National Comprehensive Cancer Network (NCCN) has updated and released the latest content of NCCN guidelines version 1. 2023 thymomas and thymic carcinomas (known as "guidelines"). The guideline sets standards for the diagnosis and treatment of thymoma and thymic carcinoma based on high quality clinical evidence and the latest advances in research. There have been some updates and revisions in the latest two versions of the guidelines, mainly focusing on the principles of radiotherapy, the principles of systematic therapy, multidisciplinary participation and the improvement of some footnotes, compared with the first version of the guidelines in 2022. In this paper, the contents of the new guideline will be interpreted in order to provide reference for the work of thymoma and thymic carcinoma in our country at the present stage.
Objective To systematically review the effectiveness of thoracoscopy surgery and thoracotomy for thymoma. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) and cohort studies about thoracoscopy surgery versus thoracotomy for thymoma from inception to April 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs and 8 cohort studies involving 1 093 patients were included. The results of meta-analysis showed that, compared with thoracotomy, the thoracoscopy surgery could shorten operative time (MD= –22.2, 95%CI –32.92 to –12.52, P < 0.000 01), duration of ICU stay (MD= –0.76, 95%CI –0.21 to –0.30, P < 0.000 01), duration of hospital stay (MD= –3.71, 95%CI –4.47 to –2.96, P < 0.000 01) and duration of pleural drainage (MD= –1.80, 95%CI –2.42 to –1.18, P < 0.000 01), reduce volume of intraoperative blood loss (MD= –43.27, 95%CI –50.94 to –35.60, P < 0.000 01), and decrease the incidence of postoperative complications (OR=0.19, 95%CI 0.11 to 0.34, P < 0.000 01), but there was no significant difference in recurrence rate between two groups (OR=0.81, 95%CI 0.31 to 2.11, P=0.67). Conclusions Current evidence shows that, compared with thoracotomy, the thoracoscopy surgery for thymoma has shorter operative time, duration of ICU stay, duration of hospital stay, and duration of pleural drainage, as well as less blood loss and postoperative complications. Due to the limited quality of included studies, more high-quality studies are needed to verify the above conclusion.
Objective To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%,P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.
Objective To compare the differences in clinicopathological features, molecular phenotypes, and prognosis between atypical type A thymoma (AAT) and classic type A thymoma (TAT), and to clarify the aggressive nature of AAT. Methods The data of AAT patients (AAT group) and classic TAT patients (TAT group) who underwent surgical resection for thymoma at West China Hospital of Sichuan University between January 2016 and November 2024 were retrospectively collected. Comparisons on the clinical data, histopathology, immunohistochemistry (CD20, Ki-67), GTF2I mutation status, and survival outcomes were performed between the two groups. Results A total of 53 patients were enrolled, including 22 in the AAT group and 31 in the TAT group. There was no significant difference in age, sex, or initial presenting symptoms between the two groups (P>0.05). Compared with the TAT group, the AAT group had larger tumors [(5.6±2.7) vs. (4.1±2.0) cm, P=0.043], a lower proportion of Masaoka stage Ⅰ (31.6% vs. 61.3%, P=0.041), and worse survival outcomes [progression-free survival: hazard ratio (HR)=2.87, 95% confidence interval (CI) (1.42, 5.81), P=0.004; overall survival: HR=1.96, 95%CI (1.02, 3.78), P=0.013]. Pathologically, the AAT group showed more mitotic figures (mean 6/2 mm2), and tumor necrosis was observed in 45.5% of cases. There was no statistically significant difference in the CD20 expression rate (20.0% vs. 41.9%), Ki-67 index [(11.0±6.0)% vs. (8.0±6.9)%], or GTF2I mutation rate (86.7% vs. 92.3%) between the two groups (P>0.05). Conclusions AAT is a subtype of TAT with distinct aggressive pathological features, including higher mitotic activity, a tendency for necrosis, and a greater propensity for recurrence and metastasis. Pathological diagnosis should integrate morphology and molecular testing to guide more aggressive treatment and follow-up strategies.
Objective To investigate the effects of inflammatory reaction of thymomas with myasthenia gravis (MG) treated by traditional thoracotomy and minimally invasive surgery. Methods A total of 40 thymomas patients (Mssaoka Ⅰ or Ⅱ) with myasthenia gravis from August 2014 to June 2015 were treated by traditional thoracotomy (n=20) or video-assisted thoracoscopic surgery (n=20). The serum levels of IL-6, IL-8, TNF-α, CRP and CORT were measured by enzyme-linked immunosorbent assay (ELISA) methods at before anesthesia (T1), after anesthesia (T2), 2 h after skin cut (T3), 24 h post-operation (T4), 48 h post-operation (T5) and 72 h post-operation (T6) respectively. Perioperative parameters were also reported. The statistics analysis was performed by SPSS 17.0 software. Results The serum levels of IL-6, IL-8, TNF-α, CRP and CORT had no significant difference between T1 and T2, T2 and T3 (allP value>0.05) in both groups. But the serum levels of these factors after operation were obviously higher than that of before operation, commonly the highest level was reached at T4 (allP value>0.01), and also was higher at T6 than that of before the operation (allP value<0.01), except the level of TNF-α recovered rapidly to the level of before operation (allP value>0.05) in the VATS group. The operation time, postoperative drainage tube indwelling time and incision healing time in the VATS were lower than that in the control group (allP value<0.05). Conclusion VATS could be widely applied in clinical practice with lowering operative trauma and reducing the degree of inflammatory reaction.
ObjectiveTo assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis.MethodsA total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed.ResultsThe amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%, respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). ConclusionWHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.
ObjectiveTo compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of thymoma through subxiphoid uniportal approach using double sternum retractors, and subxiphoid and subcostal arch approach. Methods We retrospectively analyzed the clinical data of the patients diagnosed with thymoma who underwent VATS thymectomy from June 2023 to June 2024 in West China Hospital. Patients were categorized based on the surgical approach into two groups: a subxiphoid uniportal VATS thymectomy (SUVT) group and a subxiphoid and subcostal arch VATS thymectomy (SASAT) group. Comparisons were made between the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage, thymoma size and location, and postoperative pain assessed using the visual analogue scale (VAS). ResultsThe SUVT group consisted of 20 patients, including 11 males and 9 females, with an average age of (51.5±14.3) years. The SASAT group comprised 40 patients, including 26 males and 14 females, with an average age of (50.0±13.0) years. Compared to the SASAT group, the SUVT group had significantly larger thymomas [ (5.9±2.7) cm vs. (4.2±2.1) cm, P=0.010] and a higher proportion of neoplasms located in the superior mediastinum (30.0% vs. 2.5%, P=0.007). Additionally, the VAS pain scores on postoperative days 3, 7, and 30 were significantly lower in the SUVT group compared to the SASAT group (P<0.05). There were no statistical differences between the two groups in demographic characteristics, operative time, intraoperative blood loss, duration and volume of postoperative drainage, length of postoperative hospital stay, or the VAS pain score on the first postoperative day. Conclusion SUVT using double sternum retractors significantly reduces postoperative pain and provides superior efficacy in the resection of larger thymomas or those situated in the superior mediastinum.
ObjectiveTo investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis. MethodsWe retrospectively analyzed the clinical and follow-up data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result:sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35(5-96) months. During follow-up period, 12 patients (19%) achieved complete remission, 39 patients (62%) achieved partial remission, 7 patients (11%) kept stable, 5 patients (8%) deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease (P=0.027), history of critical illness on myasthenia gravis (P=0.035) and Osserman classification (P=0.018) were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease (P=0.001) and Osserman classification (P=0.012) were the independent risk factors for incomplete remission. ConclusionExtended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at ⅡB, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.
ObjectiveTo systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. ResultsA total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. ConclusionPORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.