Impact of Lymph Node Dissection on Thymic Malignancies: Multi-Institutional Propensity Score Matched Analysis

Yoohwa Hwang, Chang Hyun Kang, Samina Park, Hyun Joo Lee, In Kyu Park, Young Tae Kim, Geun Dong Lee, Hyeong Ryul Kim, Se Hoon Choi, Yong Hee Kim, Dong Kwan Kim, Seung Il Park, Sumin Shin, Jong Ho Cho, Hong Kwan Kim, Yong Soo Choi, Jhingook Kim, Jae Il Zo, Young Mog Shim, Chang Young LeeJin Gu Lee, Dae Joon Kim, Hyo Chae Paik, Kyung Young Chung

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15 Scopus citations

Abstract

Introduction: Surgical resection is a standard treatment for thymic malignancies. However, prognostic significance of nodal metastases and lymph node dissection remains unclear. The aim of this study is to determine prognostic significance of nodal metastases and the role of lymph node dissection (LND) in thymic malignancies. Methods: Between 2000 and 2013, 1597 patients who underwent thymectomy due to thymic malignancy were included. Predictive factors for nodal metastasis and prognostic significance of LND were evaluated. Patients were divided into two groups: (1) LND+ group, with intentional LND (446 patients, 27.9%); and (2) LND- group, without intentional LND (1151 patients, 72.1%). Propensity score matching was performed between the two groups. Results: Lymph node metastasis was identified in 20 (6.7%) of 298 patients with thymoma and 47 (31.7%) of 148 patients with thymic carcinoma. In multivariable analysis, thymic carcinoma (hazard ratio: 19.2, p < 0.001) and tumor size (hazard ratio: 1.09, p = 0.02) were significant predictive factors for lymph node metastasis. The 10-year freedom from recurrence rate of pN1 and pN2 was significantly worse than that of pN0 (p < 0.001). LND did not increase operative mortality or complication. There was no significant difference in 10-year freedom from recurrence rate between LND+ and LND- groups (82.4% versus 80.9%, p = 0.46 in thymoma; 45.7% versus 44.0%, p = 0.42 in thymic carcinoma). Conclusions: Lymph node metastasis was a significant prognostic factor in thymic malignancies. Although LND did not improve long-term outcomes in thymic malignancies, LND played a role in accurate staging, and improved prediction of prognosis.

Original languageEnglish
Pages (from-to)1949-1957
Number of pages9
JournalJournal of Thoracic Oncology
Volume13
Issue number12
DOIs
StatePublished - Dec 2018

Keywords

  • Lymph node dissection
  • Oncologic outcomes
  • Thymic malignancies

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