| Purpose Currently,surgery remains the main therapeutic modality of thymoma,but the management of unresectable thymoma is still unclear.This study aims to identify the impact of different therapeutic model on outcomes in unresectable Masaoka-Koga stage III-IV thymoma.Methods We retrospectively analyzed the database of the patients diagnosed with Masaoka-Koga stage III-IV thymoma in our hospital between January 1999 and July 2015.Patients met one of these criteria:1.Non-surgical treatment;2.Initially unresectable or resected difficultly;3.Not completely resected including palliative resection,biopsy or exploratory operation.There are 76 eligible patients,13 of them lost to follow-up,63 patients’ information is available for analysis.OS(Overall survival),DSS(Disease-Specific Survival)and PFS(Progression-Free Survival)were estimated by the Kaplan-Meier method.Outcomes for patients treated with different treatments were compared using the Log-Rank test.Multivariate analysis was performed with the Cox proportional hazards model to analyze factors predictive of the outcome.Results Among the 63 available patients,the median follow-up was 78.4(23.9-224.3)months,the median age was 45(23-78),26(41.3%)stage III patients,22(34.9%)stage IVa patients,15(23.8%)stage IVb patients.There are 8 patients received neoadjuvant therapy followed by surgery,8 patients received incomplete resection surgery followed by adjuvant therapy,9 patients received biopsy surgery followed by adjuvant therapy,38 patients received non-surgical treatment.The overall 5-year OS,DSS and PFS is 71.3%,72.5%and 55.3%.After neoadjuvant therapy,the PR rate was 87.5%,the R0 resection rate was 62.5%,the 5 and 10 year OS was 100.0%and 66.7%,the result was similar to incomplete resection group in OS(P=0.931),DSS(P=0.886)and PFS(P=0.171).The result of non-surgical group was similar to the biopsy group in OS(P=0.886),DSS(P=0.732)and PFS(P=0.903).While the result of incomplete resection group had significant difference with the biopsy group in OS(P=0.016)and DSS(P=0.016)but not in PFS(P=0.903).There was no significant difference among different therapy regimen of non-surgical treatment(P=0.061).The main failure pattern is regional recurrence,pleural not contiguous with thymus is the most common recurrence site(36.5%).Single factor analysis shows that Masaoka-Koga stage(P=0.003),surgery(P=0.012),.radiotherapy(P=0.019),radiotherapy duration(P=0.026),chemotherapy(P=0.020),response rate(P<0.001)and radiation pneumonia(P=0.038)are independent prognostic factors.Lower Masaoka-Koga stage and received surgical treatment have favorable prognosis.Received concurrent and sequential chemoradiation therapy,longer radiotherapy duration,SD/PD and radiation pneumonia have poor prognosis.Multiple-factor analysis shows that Masaoka-Koga stage(P=0.060),radiotherapy duration(P=0.015),and response rate(P=0.006)are prognostic factors.Conclusion Surgery(P=0.012)is independent prognostic factor for Masaoka-Koga stage III-IV thymoma,received surgical treatment has favorable prognosis,wider excision has better prognosis.The biopsy has no effect on the prognosis,and its result is similar to the non-surgical group.The result of neoadjuvant therapy group is similar to the result of incomplete resection group,which are better than biopsy and non-surgical group.For the unresectable locally advanced cases,neoadjuvant therapy followed by surgery is an optional regimen,or received radiotherapy with or without chemothepay.For the advanced cases,chemotherapy with radiotherapy is recommended. |
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