Table_4_Induction Therapy Followed by Surgery for Unresectable Thymic Epithelial Tumours.doc

Background and ObjectivesThe treatment of unresectable thymic epithelial tumours (TETs) remains controversial. Here, we present the efficacy and safety of induction therapy followed by surgery for unresectable TET.
MethodsEighty-one patients with unresectable TETs treated with induction therapy followed by surgery were selected from a retrospective review of consecutive TETs from January 2005 to January 2021. Clinicopathological data were analyzed to assess tumour responses, resectability, adverse events, progression-free survival (PFS) and overall survival (OS).
ResultsInduction therapy produced a major tumour response rate of 69.1%, a tumour response grade (TRG) 1-3 rate of 84.0% and an R0 resection rate of 74.1%. The most common toxic effects were all-grade neutropenia (35.8%) and anaemia (34.6%). The 10-year OS and PFS rates were 45.7% and 35.2%. Multivariate analysis showed that ypTNM stage, ypMasaoka stage, complete resection, and TRG were significant independent prognostic factors. Exploratory research revealed that different induction modalities and downstaging of T, N, M, TNM, or Masaoka classifications did not significantly alter the pooled hazard ratio for survival.
ConclusionsInduction therapy followed by surgery is well tolerated in patients with unresectable TETs, with encouraging R0 resection rates. Multimodality management provides good control of tumors for unresectable TET patients.

背景与目的 不可切除胸腺上皮肿瘤（unresectable thymic epithelial tumours, TETs）的临床治疗仍存在争议。本研究旨在评估诱导治疗联合手术方案用于不可切除胸腺上皮肿瘤的疗效与安全性。
方法 本研究从2005年1月至2021年1月连续收治的胸腺上皮肿瘤患者的回顾性队列中，纳入81例接受诱导治疗后行手术治疗的不可切除胸腺上皮肿瘤患者。收集患者的临床病理资料，分析其肿瘤应答情况、可切除性、不良事件、无进展生存期（progression-free survival, PFS）与总生存期（overall survival, OS）。
结果 诱导治疗的主要肿瘤应答率为69.1%，肿瘤应答分级（tumour response grade, TRG）1~3级占比为84.0%，R0切除率达74.1%。最常见的不良事件为全级中性粒细胞减少症（35.8%）与贫血（34.6%）。患者10年总生存期与无进展生存率分别为45.7%与35.2%。多因素分析显示，ypTNM分期、ypMasaoka分期、根治性切除与肿瘤应答分级均为独立预后影响因素。探索性研究表明，不同诱导治疗模式以及T、N、M、TNM或Masaoka分期的降期情况，均未对生存的合并风险比产生显著影响。
结论 诱导治疗联合手术方案在不可切除胸腺上皮肿瘤患者中耐受性良好，R0切除率令人满意。多模态综合治疗可有效控制不可切除胸腺上皮肿瘤患者的肿瘤进展。