Clinical value of chemotherapy for thymictumors: a retrospective analysis based on the results of the Chinese Alliance of Research for Thymomas database

doi:10.3877/cma.j.issn.2095-8773.2015.01.004

Abstract

Abstract:

Objective

To explore the clinical value of chemotherapy in the treatment of thymic tumors.

Methods

739 patients with Masaoka stage Ⅲ/Ⅳa or the chemotherapy cases between March 1994 and December 2012 were retrospectively analyzed based on the Chinese Alliance of Research for Thymomas(ChART)database. The clinical value of different modes of chemotherapy was estimated, the survival curves were drawn according to different subgroups, and the factors affecting the prognosis were analyzed.

Results

The Masaoka-Koga stage, completion of resection and pathological type were the main influencing factors of long-term survival. The efficiency of primary chemotherapy was 50.8%(30/59), and the objective response rate was 11.9%(7/59). The primary chemotherapy improved complete resection rate from 66.6%(397/596) to 72.9%(43/59). The 5-year survival and 10-year survival of non-postoperative chemotherapy group and postoperative chemotherapy group in patients with Masaoka-Koga Ⅲ/Ⅳ thymic carcinoma were 71.0% vs 66.6% and 53.5% vs 42.6%, respectively(χ²=0.003, P=0.953). The 5-year survival of non-postoperative chemotherapy group and postoperative chemotherapy group in patients with stage IV thymic tumor were 85.7% and 76.1%, respectively(χ²=0.030, P=0.862). The 5-year survival and 10-year survival of non-postoperative chemotherapy group and postoperative chemotherapy group in patients with stage Ⅲ thymoma were 92.1% vs 65.0% and 88.1% vs 59.6%, respectively(χ²=13.294, P=0.000). For the patients with complete resected thymoma in stage Ⅲ and Ⅳ, the 5-year survival of patients without and with postoperative chemotherapy were 92.8% and 67.2%, respectively(χ²=10.856, P=0.001).

Conclusions

Primary chemotherapy can slightly improve the complete resection rate, while postoperative chemotherapy cannot improve the long-term outcomes of thymic tumors. Postoperative chemotherapy does no good to the MasaokaⅢ thymoma and thymic tumor with localized advanced complete resection.

Key words: Thymic tumor, Chemotherapy, Surgery, Prognosis

Ke Ma, Yongtao Han, Keneng Chen, Wentao Fang, the Chinese Alliance for Research of Thymoma. Clinical value of chemotherapy for thymictumors: a retrospective analysis based on the results of the Chinese Alliance of Research for Thymomas database[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(01): 13-19.

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References 15

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指标		例数(%)
性别		?
?	男性	451(61.0)
?	女性	288(39.0)
Masaoka-Koga分期		?
?	Ⅰ＋Ⅱ期	77(10.4)
?	Ⅲ＋Ⅳ期	638(86.3)
?	分期不明确	24(3.2)
手术		?
?	R0	440(59.5)
?	R1	63(8.5)
?	R2	152(20.6)
?	活检	26(3.5)
?	未手术	58(7.8)
化疗		?
?	初始化放疗＋手术(不含活检)	59(8.0)
?	手术(不含活检)＋术后化放疗	259(35.0)
?	单纯化疗(含活检)	75(10.1)
?	未化疗	346(46.8)
病理分型		?
?	A型	17(2.3)
?	AB型	51(6.9)
?	B1型	47(6.4)
?	B2型	86(11.6)
?	B3型	175(23.7)
?	C型(胸腺癌)	325(44.0)
?	未分型	38(5.1)

指标		例数(%)
性别		?
?	男性	451(61.0)
?	女性	288(39.0)
Masaoka-Koga分期		?
?	Ⅰ＋Ⅱ期	77(10.4)
?	Ⅲ＋Ⅳ期	638(86.3)
?	分期不明确	24(3.2)
手术		?
?	R0	440(59.5)
?	R1	63(8.5)
?	R2	152(20.6)
?	活检	26(3.5)
?	未手术	58(7.8)
化疗		?
?	初始化放疗＋手术(不含活检)	59(8.0)
?	手术(不含活检)＋术后化放疗	259(35.0)
?	单纯化疗(含活检)	75(10.1)
?	未化疗	346(46.8)
病理分型		?
?	A型	17(2.3)
?	AB型	51(6.9)
?	B1型	47(6.4)
?	B2型	86(11.6)
?	B3型	175(23.7)
?	C型(胸腺癌)	325(44.0)
?	未分型	38(5.1)

分层因素		总例数	5年生存率	10年生存率	χ²值	P值
Ⅲ＋Ⅳ期		?	?	?	0.003	0.953
?	未术后化疗	135	71.0%	53.5%	?	?
?	术后化疗	134	66.6%	42.6%	?	?
Ⅲ期		?	?	?	0.990	0.320
?	未术后化疗	86	79.9%	53.4%	?	?
?	术后化疗	107	70.3%	41.8%	?	?
Ⅳ期		76	?	?	1.208	0.272
?	未术后化疗	28	75.6%	0	?	?
?	术后化疗	48	41.8%	0	?	?
R0切除		?	?	?	0.215	0.643
?	未术后化疗	67	85.4%	67.3%	?	?
?	术后化疗	65	80.7%	61.3%	?	?
R1＋R2切除		?	?	?	0.276	0.599
?	未术后化疗	37	48.8%	39.0%	?	?
?	术后化疗	69	53.9%	29.9%	?	?

分层因素		总例数	5年生存率	10年生存率	χ²值	P值
Ⅲ＋Ⅳ期		?	?	?	0.003	0.953
?	未术后化疗	135	71.0%	53.5%	?	?
?	术后化疗	134	66.6%	42.6%	?	?
Ⅲ期		?	?	?	0.990	0.320
?	未术后化疗	86	79.9%	53.4%	?	?
?	术后化疗	107	70.3%	41.8%	?	?
Ⅳ期		76	?	?	1.208	0.272
?	未术后化疗	28	75.6%	0	?	?
?	术后化疗	48	41.8%	0	?	?
R0切除		?	?	?	0.215	0.643
?	未术后化疗	67	85.4%	67.3%	?	?
?	术后化疗	65	80.7%	61.3%	?	?
R1＋R2切除		?	?	?	0.276	0.599
?	未术后化疗	37	48.8%	39.0%	?	?
?	术后化疗	69	53.9%	29.9%	?	?

分层因素		病例数	5年生存率	10年生存率	χ²值	P值
Ⅲ期		?	?	?	13.294	0.000
?	未术后化疗	191	92.1%	88.1%	?	?
?	术后化疗	37	65.0%	59.6%	?	?
Ⅳ期		?	?	?	0.030	0.862
?	未术后化疗	33	85.7%	0	?	?
?	术后化疗	29	76.1%	57.1%	?	?
R0切除		?	?	?	10.856	0.001
?	未术后化疗	172	92.8%	87.4%	?	?
?	术后化疗	36	67.2%	0	?	?
R1＋R2切除		?	?	?	1.392	0.238
?	未术后化疗	52	85.9%	66.8%	?	?
?	术后化疗	30	73.5%	65.4%	?	?
A＋AB＋B1		?	?	?	7.163	0.007
?	未术后化疗	65	93.1%	93.1%	?	?
?	术后化疗	11	41.7%	0	?	?
B2＋B3		?	?	?	7.456	0.006
?	未术后化疗	159	91.3%	81.2%	?	?
?	术后化疗	55	73.2%	60.9%	?	?

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