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Published on: December 29, 2014
Oncological Outcomes of Complete Versus Limited Thymectomy in Early Stage Thymic Epithelial Tumors: A Systematic
Riccardo Tajè1,2, Filippo Tommaso Gallina1, Gabriele Alessandrini1
1Department of Thoracic Surgery, IRCCS National Cancer Institute "Regina Elena," Rome, Italy.
Objectives:
To clarify the role of limited versus complete thymectomy in stage I thymic epithelial tumors (TETs) using standardized survival measures and predefined oncological outcomes.
Methods:
An individual patient data (IPD) meta-analysis of studies investigating complete versus limited thymectomy for stage I TETs was conducted. IPD was extracted from published Kaplan-Meier curves using the IPDfromKM method.Primary end point of the study was freedom from recurrence (FFR) in complete versus limited thymectomy. Secondary end points were time to progression (TTP), overall survival, recurrence rate in the overall population and stratified per Masaoka-Koga stage, and survival measures according to resection extension (thymomectomy alone versus hemi-thymectomy versus subtotal thymectomy).Hazard ratios and relative 95% confidence intervals (95% CIs) were estimated with Cox regression analyses. Odds ratio (OR) with 95% CI was used to derive categorical variables.
Results:
Overall, IPD from 2314 patients (1434 complete thymectomy and 880 limited thymectomy) from seven retrospective studies were retrieved.For FFR, IPD were extracted from three studies including 307 patients receiving complete thymectomy (n = 178) and limited thymectomy (n = 129). Median follow-up was 55.7 months (95% CI 52.3-59). The 10-year FFR for complete versus limited thymectomy was 90.2% versus 92.1%, respectively.No differences were found in TTP, overall survival, and recurrence rate in the two groups.In those patients presenting a Masaoka-Koga stage II disease, OR for recurrence favored complete than limited thymectomy (p = 0.02).Finally, in those receiving limited thymectomy, thymomectomy alone had the worst FFR.
Conclusion:
No evidence favored limited than complete thymectomy in early stage TET treatment according to standardized survival measures. However, in Masaoka-Koga stage II disease, complete thymectomy demonstrated lower recurrence rate. Finally, among patients receiving limited thymectomy, thymomectomy alone leads to worse prognosis.
