Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis

Abstract

Background: Optimal recurrent thymoma management remains arguable because of limited patient numbers, and relatively late and variable recurrence patterns. Given the absence of high-quality evidence and relatively small study cohorts, we performed a quantitative meta-analysis to determine the outcome of surgical and non-surgical approaches assessing the five-year overall survival (5y overall survival (OS)) in patients with recurrent thymoma. Methods: We performed a comprehensive literature search and analysis according to PRISMA guidelines of studies published from 1 January 1980 until 18 June 2020 from PubMed/MEDLINE, EMBASE, and Scopus. We included studies with the cohorts’ superior to 30 patients describing recurrent thymoma treatment, comparing surgical and non-surgical approaches reporting survival data. Results: Literature search revealed 3017 articles. Nine studies met all inclusion criteria and were selected for the meta-analysis. The recurrences were local/regional in 73–98% of cases and multiple in 49–72%. After treatment, 5y OS ranged from 48–77% and 10y OS from 37–51%. The quantitative meta-analysis showed a better outcome comparing surgical vs other treatments. Two studies showed statistically significant risk differences in the 5y OS favoring complete resection. After pooling results of seven studies using the random model, the combined 5y OS risk difference was 0.39, with lower and upper limits of 0.16 and 0.62, respectively (p = 0.001), and a moderate heterogeneity among studies (p = 0.098, I2 = 43.9%). Definitive conclusions could not be drawn regarding the prognostic impact of myasthenia gravis, histology, and patterns of relapse reported in literature. Conclusions: Surgical treatment after thymoma recurrence is associated with a significant better 5y OS; therefore, surgical resection should be preferred in all technically feasible cases.

Updated outcomes of surgical treatment for recurrent thymic tumour: a report from the Japanese nationwide database

“…Regarding meta-analyses, Hamaji et al analysed 11 studies and reported favourable 5-year overall survival of re-resected cases after thymoma recurrence [ 19 ]. Chiappetta et al analysed 7 studies, including our initial report from JART, and concluded that re-resection was associated with better 5-year overall survival, which should be preferred [ 20 ]. In addition to re-resection, limited number of studies discuss the experiences and outcomes of hyperthermic intrathoracic chemotherapy for disseminated thymoma [ 21–24 ].…”

Erythroderma in a Patient With Thymoma-Associated Myasthenia Gravis

“…In this patient, the location of the recurrent thymoma posed a great surgical risk and reoperation was abandoned. 1 The IL-23/ Th17 pathway in myasthenia gravis relating to thymoma was active 2 ; therefore the patient was given a combination treatment of radiotherapy (total of 60 Gy in 28 fractioned doses) for the recurrent thymoma and subcutaneous injection of ixekizumab. After 2 months of presentation, the patient's skin symptoms were greatly improved.…”

Thymoma and Thymic Carcinoma: Surgical Resection and Multidisciplinary Treatment

“…The definition of advanced thymoma is based on pathological specimens presenting infiltration of thoracic structures, such as mediastinal pleura, pericardium, phrenic nerve, lungs, large vessels, etc.) or pleural-pericardial spread [ 22 ]. The subxiphoid VATS approach may also be appropriate for treating some locally advanced thymic tumors [ 48 ].…”

“…Surgical resection is the mainstay of the treatment for thymoma and thymic carcinoma, while a multimodal approach is proved to be useful for many patients [ 7 , 20 , 21 , 22 ]. The ability to perform complete surgical resection to treat thymic carcinoma and thymoma is an important factor in recurrence and survival after surgery [ 23 , 24 ].…”