Postoperative radiotherapy for completely resected thymoma and thymic carcinoma: a systematic review and meta-analysis: trial

Postoperative radiotherapy for completely resected thymoma and thymic carcinoma: a systematic review and meta-analysis

Phase meta-analysisN = 10,543

Population

10,543 patients in 31 retrospective studies of completely resected thymoma or thymic carcinoma

Design

Systematic review and random-effects meta-analysis of 31 studies (10,543 patients) comparing OS and/or DFS between PORT and surgery alone after complete resection of thymoma or thymic carcinoma (searches to 10 April 2024): 17 studies of thymoma (4,763 patients), seven of thymic carcinoma (1,045) and seven of mixed histologies (4,735). The open-access full text describes the 31 studies as retrospective, with 4,945 patients who had PORT and 5,598 who had surgery alone. Hazard ratios in the abstract are for PORT versus surgery alone.

Arms

Surgery alone (control, n = 5,598): Complete resection without postoperative radiotherapy
Surgery plus PORT (experimental, n = 4,945): Complete resection followed by postoperative radiotherapy

People

He T, senior author Dang J

OSHR 0.73 (95% CI 0.59–0.91)DFSHR 0.62 (95% CI 0.43–0.89)OSHR 0.73 (95% CI 0.56–0.96)OSHR 0.72 (95% CI 0.49–1.07)OSHR 0.81 (95% CI 0.55–1.19)OSHR 0.50 (95% CI 0.34–0.74)

Show the numbers

Results reported for Postoperative radiotherapy for completely resected thymoma and thymic carcinoma: a systematic review and meta-analysis
Endpoint	Analysis	Surgery plus PORT	Surgery alone	Effect
OSAll 31 studies (thymoma, thymic carcinoma and mixed)	finalHe 2024	—	—	HR 0.73 (95% CI 0.59–0.91)Random-effects pooled estimate from retrospective studies. Estimates restricted to multivariate-adjusted hazard ratios are reported separately in the abstract (OS HR 0.60, 95% CI 0.43-0.83). Heterogeneity I2 = 55% (full text).
DFSAll 31 studies (thymoma, thymic carcinoma and mixed)	finalHe 2024	—	—	HR 0.62 (95% CI 0.43–0.89)Random-effects pooled estimate from retrospective studies. Heterogeneity I2 = 78% (full text).
OSThymoma subgroup (17 studies)	exploratoryHe 2024	—	—	HR 0.73 (95% CI 0.56–0.96)Subgroup analysis.
OSThymic carcinoma subgroup (seven studies)	exploratoryHe 2024	—	—	HR 0.72 (95% CI 0.49–1.07)Subgroup analysis; the confidence interval includes 1.
OSStage 2 disease subgroup	exploratoryHe 2024	—	—	HR 0.81 (95% CI 0.55–1.19)Subgroup analysis; the confidence interval includes 1. The abstract reports a DFS hazard ratio of 0.97 (95% CI 0.51-1.83) for the same subgroup.
OSStage 3-4 disease subgroup	exploratoryHe 2024	—	—	HR 0.50 (95% CI 0.34–0.74)Subgroup analysis. The abstract reports a DFS hazard ratio of 0.44 (95% CI 0.27-0.70) for the same subgroup.

Results reported for Postoperative radiotherapy for completely resected thymoma and thymic carcinoma: a systematic review and meta-analysis
Endpoint	Analysis	Surgery plus PORT	Surgery alone	Effect
OSAll 31 studies (thymoma, thymic carcinoma and mixed)	finalHe 2024	—	—	HR 0.73 (95% CI 0.59–0.91)Random-effects pooled estimate from retrospective studies. Estimates restricted to multivariate-adjusted hazard ratios are reported separately in the abstract (OS HR 0.60, 95% CI 0.43-0.83). Heterogeneity I2 = 55% (full text).
DFSAll 31 studies (thymoma, thymic carcinoma and mixed)	finalHe 2024	—	—	HR 0.62 (95% CI 0.43–0.89)Random-effects pooled estimate from retrospective studies. Heterogeneity I2 = 78% (full text).
OSThymoma subgroup (17 studies)	exploratoryHe 2024	—	—	HR 0.73 (95% CI 0.56–0.96)Subgroup analysis.
OSThymic carcinoma subgroup (seven studies)	exploratoryHe 2024	—	—	HR 0.72 (95% CI 0.49–1.07)Subgroup analysis; the confidence interval includes 1.
OSStage 2 disease subgroup	exploratoryHe 2024	—	—	HR 0.81 (95% CI 0.55–1.19)Subgroup analysis; the confidence interval includes 1. The abstract reports a DFS hazard ratio of 0.97 (95% CI 0.51-1.83) for the same subgroup.
OSStage 3-4 disease subgroup	exploratoryHe 2024	—	—	HR 0.50 (95% CI 0.34–0.74)Subgroup analysis. The abstract reports a DFS hazard ratio of 0.44 (95% CI 0.27-0.70) for the same subgroup.

Hazard ratio (95% CI) by endpoint. Values below 1 favour the experimental arm.

Data table

Endpoint	HR	95% CI
OS	0.73	0.59–0.91
DFS	0.62	0.43–0.89
OS	0.73	0.56–0.96
OS	0.72	0.49–1.07
OS	0.81	0.55–1.19
OS	0.5	0.34–0.74

Appears in

2015 Postoperative radiotherapy: conflicting registry data

Sources

He T, Yao J, Chen J, Liu T, Dang J. Postoperative radiotherapy for completely resected thymoma and thymic carcinoma: A systematic review and meta-analysis. PLoS One. 2024;19(8):e0308111.
PubMed DOI