Outcomes of thymoma after multimodal therapy and determinants of survival:A 16-year experience of a tertiary cancer center

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Background: In this study, we aimed to evaluate the factors that contribute tosurvival outcomes in patients with thymoma treated with multimodal approaches. Methods: A total of 203 patients (105 males, 98 females; median age: 49 years;range, 17 to 77 years) with Masaoka-Koga Stage II-IV thymoma betweenJanuary 2002 and December 2018 were retrospectively analyzed. Data includingdiagnosis of myasthenia gravis, diagnosis of diabetes mellitus, disease stage,histological type of tumor, capsule invasion and surgical margin status,lymphadenectomy, adjuvant radiotherapy or chemotherapy, time from surgeryto the first day of adjuvant treatment, length of hospital stay, and overall anddisease-free survival rates were recorded. Results: Of the patients, 91 had Stage II, 67 had Stage III, and 45 had Stage IVdisease. A total of 123 patients (61%) had myasthenia gravis. Seventy-six patientsreceived adjuvant radiotherapy and 48 patients received either neoadjuvant(n=35) or adjuvant (n=25) chemotherapy. Higher disease stage, presence ofR1 resection, and treatment with chemotherapy were significant factors fordecreased disease-free survival time. Older age, higher disease stage, longerpostoperative hospital stay, chemotherapy, and disease recurrence were effectivecontributors to decreased overall survival time. Adjuvant radiotherapy had astatistically significant positive effect on overall survival only in patients withcompletely resected Stage IV disease (five-year overall survival: 94.7% vs. 79.1%,respectively; p=0.015). In the multivariate analysis, older age (hazard ratio: 4.26),higher disease stage (hazard ratio: 2.95), and longer hospitalization time (hazardratio: 3.81) were significant prognostic factors for overall survival. Patientswith local recurrence who underwent complete resection had a survival timecomparable to non-recurrent patients (p=0.753). Conclusion: For patients with thymoma, higher disease stage, age ?50 years,longer hospitalization, and need for chemotherapy are associated with worsesurvival rates. Adjuvant chemotherapy has a positive impact on Stage IV disease.Resection of recurrent lesions has a valuable impact on survival.


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