Author of

• 10897

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  P1.15 - Poster Session 1 - Thymoma (ID 189)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Thymoma & Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10905

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    P1.15-008 - A multivariate analysis of factors predicting survival in 70 patients with thymic carcinoma: implications for treatment strategy (ID 2941)

    09:30 - 09:30  |  Author(s): S. Murakami
    • Abstract

    Background
    BACKGROUND: Thymic carcinomas are considered to be more aggressive than thymomas and carry a worse prognosis. Although a multimodality treatment is made in many cases as for thymic carcinomas, optimal therapeutic strategy still remains controversial especially in thymic carcinomas having poor prognostic factors. In the present study, we attempted to clarify the prognostic factors based on the survival to establish suitable treatment strategy.

    Methods
    METHODS: We performed a single-institution retrospective cohort study. Between June 1987 and October 2012, 70 patients were eventually given a diagnosis of thymic carcinoma. Data included patient demographics, stage, first treatment (e.g. chemotherapy (CT), chemoradiotherapy (CRT), and surgery (S)), pathologic findings, and outcomes. For the univariate analysis, we constructed survival curves using the Kaplan-Meier method and compared survival between groups using log-rank tests. Multivariate analysis was performed by constructing a Cox proportional hazards model using the significant factors from the univariate analysis. The analyses were performed with the Stat view v5.0 statistical software program.

    Results
    RESULTS: The overall 2- and 5-year survival rate was 61.9% and 36.4%, respectively ; mean and median observation time was 30M and 24M, respectively. Two-year survival rates in patients treated with CT, CRT, and S group were 38.7, 52.4, and 80.5%, and 5-year survival rates in patients treated with CT, CRT, and S group were 17.4, 21.0, and 55% for all patients. S group showed significantly better prognosis than the others in overall stage (p=0.0006). Patients undergoing S, however, had similar survival compared with undergoing CT or CRT alone in stage IV a,b subset; CT vs. CRT (p=0.6598), CT vs. S (p=0.1159), CRTvs.S (p=0.3030). Univariate analysis among patients underwent surgery revealed two significant prognostic factors (P <.05): stage by the Masaoka system and resection status. Based on the result, 5-year survival rate in each factor were compared statistically by Kaplan–Meier’s method; Masaoka stage II,III vs. IVa,b =82.5% vs.35.3% (p=0.0182), complete resection vs. incomplete resection=76.4% vs.34.1% (p=0.0173). Multivariate analysis revealed no statistically significant independent prognostic factor, probably due to confounding. The hazard ratio for death for being Masaoka stage II,III was 0.463【95%CI 0.082-2.623】(p=0.3843), for being complete resection was 0.552【95%0.110-2.762】(p=0.4701). According to the subset analysis on CT group, response to first-line chemotherapy was an independent prognostic factor.

    Conclusion
    CONCLUSIONS: Our analyses indicated that stage by the Masaoka system and resection status would have the prognostic impact. If complete excision is possible at earlier than Masaoka stage III, it may be cured completely. The role of debulking surgery at stage IV a,b was negative. Patient selection, accurate staging, and choice of anticancer drug with a high response rate may be critical to optimizing outcomes.