| Background and purposeThymic carcinoma is a kind of thymic epithelial tumor with low incidence and rare clinical features.The occurrence and development of thymic cancer is occult and often diagnosed in the advanced stage.Clinically,there is controversy about the treatment of advanced thymic cancer.Most of the published literature in the medical about the survival of thymic cancer are small-sample retrospective analyses from single institutions,which are less convincing.In this study,we retrospectively analyzed the clinical data of 40patients with locally advanced thymic carcinoma who underwent surgery from January2013 to January 2017,and conducted long-term follow-up to explore the risk factors for postoperative survival in patients with advanced thymic carcinoma.This study aims to further explore the prognostic factors of patients with thymic cancer,and provide some reference for clinical treatment.MethodsA retrospective collection of data from patients who underwent thymoma resection from January 2013 to January 2017 in the Department of Thoracic Surgery,Affiliated Hospital of Qingdao University.All patients underwent thymic cancer surgery with clear pathological diagnosis and accurate staging.Through telephone follow-up and outpatient follow-up,the collected clinical data included:gender,age,lactate dehydrogenase(LDH),carcinoembryonic antigen(CEA),alkaline phosphatase(ALP)Tumor diameter,pathological malignancy,TNM staging and Masaoka-Koga staging,radiotherapy,chemotherapy,preoperative neoadjuvant therapy and surgical nature,surgical approach,etc.The Kaplan-Meier method was used to calculate the overall survival rate.The Log-rank test was used to compare the survival curves of each group.The Cox regression risk ratio model was used to analyze the prognostic risk factors.In some analyses,1:1orientation score matching was used.After analysis,the two groups of data were compared using theχ~2 test and the Fisher’s exact test.Data analysis was performed using SPSS 25.0.ResultsA total of 40 patients with stage III-IV thymic cancer were included in the analysis.The rate of loss of follow-up in this study was 5%(2/40).The median follow-up time was46 months(range,14-72 months)and the mean follow-up time was 45.15 months.The3-year OS was 71.6(95%CI 57.3-85.9%)and the 5-year OS was 67.6%(95%CI52.1-83.1%).The univariate analyses showed that serum LDH levels(≥240/<240 IU/L,P=0.009),tumor diameter(≥6/<6cm,P=0.031),pathological malignancy(lower malignancy/high malignancy,P=0.003),T staging/TNM staging/Masaoka staging(T3/T4,stage III/IV,P=0.006),radiotherapy(yes/no,P=0.011),whether neoadjuvant therapy(yes/no,P=0.031),surgical approach(thoracic surgery/medial approach to the sternum,P=0.009),and surgical properties(R0/non-R0,P<0.001)were risk factors for survival in patients with advanced thymic cancer.The multivariate analyses showed that serum LDH levels(≥240/<240 IU/L,HR=3.521,95%CI 1.820-15.119,P=0.045),pathological malignancy(highly malignant/low malignant,HR=0.166,95%CI 0.037-0.737,P=0.018),Masaoka stage(stage III/IV,HR=4.230,95%CI 1.990-18.072,P=0.032),surgical properties(R0/non-R0,HR=3.755,95%CI 1.880-16.020,P=0.031)were independent risk factors for the survival of patients with advanced thymic cancer.ConclusionsThe survival analysis of patients with advanced thymic carcinoma after surgery showed that the survival rate of different subgroups of Masaoka-Koga stage III-IV thymic carcinoma was significantly different.The multivariate analyses showed that lower serum LDH levels,low-grade malignant pathological types,lower Masaoka-Koga staging,and complete radical resection were independent prognostic factors for postoperative survival in patients with advanced thymic cancer.The univariate analyses showed that small tumor diameter,preoperative neoadjuvant therapy,postoperative adjuvant radiotherapy,and sternal median approach improved postoperative survival in patients with advanced thymic cancer.Therefore,further standardization of surgical indications for thymic cancer patients and postoperative adjuvant therapy is expected to fundamentally improve the prognosis of patients with thymic cancer. |
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