Clinical value of Postoperative radiation therapy for thymic tumors: a retrospective study from the Chinese Alliance for Research of Thymoma

doi:10.3877/cma.j.issn.2095-8773.2015.01.005

Abstract

Abstract:

Objective

To determine the value of postoperative radiation therapy in stage Ⅱ-Ⅲ thymic tumors.

Methods

The data of patients from the Chinese Alliance of Research for Thymomas (ChART) database between April 1994 and March 2013 were retrospectively analyzed, and the patients were divided into postoperative radiation therapy group and non-postoperative radiation therapy group. The prognosis was estimated with Kaplan-Meier method, and the multi-variate survival analysis was carried out using Cox proportional hazard model.

Results

Pathological type, Masaoka-Koga stage and completion of resection were main prognostic factors of thymic tumors. For the thymic tumor patients with complete resection, the 5-year survival of patients in postoperative radiation therapy group and non-postoperative radiation therapy group were 87.7%±2.5% and 87.8%±4.0%, and the 10-year survival were 80.8%±3.6% and 83.8%±5.4%, respectively(P=0.529, log-rank test). For the thymic tumor patients with incomplete resection, the 5-year survival of patients in postoperative radiation therapy group and non-postoperative radiation therapy group were 73.4%±6.1% and 40.4%±15.5%, and the 10-year survival were 46.3%±12.4% and 40.4%±15.5%, respectively(P=0.017, log-rank test). For the thymic carcinoma patients, the 5-year survival of patients in postoperative radiation therapy group and non-postoperative radiation therapy group were 79.3%±3.9% and 65.4%±11.1%, and the 10-year survival were 49.2%±10.6% and 54.5%±13.6%, respectively(P=0.054, Breslow test).

Conclusions

Postoperative radiation therapy after complete resection does not improve the prognosis of thymic tumors. Postoperative radiation therapy is associated with improved prognosis in patients receiving incomplete resection with thymomas and those with thymic carcinoma.

Key words: Thymic tumor, Thymic carcinoma, Postoperative radiation therapy, Prognosis

Fu Yang, Jianhua Fu, the Chinese Alliance for Research of Thymoma. Clinical value of Postoperative radiation therapy for thymic tumors: a retrospective study from the Chinese Alliance for Research of Thymoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(01): 20-28.

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References 34

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临床特征		总例数(548例)	未术后放疗[例(%)](201例)	术后放疗[例(%)](347例)	χ²值	P值
性别		?	?	?	9.912	0.002
?	男性	323	101(31.3)	222(68.7)	?	?
?	女性	225	100(44.4)	125(55.6)	?	?
年龄		?	?	?	2.265	0.132
?	≤53岁	293	99(33.8)	194(66.2)	?	?
?	>53岁	255	102(40.0)	153(60.0)	?	?
伴瘤综合征		?	?	?	0.456	0.499
?	有	101	40(39.6)	61(60.4)	?	?
?	无	447	161(36.0)	286(64.0)	?	?
病理类型		?	?	?	77.231	0.000
?	A＋AB型	119	82(68.9)	37(31.1)	?	?
?	B型	264	88(33.3)	176(66.7)	?	?
?	胸腺癌	165	31(18.8)	134(81.2)	?	?
Masaoka-Koga分期		?	?	?	55.656	0.000
?	Ⅱa期	29	10(34.5)	19(65.5)	?	?
?	Ⅱb期	194	111(57.2)	83(42.8)	?	?
?	Ⅲ期	325	80(24.6)	245(75.4)	?	?
手术路径		?	?	?	12.760	0.005
?	正中胸骨切口	373	123(33.0)	250(67.0)	?	?
?	肋间隙切口	117	45(38.5)	72(61.5)	?	?
?	VATS	50	29(58.0)	21(42.0)	?	?
?	其他	8	4(50.0)	4(50.0)	?	?
病理切除状况		?	?	?	16.785	0.000
?	R0	472	189(40.0)	283(60.0)	?	?
?	R1	20	4(20.0)	16(80.0)	?	?
?	R2	56	8(14.3.0)	48(85.7)	?	?
胸腺切除程度		?	?	?	6.742	0.009
?	全胸腺切除	392	157(40.1)	235(59.9)	?	?
?	部分胸腺切除	156	44(28.2)	112(71.8)	?	?
化疗情况		?	?	?	37.193	0.000
?	未术后化疗	430	186(43.3)	244(56.7)	?	?
?	术后化疗	118	15(12.7)	103(87.3)	?	?

临床特征		总例数(548例)	未术后放疗[例(%)](201例)	术后放疗[例(%)](347例)	χ²值	P值
性别		?	?	?	9.912	0.002
?	男性	323	101(31.3)	222(68.7)	?	?
?	女性	225	100(44.4)	125(55.6)	?	?
年龄		?	?	?	2.265	0.132
?	≤53岁	293	99(33.8)	194(66.2)	?	?
?	>53岁	255	102(40.0)	153(60.0)	?	?
伴瘤综合征		?	?	?	0.456	0.499
?	有	101	40(39.6)	61(60.4)	?	?
?	无	447	161(36.0)	286(64.0)	?	?
病理类型		?	?	?	77.231	0.000
?	A＋AB型	119	82(68.9)	37(31.1)	?	?
?	B型	264	88(33.3)	176(66.7)	?	?
?	胸腺癌	165	31(18.8)	134(81.2)	?	?
Masaoka-Koga分期		?	?	?	55.656	0.000
?	Ⅱa期	29	10(34.5)	19(65.5)	?	?
?	Ⅱb期	194	111(57.2)	83(42.8)	?	?
?	Ⅲ期	325	80(24.6)	245(75.4)	?	?
手术路径		?	?	?	12.760	0.005
?	正中胸骨切口	373	123(33.0)	250(67.0)	?	?
?	肋间隙切口	117	45(38.5)	72(61.5)	?	?
?	VATS	50	29(58.0)	21(42.0)	?	?
?	其他	8	4(50.0)	4(50.0)	?	?
病理切除状况		?	?	?	16.785	0.000
?	R0	472	189(40.0)	283(60.0)	?	?
?	R1	20	4(20.0)	16(80.0)	?	?
?	R2	56	8(14.3.0)	48(85.7)	?	?
胸腺切除程度		?	?	?	6.742	0.009
?	全胸腺切除	392	157(40.1)	235(59.9)	?	?
?	部分胸腺切除	156	44(28.2)	112(71.8)	?	?
化疗情况		?	?	?	37.193	0.000
?	未术后化疗	430	186(43.3)	244(56.7)	?	?
?	术后化疗	118	15(12.7)	103(87.3)	?	?

项目		胸腺瘤[例(%)]		胸腺癌[例(%)]	χ ²值	P值
项目		A＋AB型	B型	胸腺癌[例(%)]	χ ²值	P值
性别		?	?	?	10.238	0.006
?	男性	63(19.5)	146(45.2)	114(35.3)	?	?
?	女性	56(24.9)	118(52.4)	51(22.7)	?	?
年龄		?	?	?	14.722	0.001
?	≤53岁	51(17.4)	163(55.6)	79(27.0)	?	?
?	>53岁	68(26.7)	101(39.6)	86(33.7)	?	?
伴瘤综合征		?	?	?	45.746	0.000
?	有	25(24.8)	73(72.3)	3(3.0)	?	?
?	无	94(21.0)	191(42.7)	162(36.2)	?	?
手术路径		?	?	?	21.380	0.002
?	正中胸骨切口	64(17.2)	191(51.2)	118(31.6)	?	?
?	肋间隙切口	34(29.1)	44(37.6)	39(33.3)	?	?
?	VATS	18(36.0)	25(50.0)	7(14.0)	?	?
?	其他	3(37.5)	4(50.0)	1(12.5)	?	?
手术根治性		?	?	?	39.814	0.000
?	根治性	115(24.3)	238(50.3)	120(25.4)	?	?
?	姑息性	4(5.3)	26(34.7)	45(60.0)	?	?
胸腺切除程度		?	?	?	10.181	0.006
?	全胸腺切除	84(21.4)	204(52.0)	104(26.5)	?	?
?	部分胸腺切除	35(22.4)	60(38.5)	61(39.1)	?	?
化疗情况		?	?	?	89.886	0.000
?	未术后化疗	111(25.8)	231(53.7)	88(20.5)	?	?
?	术后化疗	8(6.8)	33(28.0)	77(65.3)	?	?
放疗情况		?	?	?	77.231	0.000
?	未术后放疗	82(40.8)	88(43.8)	31(15.4)	?	?
?	术后放疗	37(10.7)	176(50.7)	134(38.6)	?	?

项目		胸腺瘤[例(%)]		胸腺癌[例(%)]	χ ²值	P值
项目		A＋AB型	B型	胸腺癌[例(%)]	χ ²值	P值
性别		?	?	?	10.238	0.006
?	男性	63(19.5)	146(45.2)	114(35.3)	?	?
?	女性	56(24.9)	118(52.4)	51(22.7)	?	?
年龄		?	?	?	14.722	0.001
?	≤53岁	51(17.4)	163(55.6)	79(27.0)	?	?
?	>53岁	68(26.7)	101(39.6)	86(33.7)	?	?
伴瘤综合征		?	?	?	45.746	0.000
?	有	25(24.8)	73(72.3)	3(3.0)	?	?
?	无	94(21.0)	191(42.7)	162(36.2)	?	?
手术路径		?	?	?	21.380	0.002
?	正中胸骨切口	64(17.2)	191(51.2)	118(31.6)	?	?
?	肋间隙切口	34(29.1)	44(37.6)	39(33.3)	?	?
?	VATS	18(36.0)	25(50.0)	7(14.0)	?	?
?	其他	3(37.5)	4(50.0)	1(12.5)	?	?
手术根治性		?	?	?	39.814	0.000
?	根治性	115(24.3)	238(50.3)	120(25.4)	?	?
?	姑息性	4(5.3)	26(34.7)	45(60.0)	?	?
胸腺切除程度		?	?	?	10.181	0.006
?	全胸腺切除	84(21.4)	204(52.0)	104(26.5)	?	?
?	部分胸腺切除	35(22.4)	60(38.5)	61(39.1)	?	?
化疗情况		?	?	?	89.886	0.000
?	未术后化疗	111(25.8)	231(53.7)	88(20.5)	?	?
?	术后化疗	8(6.8)	33(28.0)	77(65.3)	?	?
放疗情况		?	?	?	77.231	0.000
?	未术后放疗	82(40.8)	88(43.8)	31(15.4)	?	?
?	术后放疗	37(10.7)	176(50.7)	134(38.6)	?	?

项目		Ⅱa期[例(%)]	Ⅱb期[例(%)]	Ⅲ期[例(%)]	χ²值	P值
性别		?	?	?	6.757	0.034
?	男性	14(4.3)	103(31.9)	206(63.8)	?	?
?	女性	15(6.7)	91(40.4)	119(52.9)	?	?
年龄		?	?	?	1.195	0.550
?	≤53岁	15(5.1)	98(33.4)	180(61.4)	?	?
?	>53岁	14(5.5)	96(37.6)	145(56.9)	?	?
伴瘤综合征		?	?	?	10.891	0.004
?	有	12(11.9)	35(34.7)	54(53.5)	?	?
?	无	17(3.8)	159(35.6)	271(60.6)	?	?
手术路径		?	?	?	80.796	0.000
?	正中胸骨切口	14(3.8)	112(30.0)	247(66.2)	?	?
?	肋间隙切口	7(6.0)	41(35.0)	69(59.0)	?	?
?	VATS	4(8.0)	38(76.0)	8(16.0)	?	?
?	其他	4(50.0)	3(37.5)	1(12.5)	?	?
手术根治性		?	?	?	55.784	0.000
?	根治性	29(6.1)	193(40.8)	251(53.1)	?	?
?	姑息性	0(0)	1(1.3)	74(98.7)	?	?
胸腺切除程度		?	?	?	0.351	0.839
?	全胸腺切除	22(5.6)	137(34.9)	233(59.4)	?	?
?	部分胸腺切除	7(4.5)	57(36.5)	92(59.0)	?	?
术后化疗		?	?	?	43.400	0.000
?	未术后化疗	28(6.5)	178(41.4)	224(52.1)	?	?
?	术后化疗	1(0.8)	16(13.6)	101(85.6)	?	?
术后放疗		?	?	?	55.656	0.000
?	未术后放疗	10(5.0)	111(55.2)	80(39.8)	?	?
?	术后放疗	19(5.5)	83(23.9)	245(70.6)	?	?

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