Abstract
BackgroundThymic tumors usually present with adjacent organ invasion or pleural dissemination, but very few studies have reported on occult pleural dissemination detected intraoperatively. This study aimed to investigate the risk factors that can predict pleural dissemination preoperatively.MethodsConsecutive patients with thymic tumors who underwent surgery from January 2010 to January 2017 were reviewed. Only patients without pleural dissemination detected preoperatively were included in this study. Demographic, clinical, pathological, and survival data were collected for statistical analysis. Further analyses were performed to find the risk factors of occult pleural dissemination.ResultsA total of 352 patients with thymic tumors were included in this study. Seven patients had pleural dissemination detected intraoperatively. All pleural dissemination cases were in clinical Masaoka-Koga stage III, and most underwent the video-assisted thoracoscopic surgery (VATS) approach (or VATS exploration). Univariate analysis showed that positive squamous cell carcinoma (SCC) antigen was the only predictor of pleural dissemination (p = 0.009). Tiny nodules close to the diaphragm were detected in the computed tomography scans of 1 case after reviewing the imaging data. Tumor recurrence occurred in 5 patients during follow-up. The disease-free survival rates were better in patients with a solitary nodule than those with multiple nodules (p = 0.019). No significant difference was detected in terms of disease-free survival rates between SCC antigen positive and SCC antigen negative patients.ConclusionsPositive SCC antigen was the only detected risk factor for predicting pleural dissemination in thymic tumors preoperatively in this study. The VATS approach (including VATS exploration) is suggested for patients with clinical Masaoka-Koga stage III and SCC antigen positive thymic tumors, according to our experience.
Highlights
Thymic epithelial tumors (TETs) are rare malignancies that usually occur in the anterior mediastinum in adults
Pleural dissemination was detected intraoperatively in seven patients (1.9%); no significant differences were detected between patients with versus without occult pleural dissemination in terms of demographic and clinical characteristics such as age, sex, presence of myasthenia gravis, surgical approach, and histological type
Higher rates of squamous cell carcinoma (SCC) antigen positivity were detected in patients with than in those without occult pleural dissemination (P = 0.031)
Summary
Thymic epithelial tumors (TETs) are rare malignancies that usually occur in the anterior mediastinum in adults. Thymic tumors are usually indolent [1], and complete surgical resection is considered necessary to achieve. Song et al Journal of Cardiothoracic Surgery (2021) 16:333 identify risk factors for occult pleural dissemination in patients with TETs. Thymic tumors usually present with adjacent organ invasion or pleural dissemination, but very few studies have reported on occult pleural dissemination detected intraoperatively. This study aimed to investigate the risk factors that can predict pleural dissemination preoperatively
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