초록접수 현황
| 15F-186 | 구연 발표 |
Limited Thymectomy could be Alternative Treatment Option for Early Stage Thymoma : Multi-institutional-propensity Matched Analysis
남경식¹, 변고은¹, 이창영¹, 이진구¹, 김대준¹, 김응래², 황유화², 박인규², 강창현², 김영태², 김석³, 이진희³, 조종호³, 김홍관³, 최용수³, 김진국³, 조재일³, 심영목³, 이강훈⁴, 복진산⁴, 황수경⁴, 이근동⁴, 최세훈⁴, 김형렬⁴, 김용희⁴, 김동관⁴, 박승일⁴, 정경영¹
연세대학교 의과대학 세브란스병원 흉부외과학교실¹, 서울대학교 의과대학 서울대학교병원 흉부외과학교실², 성균관대학교 의과대학 삼성서울병원 흉부외과학교실³, 울산대학교 의과대학 서울아산병원 흉부외과학교실⁴
Background : For early stage thymoma, like advanced stage thymoma, complete thymectomy has been regarded as standard treatment. But recently, several studies have showed that limited thymectomy was not inferior to complete thymectomy in terms of overall survival(OS) and freedom from recurrence(FFR). Multi-institutions data from four hospitals for 11 years were analyzed to clarify whether limited thymectomy is equally effective for management of thymoma.
Methods : Between January 2003 and December 2013, a total of 1462 patients underwent thymectomy. Of those, patients who had absent data of operation type, recurrence status, Masaoka-Koga stage(M-K stage), WHO type were excluded. Patients who had thymic carcinoma, M-K stage III and IV were also excluded. The remaining 943 patients were analyzed retrospectively. In this study, limited thymectomy(LT) includes thymomectomy and partial thymectomy. Complete thymectomy(CT) includes complete thymectomy and extended thymectomy. LT was performed in 284(30.1%) patients and CT was performed in 659(69.9%) patients. Median follow up time was 44 months(range, 1 to 145 months).Propensity-score matching(1:1) was used to adjust age, sex, associated myasthenia gravis(MG), tumor size, WHO type, M-K stage and finally 490 patients were analyzed (each 245 patients).
Results : Patients and tumor characteristics including age, sex, tumor size, M-K stage, WHO type, and rate of R0 resection were not different between two groups. Performed approach was different between groups (p<0.001). LT was mainly approached with VATS(178, 72.7%) and CT was mainly midsternotomy(171, 69.8%). Operation time(104 ± 51 min vs.149 ± 62 min, p<0.004) was longer and ICU admission rate(31.8% vs.16.3%, p<0.001) was higher in CT group. OS and FFR showed no difference between two groups. 10-year OS rates for LT and CT group were 90.6%, 97.7% (p=ns) and 10 year FFR rates were 92.9%, 98.0%,(p=ns) respectively. From the analysis of data before matching, 10-year OS(91.6% vs 97.6%,p=ns) and 10 year FFR(93.4% vs 94.2%,p=ns) also showed no difference between groups.
Conclusion : In this study, LT for early stage thymoma was not inferior to CT with respect to OS and FFR. Considering its less operation time and ICU admission rates, LT deserve more attention as treamtment of early stage thymoma. Future prospective randominzed trials are needed to confirm this issue.
Methods : Between January 2003 and December 2013, a total of 1462 patients underwent thymectomy. Of those, patients who had absent data of operation type, recurrence status, Masaoka-Koga stage(M-K stage), WHO type were excluded. Patients who had thymic carcinoma, M-K stage III and IV were also excluded. The remaining 943 patients were analyzed retrospectively. In this study, limited thymectomy(LT) includes thymomectomy and partial thymectomy. Complete thymectomy(CT) includes complete thymectomy and extended thymectomy. LT was performed in 284(30.1%) patients and CT was performed in 659(69.9%) patients. Median follow up time was 44 months(range, 1 to 145 months).Propensity-score matching(1:1) was used to adjust age, sex, associated myasthenia gravis(MG), tumor size, WHO type, M-K stage and finally 490 patients were analyzed (each 245 patients).
Results : Patients and tumor characteristics including age, sex, tumor size, M-K stage, WHO type, and rate of R0 resection were not different between two groups. Performed approach was different between groups (p<0.001). LT was mainly approached with VATS(178, 72.7%) and CT was mainly midsternotomy(171, 69.8%). Operation time(104 ± 51 min vs.149 ± 62 min, p<0.004) was longer and ICU admission rate(31.8% vs.16.3%, p<0.001) was higher in CT group. OS and FFR showed no difference between two groups. 10-year OS rates for LT and CT group were 90.6%, 97.7% (p=ns) and 10 year FFR rates were 92.9%, 98.0%,(p=ns) respectively. From the analysis of data before matching, 10-year OS(91.6% vs 97.6%,p=ns) and 10 year FFR(93.4% vs 94.2%,p=ns) also showed no difference between groups.
Conclusion : In this study, LT for early stage thymoma was not inferior to CT with respect to OS and FFR. Considering its less operation time and ICU admission rates, LT deserve more attention as treamtment of early stage thymoma. Future prospective randominzed trials are needed to confirm this issue.
책임저자: 정경영
연세대학교 의과대학 세브란스병원 흉부외과학교실
연락처 : 이창영, Tel: 02-2227-4167 , E-mail : cyleecs@yuhs.ac
