Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms

Abstract

Background and Objectives It is unclear if a specific strategy for simultaneous treatment of primary thymic neoplasms and pleural metastases confers benefit for Masaoka stage IVA disease. We reviewed our experience with thymic neoplasms with concurrent pleural metastases to identify factors influencing outcomes. Methods Records of patients who presented with stage IVA thymic neoplasms from 2000 to 2018 were assessed. Multivariate Cox proportional hazards analyses were completed to determine predictors of progression‐free and overall survival. Results Forty‐eight patients were identified, including 34 (71%) who underwent surgery. Median overall and progression‐free survival were 123 and 21 months, respectively. The extent of resection varied, and was most commonly thymectomy plus partial pleurectomy (22, 65%). Median progression‐free survival for patients who underwent surgical resection versus those who had not was 24 versus 12 months (P = .018). Following surgical resection, mediastinal recurrence was uncommon (2, 6%, vs 7, 50% nonoperatively). Five‐year survival rates in these groups were suggestive of possible benefit to surgery (87% vs 68%). Conclusions Thymic neoplasms with pleural dissemination represents a treatment challenge. As part of a multidisciplinary approach, surgery appears to be associated with more favorable long‐term results, although selection bias may account for some of the survival differences observed.

Nomogram predicts the prognosis of patients with thymic carcinoma: A population-based study using SEER data

“…Studies have indicated that surgery is a prognostic factor for thymic epithelial tumors, regardless of whether they are thymoma or thymic carcinoma. Complete resection can improve the survival rate, 27-29 which is consistent with our results. Additionally, a Japanese study 2 retrospectively analyzed 1320 patients with thymic epithelial tumors and revealed that debulking surgery is valuable for invasive thymoma, so for invasive thymoma, even if it cannot be completely removed, surgeons still need to remove as much tumor tissue as possible.…”

Thymic tumours and their special features

“…The assessment of resectability is mostly based on the surgeon expertise, but may be complex, even if the 8th TNM staging allows a better definition of resectable anatomical structures (stage IIIA). Ultimately, stage IV disease does not mean that the tumour is not amenable to complete surgical resection, especially in the setting of pleural implants [19,20]. Multidisciplinary tumour board is then highly valuable at any stage of the disease.…”

Spatial Distribution Patterns of Pleural Dissemination in Patients with Thymoma and Survival Analysis

“…Several retrospective analyses have shown that surgery is an effective treatment for pleural metastases from thymoma (simultaneous pleural metastases and heterochronic pleural metastases) and can improve patient survival. [7][8][9] Local radiotherapy for pleural metastases has also achieved good local control. [10][11][12] The combined modality of surgery, chemotherapy, and radiotherapy has been shown to improve the survival of patients with pleural metastases from thymoma.…”