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Pleural Invasion Depth of Disseminated Nodules in Patients with Stage IVa or Recurrent Thymoma: Assessment, Curative Impact, and Surgical Outcomes

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Thymoma patients with pleural dissemination are difficult to manage, and their treatment strategy remains undefined. This study aimed to investigate the clinicopathologic features of these patients, focusing on the association between the depth of pleural invasion and prognosis.

Methods

Between 2003 and 2019, the study identified 120 disseminated lesions in 20 thymoma patients. Seven patients had de novo stage IVa thymoma and 13 were recurrent cases. Extrapleural pneumonectomy was performed for 8 patients and debulking surgery for 12 patients. Invasion depth of pleural tumors was classified into two groups: when the disseminated tumors invaded the pleura beneath the elastic layer, the tumor was diagnosed as Da, and when the disseminated tumors invaded the pleura beyond the elastic layer, the tumor was diagnosed as Db.

Results

Of 120 nodules, 31 (26%), found in eight patients with recurrent malignancies, were classified as Db. The pathologic status of the surgical margin (PSM) was positive in eight patients, seven of whom had Db nodules. The 5-year overall survival (OS) rate was 100% in the Da group and 75% in the Db group (P = 0.02). The 5-year progression-free survival (PFS) rate was 66.7% in the Da group and 25% in the Db group (P = 0.02). Cox univariate analysis showed that PFS was significantly influenced by the depth of invasion (P = 0.04) and PSM (P = 0.03).

Conclusion

Depth of pleural invasion may influence survival outcomes for thymoma patients with pleural dissemination. The patients in this study with Da-disseminated nodules had an increased probability of a longer OS and PFS and tended to achieve negative PSM compared with the patients with Db.

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Acknowledgments

We thank Dr. Kota Ono (https://ono-biostat-consulting.com/), also an employee of AbbVie GK.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Shota Nakamura MD, Keita Nakanishi MD, Tomoshi Sugiyama MD, Yuka Kadomatsu MD, Harushi Ueno MD, Masaki Goto MD, Naoki Ozeki MD, Takayuki Fukui MD, Kohei Yokoi MD & Toyofumi F Chen-Yoshikawa MD

  2. Department of Pathology, Clinical Laboratory, Kasugai Municipal Hospital, Kasugai, Japan

    Hisashi Tateyama MD

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  1. Shota Nakamura MD
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Correspondence to Shota Nakamura MD.

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Nakamura, S., Tateyama, H., Nakanishi, K. et al. Pleural Invasion Depth of Disseminated Nodules in Patients with Stage IVa or Recurrent Thymoma: Assessment, Curative Impact, and Surgical Outcomes. Ann Surg Oncol 29, 1829–1837 (2022). https://doi.org/10.1245/s10434-021-10888-0

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