ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Outcomes of thymoma after multimodal therapy and determinants of survival: A 16-year experience of a tertiary cancer center
Naziye Ak1, Alper Toker2, Murat Kara2, Berker Özkan2, Melike Ülker2, Erkan Kaba3, Gülçin Yeğen4, Şule Karaman5, Nergiz Dağoğlu5, Esra Kaytan Sağlam5, Ethem Nezih Oral5, Ahmet Kızır5, Soley Bayraktar6, Rian Dişçi7, Ferhat Ferhatoğlu1, Esra Aydın1, Sezai Vatansever1, Yeşim Eralp1, Adnan Aydıner1
1Department of Medical Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
2Department of Thoracic Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
3Department of Thoracic Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
4Department of Pathology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
5Department of Radiation Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
6Department of Medical Oncology, Biruni University School of Medicine, Istanbul, Turkey
7Department of Biostatistical Science, Beykent University, Istanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2021.20529
Background: In this study, we aimed to evaluate the factors that contribute to survival outcomes in patients with thymoma treated with multimodal approaches.

Methods: A total of 203 patients (105 males, 98 females; median age: 49 years; range, 17 to 77 years) with Masaoka-Koga Stage II-IV thymoma between January 2002 and December 2018 were retrospectively analyzed. Data including diagnosis of myasthenia gravis, diagnosis of diabetes mellitus, disease stage, histological type of tumor, capsule invasion and surgical margin status, lymphadenectomy, adjuvant radiotherapy or chemotherapy, time from surgery to the first day of adjuvant treatment, length of hospital stay, and overall and disease-free survival rates were recorded.

Results: Of the patients, 91 had Stage II, 67 had Stage III, and 45 had Stage IV disease. A total of 123 patients (61%) had myasthenia gravis. Seventy-six patients received adjuvant radiotherapy and 48 patients received either neoadjuvant (n=35) or adjuvant (n=25) chemotherapy. Higher disease stage, presence of R1 resection, and treatment with chemotherapy were significant factors for decreased disease-free survival time. Older age, higher disease stage, longer postoperative hospital stay, chemotherapy, and disease recurrence were effective contributors to decreased overall survival time. Adjuvant radiotherapy had a statistically significant positive effect on overall survival only in patients with completely resected Stage IV disease (five-year overall survival: 94.7% vs. 79.1%, respectively; p=0.015). In the multivariate analysis, older age (hazard ratio: 4.26), higher disease stage (hazard ratio: 2.95), and longer hospitalization time (hazard ratio: 3.81) were significant prognostic factors for overall survival. Patients with local recurrence who underwent complete resection had a survival time comparable to non-recurrent patients (p=0.753).

Conclusion: For patients with thymoma, higher disease stage, age ?50 years, longer hospitalization, and need for chemotherapy are associated with worse survival rates. Adjuvant chemotherapy has a positive impact on Stage IV disease. Resection of recurrent lesions has a valuable impact on survival.

Keywords : Aggressive surgery, chemotherapy, Masaoka-Koga Staging, radiotherapy, survival, thymoma
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