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Screening of optimal candidates for postoperative radiotherapy among patients with resectable thymic tumors: a multicenter retrospective study

Year: 2025

Type: article

Abstract: OBJECTIVE: The role of postoperative radiotherapy (PORT) in resectable thymic epithelial tumors remains debatable. This study aimed to identify patient populations in whom PORT would be beneficial and analyzed the prognostic factors that influence survival in patients with resectable thymic tumors. METHODS: A retrospective analysis was conducted on 497 patients with resectable thymic epithelial tumors, including cases treated at our facility (January 2014 to December 2018) and cases from the SEER database (January 2014 to December 2015). Patients' data analyzed included age, gender, Masaoka-Koga stage, postoperative pathological type, and adjuvant therapy. Survival analysis was performed using the Kaplan-Meier method, while prognostic factors were evaluated using the Cox proportional hazards model. RESULTS: No significant difference in survival outcomes was observed between patients with Masaoka-Koga stage I/IIA thymic tumors who underwent surgery alone compared with those who had surgery with adjuvant radiotherapy. However, patients with stage IIB and III/IVA tumors had significant survival benefits from PORT. In indolent histological subtypes (types A, AB, and B1), PORT did not provide a significant survival advantage compared to surgery alone. Conversely, patients with aggressive subtypes (types B2 and B3) and thymic carcinoma (type C) experienced improved long-term survival with PORT. Additionally, male patients, along with those with tumors ≥ 55 mm, age < 58 years, and incomplete resection, also benefited from PORT. Univariate and multivariate Cox regression analyses revealed several prognostic factors that affect survival, including age, gender, Masaoka-Koga stage, histological type, tumor size, PORT, postoperative chemotherapy, and recurrence. Independent prognostic factors identified were sex, Masaoka-Koga stage, histological grading, PORT, and postoperative chemotherapy. CONCLUSIONS: PORT provides significant survival benefits in patients with Masaoka-Koga stage IIB and III/IVA thymic tumors, aggressive histological subtypes, and thymic carcinoma.

Source: Lung Cancer

DOI: 10.1016/j.lungcan.2025.108542