title: [Application of Postoperative Chemotherapy on Thymomas and Its Prognostic Effect].
abstract: BACKGROUND
  To study the role of postoperative chemotherapy and its prognostic effect in Masaoka-Koga stage III and IV thymic tumors.
  
  
  METHODS
  Between 1994 and 2012, 1,700 patients with thymic tumors who underwent surgery without neoajuvant therapy were enrolled for the study. Among them, 665 patients in Masaoka-Koga stage III and IV were further analyzed to evaluate the clinical value of postoperative chemotherapy. The Kaplan-Meier method was used to obtain the survival curve of the patients divided into different subgroups, and the Cox regression analysis was used to make multivariate analysis on the factors affecting prognosis. A Propensity-Matched Study was used to evaluate the clinical value of chemotherapy.
  
  
  RESULTS
  Two-hundred-twenty-one patients were treated with postoperative chemotherapy, while the rest 444 cases were not. The two groups showed significant differences (P<0.05) regarding the incidence of myasthenia gravis, World Health Organization (WHO) histological subtypes, pathological staging, resection status and the use of postoperative radiotherapy. WHO type C tumors, incomplete resection, and postoperative radiotherapy were significantly related to increased recurrence and worse survival (P<0.05). Five-year and 10-year disease free survivals (DFS) and recurrence rates in patients who underwent surgery followed by postoperative chemotherapy were 51% and 30%, 46% and 68%, comparing with 73% and 58%, 26% and 40% in patients who had no adjuvant chemotherapy after surgery (P=0.001, P=0.001, respectively). In propensity-matched study, 158 pairs of patients with or without postoperative chemotherapy (316 patients in total) were selected and compared accordingly. Similar 5-year survival rates were detected between the two groups (P=0.332).
  
  
  CONCLUSIONS
  Pathologically higher grade histology, incomplete resection, and postoperative radiotherapy were found to be associated with worse outcomes in advanced stage thymic tumors. At present, there is no evidence to show that postoperative chemotherapy may help improve prognosis in patients with Masaoka-Koga-Koga stage III and IV thymic tumors.
authors.affiliation: Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Ma
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Zhitao
authors.initials: Z
authors.lastname: Gu
authors.affiliation: Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
authors.forename: Yongtao
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China.
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.affiliation: Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Renquan
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China.
authors.forename: Ke-Neng
authors.initials: KN
authors.lastname: Chen
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China.
authors.forename: Hezhong
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China.
authors.forename: Yongyu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China.
authors.forename: Youbing
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Liewen
authors.initials: L
authors.lastname: Pang
authors.affiliation: Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China.
authors.forename: Zhentao
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.
authors.forename: Xinming
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China.
authors.forename: Yangchun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Fang
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013945:Thymoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents