Vergleich der Masaoka-Koga-Klassifikation mit der neuen TNM-Klassifikation der IASLC/ITMIG für Thymome und Thymuskarzinome

Zusammenfassung

Hintergrund Die Masaoka-Koga-Klassifikation beschreibt die Ausbreitung von malignen Thymustumoren. Ziel der Studie ist der Vergleich dieser Tumorklassifikation mit der neuen TNM-Klassifikation, um Unterschiede in der Stadienverteilung, klinische Anwendbarkeit und therapeutische Konsequenzen zu evaluieren.

Methoden Retrospektive Analyse aller operativ behandelten Patienten mit einem Thymom/Thymuskarzinom, die im Zeitraum von Januar 2005 bis Dezember 2015 in 2 thoraxchirurgischen Zentren behandelt wurden. Das exakte Tumorstadium wurde durch die Bildgebung, Auswertung der Operationsberichte und histologische Befunde festgelegt.

Ergebnisse Insgesamt wurden 118 Patienten (männlich 51%) mit einem mittleren Alter von 56 ± 14,8 Jahren eingeschlossen. Indikationen für die Operation waren der Primärtumor (n = 97), ein pleuraler Tumorbefall (n = 15) und das mediastinale Tumorrezidiv (n = 6). Die radikale Tumorresektion erfolgte in 92% der Fälle einzeitig (n = 109), während 9 Patienten (8%) zweizeitig operiert wurden. Eine operative Revision war bei n = 12 (10,1%) notwendig und die Letalität im Krankenhaus betrug 1,7% (n = 2). Da das Masaoka-Koga-Stadium I (n = 34) und II (n = 16) in der TNM-Klassifikation unter dem Stadium T1 (n = 58) zusammengefasst wird, umfasst dieses Stadium mehr Fälle als in der Masaoka-Koga-Klassifikation. Die lokal fortgeschrittenen Stadien (Masaoka-Koga-Stadium III n = 22 vs. UICC-Stadium IIIA + IIIB n = 20) und die metastasierten Stadien (Masaoka-Koga-Stadium IV n = 36 vs. UICC-Stadium IV n = 39) waren im Vergleich annähernd unverändert.

Schlussfolgerung Durch die neue TNM-Klassifikation ergaben sich Änderungen insbesondere in den Anfangsstadien (Downstaging), jedoch ohne therapeutische Konsequenz. Obwohl die Zuordnung zu den fortgeschrittenen Stadien fast unverändert blieb, bietet die neue TNM-Klassifikation hier klinisch relevante Differenzierungen.

Abstract

Background The Masaoka-Koga classification describes the extent and spread of thymic epithelial malignancies. The objective of this study was to evaluate the Masaoka-Koga and the new TNM-staging system regarding differences in stage distributions, clinical implementation and therapeutic consequences.

Methods Retrospective analysis of all patients who underwent surgery between January 2005 and December 2015 for thymoma/thymic carcinoma in two centres for thoracic surgery. The final tumour stages were determined on the basis of preoperative imaging, surgical reports and histological findings.

Results A total of 118 patients (male 51%) with a mean age of 56 ± 14.8 years were included. Indications for surgery were primary mediastinal tumour (n = 97), pleura dissemination (n = 15) or mediastinal recurrence (n = 7). Radical tumour resection was performed in 92% of patients (n = 109) within one operation, whereas 8% of patients (n = 9) underwent two operations. Surgical revision was necessary in 12 patients (10.1%) and in-hospital mortality was 1.7% (n = 2). Early Masaoka-Koga stages I (n = 34) and II (n = 16) shifted to the new UICC stage I (T1: n = 58). Locally advanced stages (Masaoka-Koga stage III n = 22 vs. UICC stage IIIA + IIIB n = 20) and metastasised stages (Masaoka-Koga stage IV n = 36 vs. UICC stage IV n = 39) remained very similar.

Conclusions The new TNM staging system gave rise to changes, especially in early stages (downstaging), but these had no therapeutic implications. Although advanced stages were very similar, the new TNM staging provides more clinically relevant differentiation.

Schlüsselwörter

Thymom - Thymuskarzinom - Masaoka-Koga - TNM-Klassifikation

Key words

thymoma - thymic carcinoma - Masaoka-Koga - TNM-staging

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