Clinical characteristics and outcomes for patients with thymic carcinoma: evaluation of Masaoka staging.
Clinical characteristics and outcomes for patients with thymic carcinoma: evaluation of Masaoka staging.
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DOI：
10.1097/jto.0000000000000363
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发表时间：
2014-12
期刊：
影响因子：
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通讯作者：
Riely GJ
中科院分区：
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作者：
Litvak AM;Woo K;Hayes S;Huang J;Rimner A;Sima CS;Moreira AL;Tsukazan M;Riely GJ
胸腺癌是一种罕见的癌症，关于预后的数据有限，特别是对于那些晚期疾病的患者。我们确定了1993年至2012年间诊断的胸腺癌患者。分析患者特征、无复发生存期（RFS）和总生存期（OS）。确定了121例胸腺癌患者。Masaoka分期越高，OS和RFS越差（I、II、III、IVa和IVb期的5年OS分别为100%、81%、51%、24%和17%，p<0.001; I/II、III和IV期的5年RFS分别为80%、28%和7%，p<0.001）。仅IVb期淋巴结（LN）疾病患者的5年OS优于远处转移患者（24% vs. 7%，p=0.025）。在61例IVb期疾病患者中，22/29例仅LN疾病患者（76%）接受了根治性切除术，3/32例远处转移患者（9%）接受了根治性切除术。22例LN患者采用综合治疗。3例（14%）患者在长期随访（范围：3.4+年至6.8+年）后仍无疾病。我们描述了一个大型系列的胸腺癌患者在北美的临床特征。Masaoka staging系统有效地演示了OS和RFS。与远处转移患者相比，IVb期仅LN疾病患者的OS显著更好，其中一部分患者通过多种方式治疗维持长期RFS。如果得到验证，这些数据将支持修订的分期系统，将IVb期疾病分为两组。
Thymic carcinomas are rare cancers with limited data regarding outcomes, particularly for those patients with advanced disease. We identified patients with thymic carcinomas diagnosed between 1993 and 2012. Patient characteristics, recurrence free survival (RFS), and overall survival (OS) were analyzed. One hundred twenty-one patients with thymic carcinomas were identified. Higher Masaoka stage was associated with worse OS and RFS (5-yr OS of 100%, 81%, 51%, 24%, and 17% for stage I, II, III, IVa and IVb respectively, p<0.001 and 5-yr RFS of 80%, 28%, and 7% for stage I/II, III, and IV respectively, p<0.001). Patients with stage IVb lymph node (LN) only disease had a better 5-year OS as compared to patients with distant metastasis (24% vs. 7%, p=0.025). Of the 61 patients with stage IVb disease, 22/29 patients (76%) with LN-only disease underwent curative intent resection vs. 3/32 patients (9%) with distant metastasis. Twenty-two patients with LN involvement were treated with multi-modality therapy. Three (14%) remain free of disease with long-term follow-up (range: 3.4+ years to 6.8+ years). We describe the clinical features of a large series of patients with thymic carcinoma in North America. The Masaoka staging system effectively prognosticated OS and RFS. Patients with stage IVb LN-only disease had significantly better OS as compared to patients with distant metastasis with a subset of patients sustaining long term RFS with multi-modality therapy. If validated, these data would support a revised staging system with sub-classification of stage IVb disease into two groups.