Neoadjuvant Glucocorticoids Facilitate Resection in Advanced B-Type Thymomas: A Propensity-Matched Analysis of...

Locally advanced B-type thymomas frequently present technical challenges for R0 resection. Given the limitations of conventional neoadjuvant therapies, this study investigated glucocorticoids (GCs) as a potential downstaging strategy to improve surgical feasibility.

A propensity score-matched analysis was conducted in patients with Masaoka-Koga stage III-IV B-type thymomas (2017-2024). The intervention cohort (GC + Surgery, n = 36) received oral prednisone acetate (0.6 mg/kg/d, maximum dose 50 mg/d for 2-4 weeks) followed by surgery, while matched controls (Surgery, n = 36) underwent immediate resection. Outcomes included surgical parameters (operative time, blood loss, R0 rates), perioperative complications, and survival.

Neoadjuvant GCs yielded an objective response rate of 64.8% (13.2% complete response, 51.6% partial response). The GC + Surgery cohort demonstrated reduced operative time (182.8 vs. 426.0 min; p < 0.001) and median blood loss (165 vs. 1285 mL; p < 0.001), along with increased utilization of VATS approaches (55.6% vs. 13.9%; p < 0.001). R0 resection rates were 97.2% versus 86.1% (p = 0.115), with no R2 resections observed in the GC group. Perioperative complication profiles appeared comparable between groups. At a median follow-up of 52 months, the GC + Surgery group showed higher 5-year progression-free survival (83.4% vs. 72.4%; p = 0.033), though overall survival differences did not reach statistical significance (94.1% vs. 85.9%; p = 0.272).

These findings suggest neoadjuvant glucocorticoids may enhance resectability in advanced B-type thymomas, potentially enabling less invasive procedures and improving intermediate-term disease control.