Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: a population based study

Abstract

// Dongliang Bian 1, * , Feng Zhou 1, * , Weiguang Yang 2 , Kaixuan Zhang 1, * , Linsong Chen 1 , Gening Jiang 1 , Peng Zhang 1 , Chunyan Wu 3 , Ke Fei 1 and Lei Zhang 1 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, P.R. China 2 School of Medicine, Tongji University, Shanghai 200092, P.R. China 3 Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, P.R. China * These authors contributed equally to this work Correspondence to: Ke Fei, email: fkyyfk@126.com Chunyan Wu, email: wuchunyan581@sina.com Lei Zhang, email: 13816121971@163.com Keywords: thymoma; tumor size; surgery; postoperative radiotherapy; chemotherapy Received: September 18, 2017      Accepted: November 16, 2017      Published: January 23, 2018 ABSTRACT Background: Thymoma, though a rare tumor disease, is the most common tumor of the anterior mediastinum. However, tumor size, as a critical factor, has been underestimated. Results: Age, advanced tumor stage, and preoperative radiotherapy were poor prognostic factors of overall survival (OS) and disease specific survival (DSS) ( P < 0.05 for all). Besides, tumor size was significantly related to survival. The larger tumor size indicated the less OS and DSS ( P < 0.001 for all). Multivariate analysis revealed elder age, advanced stage, larger size were independent adverse predictors for survival ( P < 0.05 for all). Logistic analysis revealed larger tumor size had greater rate of metastasis ( P < 0.001). In the group with tumors smaller than 90mm, chemotherapy was a negative predictive factor of DSS ( P < 0.05 for all), and it significantly decreased OS especially with tumor sizes between 50 and 90 mm ( P < 0.001). Materials and Methods: A total of 1,272 thymoma patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Survival based on thymoma size and other characteristics of tumors were analyzed by univariate and multivariate analysis. Correlation between thymoma size and thymoma metastatic status was contributed by logistic regression analysis. The efficiency of adjuvant therapy was analysis by stratification analysis. Conclusions: Thymoma size could predict postoperative survival and guide chemotherapeutic regimens of patients. Larger tumor size indicated worse survival and higher metastatic rate. If thymoma is smaller than 90mm, traditional chemotherapy should be prohibited. While chemotherapy could be performed moderately when thymoma larger than 90 mm.