The Western Thoracic Surgical Association

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The Role of Neoadjuvant Therapy Prior to Surgical Resection in Locally Advanced Thymic Cancer: A National Cancer Database Analysis
*Samuel Kim1, Chiu-Hsieh Hsu2, Charles Hsu1
1University of Arizona School of Medicine, Tucson, AZ;2University of Arizona College of Public Health, Tucson, AZ

Objectives:
The role of neoadjuvant therapy (chemotherapy with or without radiation) for locally advanced thymic carcinoma remains poorly defined and controversial. We used the National Cancer Data Base (NCDB) to investigate the impact of neoadjuvant therapy prior to resection of stage II and III thymic carcinoma on overall survival (OS).
Methods:
Patients with Stage II and III thymic carcinoma who underwent curative resection were queried from NCDB and categorized according to Masaoka-Koga stage groups. Patients were grouped based on pre-operative treatment status (Upfront surgery vs. Neoadjuvant therapy followed by surgery group). Kaplan-Meier estimates of OS and univariate and multivariate Cox proportional hazards regression analyses were performed.
Results:
From 2004-2014, 1441 patients underwent surgical resection for thymic carcinoma. Of these, 166 patients were Masaoka stage II and 517 patients were stage III. For stage II patients, in univariate analysis, age (p<0.001) and positive margin status (p=0.01) were the factors associated with decreased OS. For stage III cancer, nodal involvement (p<0.01), positive margin (p<0.001), increasing tumor size (p =0.03) were factors associated with decreased OS. In multivariate analysis, there was no difference in survival between the Upfront surgery group and Neoadjuvant group in stage II cancer patients (HR 0.85, CI 0.43-1.66; p=0.63). For stage III patients, multivariate analysis showed significant improved OS for the Neoadjuvant group over Upfront surgery group (HR 0.65, CI 0.48-0.87; p<0.01). In particular, neoadjuvant therapy was associated with improved survival among patients with positive margins (HR 0.53, CI 0.37- 0.76; p<0.001).
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Conclusions:
Compared to upfront surgery, neoadjuvant therapy was associated with longer OS in stage III thymic but not stage II thymic carcinoma patients. The greatest relative benefits of neoadjuvant therapy were observed for stage III patients with positive margins.

OS for Stage III Thymic Cancer Patients with Positive Margin by Treatment Sequence (N=79)
GroupDeadAliveUnadjusted HRAdjusted HR
Upfront Surgery2139------
Neoadjuvant19400.63 (0.44, 0.89); p<0.010.53 (0.37, 0.76), p<0.001


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