title: [Preoperative Induction Therapy for Locally Advanced Thymic Tumors: A Retrospective Analysis Using the ChART Database].
abstract: BACKGROUND
  To evaluate the role of preoperative induction therapy on prognosis of locally advanced thymic malignancies.
  
  
  METHODS
  Between 1994 and 2012, patients received preoperative induction therapies (IT group) in the Chinese Alliance for Research in Thymomas (ChART) database, were compared with those having surgery directly after preoperative evaluation (DS group). All tumors receiving induction therapies were locally advanced (clinically stage III-IV) before treatment and those turned out to be in pathological stage I and II were considered downstaged by induction. Clinical pathological characteristics were retrospectively analyzed. To more accurately study the effect of induction therapies, stage IV patients were then excluded. Only stage I-III tumors in the IT group and stage III cases in the DS group were selected for further comparison in a subgroup analysis.
  
  
  RESULTS
  Only 68 (4%) out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals (OS) of 49.7% and 19.9%. Seventeen patients (25%) were downstaged after induction. Significantly more thymomas were downstaged than thymic carcinomas (38.7% vs 13.9%, P=0.02). Tumors downstaged after induction had significantly higher 5-year OS than those not downstaged (93.8% vs 35.6%, P=0.013). For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group (P<0.001), although R0 resection were similar (76.4% vs 73.3%, P=0.63). However, 5-year OS in tumors downstaged after induction (93.8%) was similar to those in the DS group (85.2%, P=0.438), both significantly higher than those not downstaged after induction (35.6%, P<0.001).
  
  
  CONCLUSIONS
  Only 68 (4%) out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals (OS) of 49.7% and 19.9%. Seventeen patients (25%) were downstaged after induction. Significantly more thymomas were downstaged than thymic carcinomas (38.7% vs 13.9%, P=0.02). Tumors downstaged after induction had significantly higher 5-year OS than those not downstaged (93.8% vs 35.6%, P=0.013). For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group (P<0.001), although R0 resection were similar (76.4% vs 73.3%, P=0.63). However, 5-year OS in tumors downstaged after induction (93.8%) was similar to those in the DS group (85.2%, P=0.438), both significantly higher than those not downstaged after induction (35.6%, P<0.001). .
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, 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, Affiliated Hospital of Qingdao University, Qingdao 266001, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
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, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Liejie
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, Sichuan Cancer Hospital, Chengdu 610041, China.
authors.forename: Yongtao
authors.initials: Y
authors.lastname: Han
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; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002681:China; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D012189:Retrospective Studies; 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