{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:08:43Z","timestamp":1788502123547,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Optimal recurrent thymoma management remains arguable because of limited patient numbers, and relatively late and variable recurrence patterns. Given the absence of high-quality evidence and relatively small study cohorts, we performed a quantitative meta-analysis to determine the outcome of surgical and non-surgical approaches assessing the five-year overall survival (5y overall survival (OS)) in patients with recurrent thymoma. Methods: We performed a comprehensive literature search and analysis according to PRISMA guidelines of studies published from 1 January 1980 until 18 June 2020 from PubMed\/MEDLINE, EMBASE, and Scopus. We included studies with the cohorts\u2019 superior to 30 patients describing recurrent thymoma treatment, comparing surgical and non-surgical approaches reporting survival data. Results: Literature search revealed 3017 articles. Nine studies met all inclusion criteria and were selected for the meta-analysis. The recurrences were local\/regional in 73\u201398% of cases and multiple in 49\u201372%. After treatment, 5y OS ranged from 48\u201377% and 10y OS from 37\u201351%. The quantitative meta-analysis showed a better outcome comparing surgical vs other treatments. Two studies showed statistically significant risk differences in the 5y OS favoring complete resection. After pooling results of seven studies using the random model, the combined 5y OS risk difference was 0.39, with lower and upper limits of 0.16 and 0.62, respectively (p = 0.001), and a moderate heterogeneity among studies (p = 0.098, I2 = 43.9%). Definitive conclusions could not be drawn regarding the prognostic impact of myasthenia gravis, histology, and patterns of relapse reported in literature. Conclusions: Surgical treatment after thymoma recurrence is associated with a significant better 5y OS; therefore, surgical resection should be preferred in all technically feasible cases.<\/jats:p>","DOI":"10.3390\/cancers13071559","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T04:29:14Z","timestamp":1616992154000},"page":"1559","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-6911","authenticated-orcid":false,"given":"Marco","family":"Chiappetta","sequence":"first","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2873","authenticated-orcid":false,"given":"Ugo","family":"Grossi","sequence":"additional","affiliation":[{"name":"Regional Hospital Treviso, DISCOG, University of Padua, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Sperduti","sequence":"additional","affiliation":[{"name":"Biostatistics, Regina Elena National Cancer Institute, IRCCS, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Margaritora","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Marulli","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, University Hospital of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"University of Campania Luigi Vanvitelli, I-80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6421-2270","authenticated-orcid":false,"given":"Alberto","family":"Sandri","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, San Luigi Hospital, Regione Gonzole 10, Orbassano, 10043 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Cusumano","sequence":"additional","affiliation":[{"name":"Policlinico Vittorio Emanuele Hospital, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9808-8260","authenticated-orcid":false,"given":"Masatsugu","family":"Hamaji","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Kyoto University Hospital, Kyoto 602-8566, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Cesario","sequence":"additional","affiliation":[{"name":"Open Innovation Manager, Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-5554","authenticated-orcid":false,"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ejca.2007.11.004","article-title":"Thymic epithelial tumours: A population-based study of the incidence, diagnostic procedures and therapy","volume":"44","author":"Blaauwgeers","year":"2008","journal-title":"Eur. J. 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