微创胸腺切除术可用于局部晚期胸腺恶性肿瘤：一项倾向评分匹配分析的真实世界研究

SCI 25 January 2022

Minimally Invasive Thymectomy Could Be Attempted for Locally Advanced Thymic Malignancies: A Real-World Study with Propensity-score Matched Analysis

(Journal of thoracic oncology, IF: 20.121)

Gu Z, Hao X, Liu Y, Xu N, Zhang X, Li B, Mao T, Fang W. Minimally Invasive Thymectomy Could Be Attempted for Locally Advanced Thymic Malignancies: A Real-World Study with Propensity-score Matched Analysis. J Thorac Oncol. 2023 Jan 12:S1556-0864(22)01989-X. doi: 10.1016/j.jtho.2022.12.013. Epub ahead of print. PMID: 36642159.

Corresponding author:  Professor Wentao Fang ，Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 Huaihai Road West, Shanghai 200030, China ，Email: vwtfang@hotmail.com

Introduction 简介  

Increasing evidence supports minimally invasive thymectomy (MIT) for early-stage thymic malignancies over open median sternotomy thymectomy (MST). However, whether MIT could be attempted for locally advanced disease remains unclear.

越来越多的证据支持微创胸腺切除术（minimally invasive thymectomy，MIT）治疗早期胸腺恶性肿瘤优于开放胸骨正中切开胸腺切除术（median sternotomy thymectomy，MST）。然而，MIT能否用于局部晚期疾病尚不清楚。

Methods 方法  

The clinical data of consecutive patients with stage T2-3NxM0 (8th edition TNM staging) thymic malignancies who underwent MIT or MST were identified from a prospectively maintained database. The co-resected structures were rated with a resection index (RI) to evaluate surgical difficulty. The impact of surgical approach on treatment outcomes was investigated through propensity-score matched analysis and multivariable analysis.

接受MIT或MST的T2-3NxM0期（第8版TNM分期）胸腺恶性肿瘤患者的临床数据是从前瞻性维护的数据库中确定的。用切除指数（resection index，RI）对共切除结构进行评分，以评估手术难度。通过倾向评分匹配分析和多变量分析研究手术入路对治疗结果的影响。

Results 结果  

From January 2008 to December 2019, 128 patients were included; MIT was initially attempted in 58 (45.3%) cases, and 8 (13.8%) were converted to MST during surgery. The conversion group had similar perioperative outcomes to the MST group, except for a longer operation time. After propensity-score matching, the RI scores were similar between the MIT and MST groups (3.5 vs. 3.7, p=0.773). The MIT group had significantly less blood loss (p<0.001), fewer postoperative complications (p=0.048), a shorter duration of chest drainage (p<0.001), and a shorter hospitalization duration (p<0.001) than the MST group. The 5-year freedom from recurrence rate was not different between the two groups (78.2% vs. 78.5%, p=0.942). In multivariable analysis, surgical approach was not associated with freedom from recurrence (p=0.727).

2008年1月至2019年12月，纳入128例患者；58例（45.3%）患者最初尝试了MIT，8例（13.8%）在手术中转为MST。除手术时间较长外，转换组围手术期预后与MST组相似。倾向评分匹配后，MIT组和MST组的RI评分相似（3.5 vs. 3.7，p=0.773）。与MST组相比，MIT组出血量明显减少（p<0.001），术后并发症减少（p=0.048），胸腔引流时间缩短（p<0.001），住院时间缩短（p<0.001）。两组患者5年无复发率无差异（78.2% vs. 78.5%，p=0.942）。在多变量分析中，手术入路与复发无相关性（p=0.727）。

Conclusions 结论  

MIT could be safely attempted in carefully selected patients with locally advanced thymic tumors. Conversion did not compromise surgical outcomes. Patients may benefit from the less traumatic procedure and thus better recovery, with comparable long-term oncological outcomes.

在精心挑选的局部晚期胸腺肿瘤患者中，可以安全地尝试MIT。转换手术入路不影响手术结果。患者可能受益于创伤较小的手术，从而更好地恢复，具有相当的长期肿瘤预后。

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