• J. Thorac. Cardiovasc. Surg. · Jan 2016

    Comparative Study

    Multimodality therapy for locally advanced thymomas: A propensity score-matched cohort study from the European Society of Thoracic Surgeons Database.

    • Giovanni Leuzzi, Gaetano Rocco, Enrico Ruffini, Isabella Sperduti, Frank Detterbeck, Walter Weder, Federico Venuta, Dirk Van Raemdonck, Pascal Thomas, Francesco Facciolo, and ESTS Thymic Working Group.
    • Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy. Electronic address: gio.leuzzi@yahoo.it.
    • J. Thorac. Cardiovasc. Surg. 2016 Jan 1; 151 (1): 47-57.e1.

    ObjectiveThis study investigated the prognostic impact of multimodality therapies in locally advanced thymomas.MethodsFrom January 1990 to January 2010, clinicopathological, surgical, and oncological features were retrospectively reviewed in a cohort of 370 Masaoka-Koga stage III thymomas (World Health Organization classification A to B3) collected from 37 institutions. A multivariate Cox proportional hazard model was created to identify independent predictors of overall, cancer-specific (CSS), and relapse-free survivals. Furthermore, a propensity score-matching analysis for exposure to adjuvant (AT) therapy was generated.ResultsInduction therapy and AT were administered to 88 (24.9%) and 245 (69.4%) patients, respectively. Overall, 5- and 10-year overall survival, CSS, and relapse-free survivals were 82.8%, 88.4%, and 80.0%, and 68.9%, 83.3%, and 71.5%, respectively. At multivariable analysis performed in the matched cohort, AT was confirmed as the strongest predictive factor for overall survival (hazard ratio, 2.83; 95% confidence interval, 0.88-9.12; P = .08) and CSS (hazard ratio, 4.70; 95% confidence interval, 1.00-22.2; P = .05). Pathologic T classification (according to International Association for the Study of Lung Cancer and International Thymic Malignancy Interest Group TNM staging proposal) was an independent factor for relapse (hazard ratio, 8.69; 95% confidence interval, 1.08-70.04; P = .04). When CSS was adjusted for T classification, AT confirmed a significant survival advantage for pT3 tumors (P = .04). On the other hand, for thymomas larger than 5 cm, stratifying for tumor size and AT did not affect 5-year CSS (P = .17).ConclusionsOur results indicate that AT is beneficial for locally advanced thymomas, mainly for specific pathologic features (pT3 or tumor size smaller than 5 cm). Further larger studies are needed to confirm these data.Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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