TY - JOUR
T1 - A Recurrence Predictive Model for Thymic Tumors and Its Implication for Postoperative Management
T2 - a Chinese Alliance for Research in Thymomas Database Study
AU - AME Thoracic Surgery Cooperative Group
AU - Liu, Hui
AU - Gu, Zhi Tao
AU - Qiu, Bo
AU - Detterbeck, Frank C.
AU - Roden, Anja C.
AU - Ruffini, Enrico
AU - Okumura, Meinoshin
AU - Girard, Nicolas
AU - Xiang, Yang Wei
AU - Liu, Yuan
AU - Du, Zhi Cheng
AU - Hao, Yuan Tao
AU - Fu, Jian Hua
AU - Zhang, Peng
AU - Pang, Lie Wen
AU - Chen, Ke Neng
AU - Wang, Yun
AU - Yu, Zhen Tao
AU - Mao, Teng
AU - Fang, Wen Tao
N1 - Publisher Copyright:
© 2019 International Association for the Study of Lung Cancer
PY - 2020/3
Y1 - 2020/3
N2 - Objective: Our aim was to investigate appropriate postoperative management based on the risk of disease recurrence in thymic epithelial tumors after complete resection. Methods: The Chinese Alliance for Research in Thymomas retrospective database was reviewed. Patients having stage I to IIIa tumors without pretreatment and with complete resection were included. Clinicopathologic variables with statistical significance in the multivariate Cox regression were incorporated into a nomogram for building a recurrence predictive model. Results: A total of 907 cases, including 802 thymomas, 88 thymic carcinomas, and 17 neuroendocrine tumors, were retrieved between 1994 and 2012. With a median follow-up of 52 months, the 10-year overall survival rate was 89.5%. Distant and/or locoregional recurrences were noted in 53 patients (5.8%). The nomogram model revealed histologic type and T stage as independent predictive factors for recurrence, with a bootstrap-corrected C-index of 0.86. On the basis of this model, patients with T1 thymomas or T2 or T3 type A, AB, or B1 thymomas had a significantly lower incidence of recurrence (low-risk group) than those with T2 or T3 type B2 or B3 thymomas and all thymic carcinomas and neuroendocrine tumors (high-risk group) (2.7% versus 20.1% [p < 0.001]). In the high-risk group, more than half of the recurrences (55.2% [16 of 29]) were seen within the first 3 postoperative years, whereas all recurrences but one were recorded within 6 years after surgery. Recurrence occurred quite evenly over 10 postoperative years in the low-risk group. Conclusions: A 6-year active surveillance should be considered in high-risk patients regardless of adjuvant therapy. For low-risk patients, annual follow-up may be sufficient. Studies examining postoperative adjuvant therapies would be plausible in high-risk patients.
AB - Objective: Our aim was to investigate appropriate postoperative management based on the risk of disease recurrence in thymic epithelial tumors after complete resection. Methods: The Chinese Alliance for Research in Thymomas retrospective database was reviewed. Patients having stage I to IIIa tumors without pretreatment and with complete resection were included. Clinicopathologic variables with statistical significance in the multivariate Cox regression were incorporated into a nomogram for building a recurrence predictive model. Results: A total of 907 cases, including 802 thymomas, 88 thymic carcinomas, and 17 neuroendocrine tumors, were retrieved between 1994 and 2012. With a median follow-up of 52 months, the 10-year overall survival rate was 89.5%. Distant and/or locoregional recurrences were noted in 53 patients (5.8%). The nomogram model revealed histologic type and T stage as independent predictive factors for recurrence, with a bootstrap-corrected C-index of 0.86. On the basis of this model, patients with T1 thymomas or T2 or T3 type A, AB, or B1 thymomas had a significantly lower incidence of recurrence (low-risk group) than those with T2 or T3 type B2 or B3 thymomas and all thymic carcinomas and neuroendocrine tumors (high-risk group) (2.7% versus 20.1% [p < 0.001]). In the high-risk group, more than half of the recurrences (55.2% [16 of 29]) were seen within the first 3 postoperative years, whereas all recurrences but one were recorded within 6 years after surgery. Recurrence occurred quite evenly over 10 postoperative years in the low-risk group. Conclusions: A 6-year active surveillance should be considered in high-risk patients regardless of adjuvant therapy. For low-risk patients, annual follow-up may be sufficient. Studies examining postoperative adjuvant therapies would be plausible in high-risk patients.
KW - Postoperative management
KW - Postoperative surveillance
KW - Recurrence predictive model
KW - Thymic epithelial tumors
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U2 - 10.1016/j.jtho.2019.10.018
DO - 10.1016/j.jtho.2019.10.018
M3 - Article
C2 - 31726106
AN - SCOPUS:85077986954
SN - 1556-0864
VL - 15
SP - 448
EP - 456
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 3
ER -