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C. Xu



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    P1.15 - Poster Session 1 - Thymoma (ID 189)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P1.15-002 - Results and Prognostic Features of Recurrent Thymoma (ID 3020)

      09:30 - 16:30  |  Author(s): C. Xu

      • Abstract

      Background
      This study sought to analyse the results and prognosis of recurrent thymoma.

      Methods
      Between 1991 and 2012, 32 patients who developed recurrence after radical resection of thymoma were reviewed.

      Results
      The initial Masaoka staging was stage I, 3; stage II, 14; stage III, 10; stage IVa, 4;and stage IVb, 1. World Health Organization tumor type: A and AB, 5; B1, 7; B2, 6; B3, 12; and unknown, 2. Among the 32 patients, relapses were found in the following sites: pleura (20 cases), tumor bed (10),non-tumor bed in mediastinum (one), lung (seven), chest wall (six), lymph node metastasis (four) , abdominal node metastasis (one),liver (one), pleural effusion (four), and overlapped recurrence (14).The patterns of recurrence: local recurrence, 6; regional recurrence, 8; distant recurrence, 5; local and regional recurrence, 6; regional and distant recurrence, 4; local, regional and distant recurrence, 3. The median recurrence interval was 42 months (range, 5–193 months). The median follow-up time after recurrence was 49.5 months (range, 1-136months). Overall 5-year survival after recurrence was 65.5%. 7 patients with relapse in the thorax are still alive after re-resection, with a median survival time of 26 months (range, 6-95 months). The perioperative mortality was 0% and the morbidity was 14%. 4 patients with local relapse were given radiotherapy (RT) alone, with a median survival of 60 months (range, 51-107months) and one was dead of progressive disease, probably due to lower reirradiation dose (50Gy), compared to others with radical radiation dose (60Gy). In patients with regional and/or distant relapse, 6 patients received chemotherapy, and had 37.5% of overall 5-year survival. 5 patients without re-treatment had 50% of overall 1-year survival, with median survival 3 months (range,1-20months). After re-treatment, 9 patients had re-relapse, and the re-relapse free survival rate was 63% at 5 years, with a median re-relapse free survival of 53 months (range, 11-69months). 1 of 15 patients with RT had radiation pneumonitis and recovered after management. In univariate analysis, age (<55y, ≥55y; p=0.009), patterns of relapse (p=0.042), and recurrence-free interval (<20months, ≥20months; p=0.038) were prognostic factors.

      Conclusion
      Reoperation for resectable thymoma recurrences is associated with better outcome and relative safety, and it should be recommended. In patients with local recurrence of thymoma, RT may get comparable survival to re-operation. RT/CT probably is the treatment of choice when re-resection is not feasible. Younger age, local and regional recurrence, and longer relapse-free interval are associated with positive prognosis.

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    P2.15 - Poster Session 2 - Thymoma (ID 191)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P2.15-002 - Patterns and Predictors of Recurrence after radical resection of Thymoma (ID 3022)

      09:30 - 16:30  |  Author(s): C. Xu

      • Abstract

      Background
      Even after complete resection, recurrence of thymoma is not uncommon, but the recurrent patterns remain controversial. This study sought to define the patterns and predictors of relapse after complete resection of thymoma.

      Methods
      A single-institution retrospective study was performed of 331 patients who underwent radical resection of thymoma from 1991 through 2012.

      Results
      After a median follow-up of 59 months (range, 3-256), the recurrence rates was 6.9% (23/331). Overall 5- and 10-year survival rates were 92.3% and 84.9%. Cancer specific survival rates were 95% and 89.4% at 5 and 10 years, respectively. Recurrence-free survival rates were 93.6% and 87.2% at 5 and 10 years, respectively. Among the 23 patients, relapses were found in the following sites: pleura (thirteen cases), tumor bed (six), lung (six), chest wall (four), lymph node metastasis (two) , abdominal node metastasis (one),liver (one), pleural effusion (three), and over-lapped recurrence (nine). According to the definition of the International Thymic Malignancy Interest Group, 10 (43.5%) patients had local recurrence, 15 (65.2%) had regional recurrence, 10 (43.5%) had distant recurrence (six lung, one liver, one abdominal node metastasis, and two lymph node metastasis), and 9 (39.1%) had over-lapped recurrence. The difference in survival after recurrence between lung and regional relapse was statistically significant (p=0.027), but it was insignificant between lung and distant relapse (p=0.808). Recurrence rates correlated with the initial Masaoka stage: I, 1.0% (2/196); II, 9.7% (9/93) ; III, 24.2% (8/33); IVa, 42.9% (3/7); and IVb, 100% (1/1). The difference in recurrence between Masaoka stage I and II was stastically significant (p=0.000). And they also correlated with World Health Organization tumor type: A and AB, 3.2% ( 5/154 ); B1, 6% ( 4/67 ); B2, 6% ( 3/50 ); and B3, 22.7% ( 10/44). Tumor size demonstrated a step-up of recurrence at 8 cm (<8 cm, 62.8%; ≥8 cm, 37.2%; P=0.007). In multivariate analysis, Masaoka stage (p=0.005), tumor size (p=0.033), and WHO histology (p=0.046) were predictive of recurrence.

      Conclusion
      Pleura are the most common recurrent sites. Recurrence in the lung had poorer survival than the regional relapse, it should be included in the distant recurrence. Regional recurrence is the most common pattern of relapse, but local and distant recurrences are not infrequently observed. Advanced Masaoka stage, larger tumor size, and Type B3 were risk factors of recurrence.