The Prognostic Value of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma: A Propensity-Matched Study Based on SEER Database

SIMPLE SUMMARY: Although surgery has been recognized as the cornerstone of treatment for patients with resectable thymic epithelial tumors, the role of postoperative radiotherapy remains controversial. We performed this SEER-based propensity-matched analysis to investigate the prognostic value of postoperative radiotherapy in thymoma and thymic carcinoma. The results showed that postoperative radiotherapy improved both overall survival and cancer-specific survival in patients with Masaoka-Koga stage IIB–IV thymoma. This study is the first to demonstrate the prognostic value of postoperative radiotherapy in stage IIB thymic carcinoma. This large, up-to-date population-based longitudinal study may provide guidance on the use of postoperative radiotherapy for a thymoma or thymic carcinoma. ABSTRACT: (1) Objectives: The effect of postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. This study aimed to investigate the prognostic value of PORT for thymoma and thymic carcinoma in a population-based registry. (2) Methods: This retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with thymoma and thymic carcinoma between 2010 and 2019. Propensity score matching was performed to adjust statistical influences between the PORT and non-PORT groups. (3) Results: A total of 2558 patients with thymoma (n = 2138) or thymic carcinoma (n = 420) were included. In the multivariate analysis, PORT was an independent prognostic factor for OS (overall survival; p < 0.001) and CSS (cancer-specific survival; p = 0.001) in thymoma and an independent prognostic factor for OS in thymic carcinoma (p = 0.018). Subgroup analyses revealed that PORT was beneficial to OS and CSS in patients with Masaoka-Koga stage IIB-IV thymoma (OS: IIB, p < 0.001; III-IV, p = 0.005; CSS: IIB, p = 0.015; III-IV, p = 0.002) and stage IIB thymic carcinoma (OS: p = 0.012; CSS: p = 0.029). (4) Conclusion: This propensity-matched analysis identified the prognostic value of PORT in thymoma and thymic carcinoma based on the SEER database. For patients with stage IIB-IV thymoma and stage IIB thymic carcinoma, PORT was associated with improved OS and CSS. A more positive attitude towards the use of PORT for nonlocalized thymoma and thymic carcinoma may be appropriate.