In a study reported in a research letter in JAMA Surgery, Sakowitz et al found that R0 resection was more commonly achieved in patients with stage I to III thymic tumors who received surgery at high-volume centers (HVCs) for thymectomy in the United States.
Study Details and Results
The study involved National Cancer Database data for 2010 to 2021 on patients aged ≥ 18 years who underwent thymectomy for stage I to III thymoma or thymic carcinoma. HVCs were those in the top quartile of centers, which performed at least three procedures per year. The primary outcome measure was R0 resection.
Among 6,166 patients included in the analysis, 1,597 (25.9%) underwent thymectomy at HVCs. Patients in the HVC group were more likely to have higher income and private insurance. Patients in the HVC group and non-HVC group had similar disease stages at diagnosis; those in the HVC group were more likely to have received neoadjuvant chemotherapy.
In an adjusted analysis, patients in the HCV group were significantly more likely to achieve R0 resection vs the non-HVC group (adjusted odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.49–2.47). The HVC group had improved likelihood of achieving R0 resection among patients with stage I (adjusted OR = 1.94, 95% CI = 1.37–2.75), stage II (adjusted OR = 2.10, 95% CI = 1.33–3.32), and stage III disease (adjusted OR =1.80, 95% CI = 1.07–3.02).
The HVC group was more likely to undergo minimally invasive surgery (adjusted OR = 1.79, 95% CI = 1.32–2.42) and exhibited reduced 10-year mortality (HR = 0.80, 95% CI = 0.66–0.97). Hospitalization duration, rates of hospital readmission, and 30-day mortality were similar between the groups.
In a sensitivity analysis including all centers, increasing annual caseload was associated with greater odds of R0 resection per case (adjusted OR = 1.08, 95% CI = 1.06–1.11) and reduced 10-year mortality per case (HR = 0.98, 95% CI = 0.96–1.00).
The investigators stated: “In the absence of prospective trials, treatment of rare thymic tumors has been dictated by single-center reports and limited series…. In this study of the largest known registry cohort, HVC care was associated with greater odds of R0 resection and improved 10-year survival, as supported in the literature…. We proffer that this divergence in outcomes may partly stem from increased recurrence among patients with incomplete resections. Ultimately, our findings suggest patient-level benefit to centralization of care for thymic neoplasms.”
Peyman Benharash, MD, MS, of the UCLA Division of Cardiac Surgery, Center for Health Sciences, Los Angeles, is the corresponding author of the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
