Pretreatment Biopsy for Histological Diagnosis and Induction Therapy in Thymic Tumors
10.3779/j.issn.1009-3419.2016.07.05
- VernacularTitle:术前病理学诊断在胸腺肿瘤诊疗中的应用
- Author:
YUE JIE
1
;
GU ZHITAO
;
YU ZHENTAO
;
ZHANG HONGDIAN
;
MA ZHAO
;
LIU YUAN
;
FANG WENTAO
Author Information
1. 天津医科大学附属肿瘤医院食管癌中心
- Keywords:
Thymoma;
Histology;
Surgery;
Prognosis;
Biopsy
- From:
Chinese Journal of Lung Cancer
2016;19(7):437-444
- CountryChina
- Language:Chinese
-
Abstract:
Background and objectiveThe aim of this study is to investigate the value of pretreatment biopsy for histological diagnosis and induction therapies in the management of locally advanced thymic malignancies.MethodsThe clinical pathological data of patients with thymic tumors in the Chinese Alliance for Research in Thymomas (ChART) who underwent biopsy before treatment from 1994 to December 2012 were retrospectively reviewed. The application trend of preoperative histological diagnosis and its inlfuence on treatment outcome were analyzed.Results Of 1,902 cases of thymic tumors, 336 (17.1%) had undergone biopsy for histological diagnosis before therapeutic decision was decided. In recent years, percentage of pretreatment histological diagnosis signiifcantly increased in the later ten years than the former during the study period (P=0.008). There was also a signiifcant increase in thoracoscopy/mediastinoscopy/endobronchial ultrasound (E-BUS) biopsy as compared to open biopsy (P=0.029). Survival in Patients with preoperative biopsy for histology had signiifcantly higher stage lesions (P<0.001) and higher grade malignancy (P<0.001), thus a significantly lower complete resection rate (P<0.001) and therefore a significantly worse survival than those without preoperative biopsy (P=0.001). In the biopsied 336 patients, those who received upfront surgery had signiifcantly better survival than those received surgery atfer induction therapy (P=0.001). In stage III and IVa diseases, the R0 resection rate atfer induction therapies increased signiifcantly as com-pared to the surgery upfront cases (65.5%vs 46.2%,P=0.025). Tumors downstaged atfer induction had similar outcomes as those having upfront surgery (92.3%vs 84.2%,P=0.51). However, tumors not downstaged by induction had signiifcantly worse prognosis than those downstaged (P=0.004), and fared even worse than those having deifnitive chemoradiation without sur-gery (37.2%vs 62.4%,P=0.216).ConclusionIt is crucial to get histological diagnosis for thymoma before surgery or adjuvant
treatment and minimally invasive biopsy should be undertaken. Although in our study we could not ifnd the beneift of induc-tion chemotherapy before surgery in survival and recurrence rate, it could increase the R0 resection rate compared with direct surgery in late stage (III and IVa).
