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

BACKGROUND AND OBJECTIVE: To evaluate the role of preoperative induction therapy on prognosis of local-ly advanced thymic malignancies. METHODS: Between 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 directly afer 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 e?ect 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 patients (25%) were downstaged afer induction. Signifcantly more thymomas were downstaged than thymic carcinomas (38.7% vs 13.9%, P=0.02). Tumors downstaged afer induction had signifcantly 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 afer induction (93.8%) was similar to those in the DS group (85.2%, P=0.438), both signifcantly higher than those not downstaged afer induction (35.6%, P < 0.001). CONCLUSION: 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 patients (25%) were downstaged afer induction. Signifcantly more thymomas were downstaged than thymic carcinomas (38.7% vs 13.9%, P=0.02). Tumors downstaged afer induction had signifcantly 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 afer induction (93.8%) was similar to those in the DS group (85.2%, P=0.438), both signifcantly higher than those not downstaged afer induction (35.6%, P < 0.001).