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Comparative prognostic analysis of primary thymic adenocarcinoma and squamous cell carcinoma: a 20-year retrospective
Rui Han1, Chenran Guo2, Chang Zhan3
1Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China.
Background:
Primary thymic adenocarcinoma (PTAC) and primary thymic squamous cell carcinoma (PTSCC) are rare malignancies with unclear prognostic differences due to limited comparative studies. This study aimed to systematically analyze their clinicopathological features and survival outcomes in a Chinese cohort.
Methods:
In this retrospective cohort study, 70 patients (56 PTSCC, 14 PTAC) treated at Cancer Hospital Chinese Academy of Medical Sciences between [1999-2018] were analyzed. Clinicopathological data were collected, including Masaoka stage, treatment modalities, and resection status. Survival analysis used Kaplan-Meier curves and Cox regression. Propensity score matching (PSM) was applied for subgroup comparisons.
Results:
PTAC exhibited significantly worse overall survival (OS) than PTSCC [median survival time (MST): 1.29 vs. 5.51 years, P=0.002]. Multivariate analysis identified pathological subtype [PTAC vs. PTSCC, hazard ratio (HR) =0.078; 95% confidence interval (CI): 0.033-0.184; P<0.001] and advanced Masaoka stage as independent prognostic factors. Subgroup analysis revealed PTAC conferred higher mortality in advanced-stage (III/IV), large tumors (>5 cm), and symptomatic patients. R0 resection improved OS compared to R1/R2 (13.62 vs. 4.82 years, P=0.003). Exploratory analysis of neoadjuvant therapy (n=3) suggested potential survival benefits (4.82-5.88 vs. 1.77-3.32 years in matched controls).
Conclusions:
PTAC is more aggressive than PTSCC, particularly in advanced stages. Pathological subtype stratification is critical for prognostication and treatment optimization. These findings underscore the need for subtype-specific management strategies in thymic carcinomas.
