Surgical resection promising for disseminated thymoma
medwireNews: Patients with thymoma and pleural dissemination are good candidates for surgical resection, particularly if their disease has not metastasised or spread to the lymph nodes, indicate Japanese study results.
The findings show that while rates of complete surgical resection were not high in the 136-patient cohort, at 34%, it was associated with improved survival at 5 years post-surgery, as was having Masaoka stage IVA disease with 10 or fewer pleural nodules.
“The present data demonstrated that the prognosis of thymoma patients with stage IVA disease is not as dismal as expected”, write the study authors in The Annals of Thoracic Surgery.
The research team, led by Motoki Yano, from Nagoya City University Graduate School of Medical Science, also found that overall and disease-free survival were not significantly improved among stage IVA patients who received adjuvant chemo-, radio- or chemoradiotherapy, and suggest that future trials in this area are needed.
A total of 128 (94.1%) patients underwent resection and were followed up for a median of 4.4 years. The overall 5-year survival rate among the whole cohort was 83.5%, with patients with 10 or fewer pleural nodules and those who achieved macroscopically complete resection having better prognoses than those with more nodules and an incomplete resection.
Five-year survival among the 118 stage IVA patients without systemic metastasis or lymph node involvement was slightly better than for the whole cohort, at 86.7%. Similarly, more stage IVA patients who had 10 or fewer pleural nodules were alive 5 years postoperatively than their counterparts with 11 or more nodules, at 93.6% versus 82.3%, and more with complete resections were alive compared with those whose resections were incomplete, at 88.6% versus 84.5%.
Both of these associations were significant, unlike the results for the whole cohort, report Yano et al.
Conversely, the 18 Masaoka stage IVB patients had a 5-year survival rate of 67.8% and no clinicopathologic factors correlated with improved survival rates.
A number of stage IVA patients with no macroscopic residual disease underwent adjuvant chemotherapy (n=35), radiotherapy (n=53) or chemoradiotherapy (n=15). However, 5-year survival rates were not significantly different for those who underwent these therapies compared with those who did not, at a respective 89.1% and 85.9%, 83.3% and 90.0%, and 83.6% and 87.4%.
“A prospective, worldwide, randomized, controlled trial of chemotherapy or radiotherapy for advanced thymoma is eagerly awaited”, conclude Yano and co-workers.
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By Sarah Pritchard, medwireNews Reporter