Long-term, disease-specific outcomes of thymic malignancies presenting with de novo pleural metastasis Journal Article

Authors: Choe, G.; Ghanie, A.; Riely, G.; Rimner, A.; Park, B. J.; Bains, M. S.; Rusch, V. W.; Adusumilli, P. S.; Downey, R. J.; Jones, D. R.; Huang, J.
Article Title: Long-term, disease-specific outcomes of thymic malignancies presenting with de novo pleural metastasis
Abstract: Objective: Treatment of patients with thymic malignancies metastatic to the pleura or pericardium is challenging, and benefits of aggressive treatment are unclear. We sought to characterize the long-term outcomes in this population. Methods: We retrospectively identified patients who underwent resection for de novo thymic malignancies metastatic to the pleura between May 1997 and December 2017. Patients with pleural recurrence after prior thymectomy were excluded. Patient demographics, perioperative treatments, pathologic findings, and postoperative outcomes were collected. Descriptive statistics and Kaplan–Meier analyses were performed. Results: Seventy-two patients were included (median age, 51 years [range 25-80]; 36/72 women [50%]). Pathologic diagnosis was thymoma in 57 patients (79%) and thymic carcinoma in 15 patients (21%). Most patients (67/72; 93%) received chemotherapy, radiation, or both. Forty-eight patients underwent thymectomy with pleurectomy, 7 patients underwent extrapleural pneumonectomy, 10 patients underwent thymectomy alone, and 7 patients were unresectable. Macroscopic complete resection was achieved in 52 patients (73%). Five-, 10-, and 15-year overall survivals were 73%, 51%, and 18%, respectively, and median overall survival was 11 years (median follow-up, 5.9 years). Forty-six patients (64%) had disease progression (median time to progression, 2.2 years). Repeat episodes of progression and treatment were common (median, 3 episodes/patient). The longest disease-free interval was 12.4 years. Thirteen patients (18%) remain disease-free; 7 patients (10%) were disease-free for more than 5 years. The longest ongoing survival without progression or reintervention is 9.9 years. Conclusions: Prolonged survival and, in some cases, cure can be achieved in patients with thymic malignancies metastatic to the pleura or pericardium. Aggressive multimodality therapy may be appropriate for select patients. © 2019 The American Association for Thoracic Surgery
Keywords: survival; adult; cancer chemotherapy; cancer survival; aged; cancer surgery; major clinical study; overall survival; cisplatin; doxorubicin; cancer combination chemotherapy; cancer growth; conference paper; paclitaxel; cancer radiotherapy; disease free survival; postoperative care; follow up; carboplatin; progression free survival; etoposide; lung resection; cyclophosphamide; medical record review; retrospective study; docetaxel; carcinoma; brachytherapy; disease free interval; inoperable cancer; thymoma; thymectomy; extrapleural pneumonectomy; pleurectomy; disease specific survival; thymus cancer; chemoradiotherapy; induction chemotherapy; surgical patient; pleura metastasis; clinical outcome; long term survival; human; male; female; priority journal; median survival time; thymic malignancies
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 159
Issue: 2
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2020-02-01
Start Page: 705
End Page: 714.e1
Language: English
DOI: 10.1016/j.jtcvs.2019.08.037
PUBMED: 31610957
PROVIDER: scopus
Notes: Source: Scopus
Citation Impact
MSK Authors
  1. Valerie W Rusch
    734 Rusch
  2. James Huang
    135 Huang
  3. Gregory J Riely
    417 Riely
  4. Bernard J Park
    171 Park
  5. Andreas Rimner
    311 Rimner
  6. Robert J Downey
    216 Downey
  7. Manjit S Bains
    263 Bains
  8. David Randolph Jones
    198 Jones
  9. Amanda   Ghanie
    4 Ghanie
  10. Giye Choe
    4 Choe