ChART回顾性数据库局部进展期胸腺瘤的术前诱导治疗效果分析

Preoperative Induction Therapy for Locally Advanced Thymic Tumors:A Retrospective Analysis Using the ChART Database

背景与目的探讨术前诱导治疗在胸腺瘤中的应用及其对局部进展期胸腺瘤预后的影响。方法收集中国胸腺肿瘤协作组(Chinese Alliance of Research for Thymomas,ChART)1994年1月1日至2012年12月31日回顾性数据库中局部进展期胸腺瘤(Masaoka-Koga分期为Ⅲ期-IVa期)病例。分为诱导治疗组和直接手术组,对比分析两组的R0切除率、5年复发率及5年生存率等指标。诱导治疗组术后分期为Masaoka-Koga Ⅰ期-Ⅱ期的病例视为诱导治疗后降期。为更加精确评估诱导治疗效果,在剔除术后Ⅳ期病例的基础上,再次将诱导治疗组术后Masaoka-Koga Ⅰ期-Ⅲ期的病例与直接手术组Masaoka-Koga Ⅲ期的病例进行对比分析。结果 ChART回顾性数据库1,713例有效病例中,局部进展期胸腺瘤706例,仅68例(4%)作了术前诱导治疗,R0切除率为67.6%,5年复发率为44.9%,5年与10年生存率分别为49.7%和19.9%。其中17例诱导治疗后达到降期,降期亚组中胸腺瘤的比例高于胸腺癌(38.7%vs 13.9%,P=0.02);与未降期亚组相比,降期亚组获得更高的5年生存率(93.8%vs 35.6%,P=0.013)。剔除术后Ⅳ期的病例后,直接手术组和诱导治疗组R0切除率接近(76.4%vs73.3%,P=0.63),但5年生存率差异明显(85.2%vs 68.1%,P<0.001),对于降期亚组,5年生存率优于直接手术组(93.8%vs 85.2%,P=0.438),未降期亚组5年生存率仅35.6%,明显差于降期亚组和直接手术组(P<0.001)。结论术前诱导治疗目前尚未在局部进展期胸腺瘤中广泛应用,但ChART的回顾性数据研究显示通过有效的术前诱导治疗可以使难以彻底切除的病例降期后增加R0切除的机会,从而延长生存,特别是胸腺瘤的病例。这一初步结果将有助于未来的研究。

Background and objectiveTo evaluate the role of preoperative induction therapy on prognosis of local-ly advanced thymic malignancies.MethodsBetween 1994 and 2012, patients received preoperative induction therapies （IT group） in the Chinese Alliance for Research in Thymomas （ChART） database, were compared with those having surgery di-rectly atfer preoperative evaluation （DS group）. All tumors receiving induction therapies were locally advanced （clinically stage III-IV） before treatment and those turned out to be in pathological stage I and II were considered downstaged by induction. Clinical pathological characteristics were retrospectively analyzed. To more accurately study the effect of induction therapies, stage IV patients were then excluded. Only stage I-III tumors in the IT group and stage III cases in the DS group were selected for further comparison in a subgroup analysis.Results Only 68 （4%） out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals （OS） of 49.7% and 19.9%. Seventeen pa-tients （25%） were downstaged atfer induction. Signiifcantly more thymomas were downstaged than thymic carcinomas （38.7%vs 13.9%,P=0.02）. Tumors downstaged atfer induction had signiifcantly higher 5-year OS than those not downstaged （93.8%vs 35.6%,P=0.013）. For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group （P〈0.001）, although R0 resection were similar （76.4%vs 73.3%,P=0.63）. However, 5-year OS in tumors downstaged atfer induction （93.8%） was similar to those in the DS group （85.2%,P=0.438）, both signiifcantly higher than those not downstaged atfer induction （35.6%,P〈0.001）.ConclusionOnly 68 （4%） out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals （OS） of 49.7% and 19.9%. Seventeen patients （25%） were downstaged atfer induction. Signiifcantly more thymomas were downstaged than thy-mic carcinomas （38.7%vs 13.9%,P=0.02）. Tumors downstaged atfer induction had signiifcantly higher 5-year OS than those not downstaged （93.8%vs 35.6%,P=0.013）. For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group （P〈0.001）, although R0 resection were similar （76.4%vs 73.3%,P=0.63）. However, 5-year OS in tumors downstaged atfer induction （93.8%） was similar to those in the DS group （85.2%,P=0.438）, both signiifcantly higher than those not downstaged atfer induction （35.6%,P〈0.001）.