resection margins. Patients were treated with external beam radiation therapy (EBRT) alone (12 patients), or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 55 months. Results The 5-year actuarial disease-free and overall survival rates for all patients were 75% and 84%, respectively. The overall recurrence rate was 23% (14/60). Among the 48 patients with positive vaginal resection margins, 4 had pelvic recurrence (8%), and 7 had distant metastasis (15%); the recurrence rate was 21% (9/43) in those treated with EBRT and VOI, and 40% (2/5) in the EBRT-only treated group. In the 12 patients with positive parametrial margins, 3 patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32% (19/60), and grade III complications occurred in 3 patients (5%). Conclusion Postoperative radiotherapy can produce excellent control rates in patients with microscopically positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.     

Long term survival of thoracoscopic metastasectomy vs metastasectomy by thoracotomy in patients with a solitary pulmonary lesion

AIMS: The aim of this study was to compare long term survival after resection of solitary pulmonary metastasis on CT scan performed by either thoracoscopy or through a standard thoracotomy. METHODS: Patients with a solitary, CT scan confirmed, peripherally located lesion suspected for metastasis, less than 3cm in diameter were included. End points were: postoperative complication rate, disease free and overall survival and location of recurrence in the lung. RESULTS: Thirty-five patients who underwent a thoracoscopic metastasectomy with (n=19) or without (n=16) confirmatory thoracotomy were included in this study. Patients experienced more complications following a thoracotomy (n=5) compared to those who had a thoracoscopy (n=0) (P=0.049). Two patients appeared to have further disease at thoracotomy besides the CT scan identified lesion, and some at thoracoscopy. At definitive histology, seven lesions were benign and eight appeared to be a second primary. Analysis of 20 patients with histological confirmed metastasis demonstrated a 2-year disease free and overall survival rate of 50% and 67% respectively following thoracoscopic metastasectomy (n=8) compared to 42% and 70% respectively following confirmatory thoracotomy (n=12). Recurrence occurred in three of the patients after thoracoscopic metastasectomy and in five patients after thoracotomy. CONCLUSION: Our results suggest that thoracoscopic resection of solitary peripherally located metastasis is a safe and potentially curative procedure with a long term outcome that is comparable with that after resection by thoracotomy.     

Thymic carcinoma: state of the art review

Thymic carcinoma is a rare neoplasm with distinct clinical and pathological characteristics. The prognosis is often poor with an aggressive course that belies its numerical rarity. Potentially prognostic factors for survival include histopathologic grade, clinical stage, and resectability of the tumor. Five-year survival rates for all patients are approximately 30-50%, with a significant survival time differential between low-grade and high-grade neoplasms. Owing to the paucity of cases, optimal management of thymic carcinoma has yet to be defined. At present, a multimodality approach involving aggressive surgical resection, platinum-based combination chemotherapeutic interventions, and radiotherapy represent the preferred therapeutic approach. Though our knowledge remains somewhat speculative at present, several scientific, technological and therapeutic innovations may have a potentially significant impact on the future of this disease.     

Impact of Lymph Node Dissection on Thymic Malignancies: Multi-Institutional Propensity Score Matched Analysis

Introduction

Surgical resection is a standard treatment for thymic malignancies. However, prognostic significance of nodal metastases and lymph node dissection remains unclear. The aim of this study is to determine prognostic significance of nodal metastases and the role of lymph node dissection (LND) in thymic malignancies.

A staging system for soft-tissue sarcoma and its evaluation in relation to treatment

In order to define the significant factors for a staging system of soft-tissue sarcomas(STS), histologic and clinical findings in 190 adult patients with localized STS in the extremities and trunk were reviewed. The male-to-female ratio was 1.21. The histologic grading of tumors was defined according to the criteria recently proposed by us: tumors were low-grade in 65 cases, intermediate-grade in 57 cases and high-grade in 68 cases. The initial surgical procedure was as follows: intracapsular excision in 9 cases, marginal excision in 104 and wide local excision in 77, including 15 amputations. The mode of treatment was surgery alone (101 patients), surgery and chemotherapy (58), surgery and radiotherapy (22) and surgery and combined chemo- and radiotherapy (9). Univariate analysis revealed histologic grade, sex, tumor size and tumor depth to be significant prognostic factors. Multivariate analysis revealed histologic grade to be the only independent factor for prognosis. Significant clinical factors in each histologic grade were then evaluated. In the low-grade group, local recurrence significantly affected prognosis. Most of the patients with local recurrence had had marginal resection as the initial surgical procedure. No clinical factors affecting prognosis in the intermediate-grade group could be determined. In the high-grade group, patients with wide local excision and adjuvant chemotherapy had a better prognosis than those with marginal excision with or without adjuvant chemotherapy and wide local excision without chemotherapy (p=0.09). In conclusion, histologic grade was the only significant factor for the staging of STS. On the basis of our staging system, different modalities of treatment for each grade of STS might be indicated; adequate surgery is essential for the prevention of local recurrence, which resulted in reduced mortality in patients with low-grade STS. For high-grade STS, the prevention of distant metastasis by combined extensive surgery and adjuvant chemotherapy may make long-term survival possible.     

The outcomes after surgical resection in pancreatic endocrine tumors: An institutional experience

Aim

Sporadic pancreatic endocrine tumors (PET) can be managed surgically with excellent outcomes. The aim of this study was to analyze surgical outcomes and factors influencing survival.

Methods

Between 1995 and 2007, 96 patients with sporadic PET who underwent surgery at our institution were retrospectively reviewed for clinicopathologic variables and outcomes according to the World Health Organization (WHO) classifications.

Results

Thirty-nine patients had well-differentiated tumors (WDT) with benign behavior, 23 had uncertain behavior, 27 had low-grade carcinoma, and 7 were diagnosed with high-grade carcinoma. R0 resection was performed in 84 patients. No recurrence was observed in WDT regardless of its behavior or curability but 16 of 34 patients with carcinoma had recurrence. Five-year overall survival (OS) for R0-resected patients with carcinoma was 57%, and OS at 3 years for R1/R2-resected patients was 23% (P = 0.012). The WHO classification and R0 resection were independent prognostic factors in multivariate analysis.

Conclusions

This single institutional experience demonstrated that surgical resection is curative for WDT and recurrences are frequent in spite of curative resection for malignant PET. The WHO classification and R0 resection remained independent prognostic factor.     

涎腺腺泡细胞癌5例报道并文献复习

目的探讨涎腺腺泡细胞癌的临床病理学特征和预后相关因素。方法回顾性分析5例涎腺腺泡细胞癌的临床资料、组织学形态和免疫表型,并复习相关文献。结果男1例,女4例。肿瘤位于口腔牙龈1例,腮腺4例。临床表现为生长缓慢无痛性肿块4例,另1例肿瘤近期生长迅速,偶有疼痛。镜下观察:组织学形态4例呈乳头囊状型,肿瘤细胞形态温和;1例实性伴微囊型肿瘤浸润性生长伴点灶状坏死,肿瘤细胞异形明显,呈高级别转化形态。免疫组化染色示CK阳性,P63、SMA阴性;Ki-67阳性指数4例<5%,1例高级别患者为30%。4例随访13~78个月,未见肿瘤复发和转移;1例高级别患者术后10个月死亡。结论腺泡细胞癌好发于女性腮腺,通常为低度恶性,而高级别转化腺泡细胞癌预后差,其临床综合治疗尚须进一步探讨。     

Adjuvant radiotherapy for completely resected stage 2 thymoma

BACKGROUND:

The clinical benefit of postoperative mediastinal radiation for completely resected Masaoka stage 2 thymoma remains controversial. Due to its indolent nature and infrequent recurrences, no study has definitively determined the optimal approach.

METHODS:

We retrospectively reviewed 175 consecutive patients who underwent thymic resection from January 1990 to July 2008 at the University of Pennsylvania. The primary endpoint was local recurrence, defined as recurrence within the surgical bed, treated by resection alone versus resection plus radiation. Patients with high recurrence risk were referred for adjuvant radiotherapy.

RESULTS:

Seventy‐four Masaoka stage 2 patients were resected; 62 underwent complete resections with adequate postsurgical follow‐up. Thirty‐seven patients received adjuvant radiotherapy and 25 patients were observed. The median radiation dose was 5040 cGy. The median follow‐up for all patients was 52 months. The local recurrence rate was 3.2%. The proportion of recurrences in patients observed after surgery was 8% versus 0% in those who received adjuvant radiotherapy (P = .15). Size was not an independent predictor of recurrence (P = .81). The tumor‐related death rate was 0%, and overall death rate was 3.2%. One death occurred in each group, observation, and radiation. There were no grade 3 or 4 complications with radiation.

CONCLUSIONS:

Recurrence rates were low following resection of stage 2 thymoma either with or without adjuvant radiotherapy. Adjuvant radiotherapy, although well‐tolerated, did not significantly decrease the local relapse rate. Differences may be observed in future studies of patients who are at higher risk for local recurrence, based on completeness of resection, World Health Organization histology, and tumor size. Cancer 2011. © 2011 American Cancer Society.     

The presence of extrathoracic metastasis is more prognostic of survival than Masaoka stage (IVa/IVb) in metastatic thymic epithelial tumor: A retrospective cohort study

Purpose

Our aim in this study was to identify independent prognostic factors for overall survival (OS) in order to explain the heterogeneity of OS in patients with metastatic thymic epithelial tumor (TET).

Methods

Sixty-one consecutive patients with histologic diagnosis of Masaoka stage IV TET between January 1980 and March 2009 were analyzed at a single institution. Masaoka stage IVa was defined as pleural or pericardial dissemination, and IVb as lymphogenous or hematogenous metastasis. Metastasis outside the thoracic cage was defined as extrathoracic metastasis. To identify prognostic factors, relationships between clinicopathologic factors and outcomes were analyzed.

Results

Of the 61 patients, 30 (49.2%) had thymoma, 28 (45.9%) had thymic carcinoma, and the remaining 3 (4.9%) had an unclear histologic subtype. The Masaoka stage was IVa in 27 patients (44.3%) and IVb in 34 patients (55.7%). Significant independent adverse prognostic factors for OS were histologic subtype and extrathoracic metastasis (hazard ratio [HR] = 3.09 and 6.03, 95% CI: 1.41–6.74 and 1.89–19.30, p = 0.005 and 0.002, respectively). The presence of extrathoracic metastasis was also an independent prognostic factor for decreased progression-free survival time (PFS) (HR = 6.62, 95% CI: 1.19–24.17, p = 0.004). The only significant criterion for prognostic discrimination was the presence of extrathoracic metastasis in metastatic TET.

Conclusions

Significant independent prognostic factors for lower OS were the histologic subtype of thymic carcinoma and the presence of extrathoracic metastasis. A new concept of extrathoracic metastasis might provide additional information for the understanding of metastatic TET.