Postoperative radiotherapy after complete resection of Masaoka or Masaoka-Koga stage II or III thymoma: systematic review and meta-analysis of observational studies: trial

Postoperative radiotherapy after complete resection of Masaoka or Masaoka-Koga stage II or III thymoma: systematic review and meta-analysis of observational studies

Phase meta-analysisN = 4,746

Population

4,746 patients in five studies of completely resected Masaoka or Masaoka-Koga stage II or III thymoma

Design

Systematic review of four online databases and random-effects (generic inverse variance) meta-analysis of five studies that compared surgery alone with surgery plus PORT after complete resection of Masaoka or Masaoka-Koga stage II or III thymoma, using multivariate-adjusted hazard ratios. OS was the primary and disease-free survival (DFS) the secondary end point. The authors describe the evidence as observational. 2,408 of the 4,746 patients received PORT.

Primary endpoint

Arms

Surgery alone (control): Complete resection without postoperative radiotherapy
Surgery plus PORT (experimental, n = 2,408): Complete resection followed by postoperative radiotherapy

People

Tateishi Y, senior author Kaneko T

OSHR 0.68 (95% CI 0.57–0.83)OSHR 0.63 (95% CI 0.44–0.91)OSHR 0.72 (95% CI 0.55–0.95)DFSHR 0.96 (95% CI 0.70–1.33)

Show the numbers

Results reported for Postoperative radiotherapy after complete resection of Masaoka or Masaoka-Koga stage II or III thymoma: systematic review and meta-analysis of observational studies
Endpoint	Analysis	Surgery plus PORT	Surgery alone	Effect
OSFive observational studies, stage II and III combined (multivariate-adjusted hazard ratios)	finalTateishi 2021	—	—	HR 0.68 (95% CI 0.57–0.83)P<0.001Random-effects pooled estimate of adjusted hazard ratios from observational studies; I2 = 0%, p for heterogeneity = 0.97.
OSMasaoka or Masaoka-Koga stage II subgroup	finalTateishi 2021	—	—	HR 0.63 (95% CI 0.44–0.91)P=0.01Subgroup of the same meta-analysis; I2 = 0%, p for heterogeneity = 0.80.
OSMasaoka or Masaoka-Koga stage III subgroup	finalTateishi 2021	—	—	HR 0.72 (95% CI 0.55–0.95)P=0.02Subgroup of the same meta-analysis; I2 = 0%, p for heterogeneity = 0.84.
DFSFive observational studies, stage II and III combined	finalTateishi 2021	—	—	HR 0.96 (95% CI 0.70–1.33)P=0.83Secondary end point. The abstract states PORT was not associated with improved DFS; I2 = 0%, p for heterogeneity = 0.72.

Results reported for Postoperative radiotherapy after complete resection of Masaoka or Masaoka-Koga stage II or III thymoma: systematic review and meta-analysis of observational studies
Endpoint	Analysis	Surgery plus PORT	Surgery alone	Effect
OSFive observational studies, stage II and III combined (multivariate-adjusted hazard ratios)	finalTateishi 2021	—	—	HR 0.68 (95% CI 0.57–0.83)P<0.001Random-effects pooled estimate of adjusted hazard ratios from observational studies; I2 = 0%, p for heterogeneity = 0.97.
OSMasaoka or Masaoka-Koga stage II subgroup	finalTateishi 2021	—	—	HR 0.63 (95% CI 0.44–0.91)P=0.01Subgroup of the same meta-analysis; I2 = 0%, p for heterogeneity = 0.80.
OSMasaoka or Masaoka-Koga stage III subgroup	finalTateishi 2021	—	—	HR 0.72 (95% CI 0.55–0.95)P=0.02Subgroup of the same meta-analysis; I2 = 0%, p for heterogeneity = 0.84.
DFSFive observational studies, stage II and III combined	finalTateishi 2021	—	—	HR 0.96 (95% CI 0.70–1.33)P=0.83Secondary end point. The abstract states PORT was not associated with improved DFS; I2 = 0%, p for heterogeneity = 0.72.

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

Data table

Endpoint	HR	95% CI
OS	0.68	0.57–0.83
OS	0.63	0.44–0.91
OS	0.72	0.55–0.95
DFS	0.96	0.7–1.33

Appears in

2015 Postoperative radiotherapy: conflicting registry data

Sources

Tateishi Y, Horita N, Namkoong H, Enomoto T, Takeda A, Kaneko T. Postoperative Radiotherapy for Completely Resected Masaoka/Masaoka-Koga Stage II/III Thymoma Improves Overall Survival: An Updated Meta-Analysis of 4746 Patients. J Thorac Oncol. 2021;16(4):677-685.
PubMed DOI