Postoperative radiotherapy for completely resected Masaoka/Masaoka-Koga stage II/III thymoma improves overall survival: An updated meta-analysis of 4,746 patients
A partir d'une revue systématique de la littérature publiée jusqu'en juin 2020 (5 études, 4 746 patients), cette méta-analyse évalue l'efficacité d'une radiothérapie postopératoire chez des patients atteints d'un thymome de stade II-III (selon les critères de Masaoka) totalement réséqué
Introduction: Our systematic review and meta-analysis aimed to evaluate the effect of postoperative radiotherapy (PORT) on completely resected Masaoka/Masaoka-Koga (M/MK) stage II/III thymomas. Methods: We systematically searched four online databases and included studies that compared surgery alone versus surgery plus PORT for completely resected M/MK stage II/III thymoma. The multivariate adjusted hazard ratios (HRs) of overall survival (OS) and disease-free survival (DFS) were evaluated as the primary and secondary endpoints, respectively. We performed a subgroup analysis for OS with respect to M/MK stage II, III, and inseparable II/III cases. A generic inverse variance meta-analysis using a random model was conducted. Results: Five studies including 4,746 patients (among them, 2,408 patients received PORT) met our selection criteria. A meta-analysis of these five studies revealed that PORT was associated with a significantly better OS (HR, 0.68; 95% confidence interval [CI], 0.57–0.83; p < 0.001; I 2 = 0%; p for heterogeneity, 0.97). Subgroup analyses for M/MK stage II disease (HR, 0.63; 95% CI, 0.44–0.91; p = 0.01; I 2 = 0%; p for heterogeneity, 0.80) and M/MK stage III disease (HR, 0.72; 95% CI, 0.55–0.95; p = 0.02; I 2 = 0%; p for heterogeneity, 0.84) demonstrated similar results. PORT was not associated with an improved DFS (HR, 0.96; 95% CI, 0.70–1.33; p = 0.83; I 2 = 0%; p for heterogeneity, 0.72). Conclusion: Currently available evidence from observational studies suggests PORT for patients with completely resected M/MK stage II/III thymoma. A randomized trial is warranted.