title: Multimodality therapy for locally advanced thymomas: A propensity score-matched cohort study from the European Society of Thoracic Surgeons Database.
abstract: OBJECTIVE
  This study investigated the prognostic impact of multimodality therapies in locally advanced thymomas.
  
  
  METHODS
  From January 1990 to January 2010, clinicopathological, surgical, and oncological features were retrospectively reviewed in a cohort of 370 Masaoka-Koga stage III thymomas (World Health Organization classification A to B3) collected from 37 institutions. A multivariate Cox proportional hazard model was created to identify independent predictors of overall, cancer-specific (CSS), and relapse-free survivals. Furthermore, a propensity score-matching analysis for exposure to adjuvant (AT) therapy was generated.
  
  
  RESULTS
  Induction therapy and AT were administered to 88 (24.9%) and 245 (69.4%) patients, respectively. Overall, 5- and 10-year overall survival, CSS, and relapse-free survivals were 82.8%, 88.4%, and 80.0%, and 68.9%, 83.3%, and 71.5%, respectively. At multivariable analysis performed in the matched cohort, AT was confirmed as the strongest predictive factor for overall survival (hazard ratio, 2.83; 95% confidence interval, 0.88-9.12; P = .08) and CSS (hazard ratio, 4.70; 95% confidence interval, 1.00-22.2; P = .05). Pathologic T classification (according to International Association for the Study of Lung Cancer and International Thymic Malignancy Interest Group TNM staging proposal) was an independent factor for relapse (hazard ratio, 8.69; 95% confidence interval, 1.08-70.04; P = .04). When CSS was adjusted for T classification, AT confirmed a significant survival advantage for pT3 tumors (P = .04). On the other hand, for thymomas larger than 5 cm, stratifying for tumor size and AT did not affect 5-year CSS (P = .17).
  
  
  CONCLUSIONS
  Our results indicate that AT is beneficial for locally advanced thymomas, mainly for specific pathologic features (pT3 or tumor size smaller than 5 cm). Further larger studies are needed to confirm these data.
authors.affiliation: Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy. Electronic address: gio.leuzzi@yahoo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leuzzi
authors.affiliation: Department of Thoracic Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Scientific Direction, Regina Elena National Cancer Institute-IFO, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, Yale University, New Haven, Conn.
authors.forename: Frank
authors.initials: F
authors.lastname: Detterbeck
authors.affiliation: Department of Thoracic Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: Department of Thoracic Surgery, University of Rome SAPIENZA, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.affiliation: Department of Thoracic Surgery, Aix-Marseille University, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Facciolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002648:Child; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009656:North America; D057216:Propensity Score; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013934:Thymectomy / Q000009:adverse effects / Q000401:mortality; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: Masaoka; TNM; adjuvant therapy; advanced thymoma; induction therapy; multimodality treatment; stage III; thymic tumors; thymoma