Intuitive evaluation of contemporary management strategies in thymoma - the largest Indian experience.

Background: The aim was perusal of the treatment strategies, clinical outcomes and factors impacting these outcomes in thymoma. Materials and methods: A total of 119 patients diagnosed and treated cases of thymoma, at our hospital, were taken for analysis. Thirty-one patients were excluded due to inadequate medical records. Descriptive statistics were used to report demographic and clinical characteristics. Time period between diagnosis and death was defined as overall survival (OS). Multivariate analysis (MVA), using cox regression modelling, was done by including clinicopathological factors in a bid to identify prognostic factors influencing OS. SPSS version 26 was used for statistical analysis. Results: The mean age of the patients was 52.17 years and 39 (44.3%), 19 (21.6%), 17 (1.3%) and 13 (4.8%) patients presented with Masaoka stage II, IV, III and I, respectively. Surgery was done in 64 (72.7%) of the patients as a part of the treatment strategy. Radiotherapy was administered to a total of 57 patients with a median dose of 50.4 Gy. Early Masaoka stage at presentation and use of surgery in the treatment plan were statistically significant prognostic factors for a better overall survival on multivariate analysis. Conclusion: Judicious use of radiotherapy and chemotherapy in locally advanced cases may render them resectable. In a bid to gain good survival rates, aggressive multimodality treatment should be offered to the patients.

Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms.

BACKGROUND AND OBJECTIVES: It is unclear if a specific strategy for simultaneous treatment of primary thymic neoplasms and pleural metastases confers benefit for Masaoka stage IVA disease. We reviewed our experience with thymic neoplasms with concurrent pleural metastases to identify factors influencing outcomes. METHODS: Records of patients who presented with stage IVA thymic neoplasms from 2000 to 2018 were assessed. Multivariate Cox proportional hazards analyses were completed to determine predictors of progression-free and overall survival. RESULTS: Forty-eight patients were identified, including 34 (71%) who underwent surgery. Median overall and progression-free survival were 123 and 21 months, respectively. The extent of resection varied, and was most commonly thymectomy plus partial pleurectomy (22, 65%). Median progression-free survival for patients who underwent surgical resection versus those who had not was 24 versus 12 months (P = .018). Following surgical resection, mediastinal recurrence was uncommon (2, 6%, vs 7, 50% nonoperatively). Five-year survival rates in these groups were suggestive of possible benefit to surgery (87% vs 68%). CONCLUSIONS: Thymic neoplasms with pleural dissemination represents a treatment challenge. As part of a multidisciplinary approach, surgery appears to be associated with more favorable long-term results, although selection bias may account for some of the survival differences observed.

Associations between computed tomography features of thymomas and their pathological classification.

Background Thymoma exhibits a range of histological and biological features and their imaging findings varies. Purpose To evaluate the associations between CT findings of thymomas and their classification according to the Masaoka staging system and World Health Organization (WHO) classification. Material and Methods Eighty-four patients with thymoma were evaluated. Comparisons between the CT findings of Masaoka stage I/II and III/IV lesions, and the WHO type A-B1 (low risk) and B2/B3 (high risk) lesions were performed. Results Stage III/IV thymomas (mean size, 60 mm) were significantly larger than stage I/II (45 mm) lesions and had more irregular shape and contour. Necrosis and calcification were observed in 16 (59%) and nine (33%) stage III/IV thymomas, and 16 (28%) and seven (12%) stage I/II lesions, respectively. Regarding the WHO classification, the high-risk thymomas displayed irregular shape and contour more often than low-risk lesions. There were significant differences between the patterns of mediastinal invasion seen in high- and low-risk groups; 21 (68%) vs. six (12%) lesions demonstrated mediastinal fat invasion, seven (23%) vs. two (4%) lesions exhibited great vessel invasion, five (16%) vs. 0 (0%) lesions displayed pericardial invasion, and 18 (58%) vs. 10 (20%) lesions invaded the lungs, respectively. Conclusion Masaoka stage III/IV thymomas were larger in size, had more irregular shape and contour, and exhibited necrosis and calcification more often than the stage I/II lesions. In the WHO classification, high-risk thymomas demonstrated more irregular shape and contour than low-risk thymomas.

Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese Association for Research on the Thymus Database Study.

BACKGROUND: The efficacy of postoperative radiotherapy (PORT) for thymic epithelial tumors is still controversial. Using the Japanese Association for Research on the Thymus (JART) database, this study was aimed at clarifying the efficacy of PORT for Masaoka stage II and III thymic carcinoma and thymoma. METHODS: The JART database registered the records of 2835 patients collected from 32 Japanese institutions from 1991 to 2010. Thymic carcinoma and thymoma at stage II or III were extracted. The efficacy of PORT with respect to relapse-free survival (RFS) and overall survival (OS) was evaluated with the Kaplan-Meier method and Cox regression analysis. RESULTS: There were 1265 patients in all: 155 thymic carcinoma cases (12.3%) and 1110 thymoma cases (87.7%). Eight hundred ninety-five (70.8%) were at stage II, and 370 (29.2%) were at stage III. Four hundred three cases (31.9%) underwent PORT. PORT for stage II and III thymic carcinoma was associated with increasing RFS (hazard ratio, 0.48; 95% confidence interval, 0.30-0.78; P = .003) but was not associated with OS (hazard ratio, 0.94; 95% confidence interval, 0.51-1.75; P = .536). PORT for stage II and III thymoma was not associated with RFS or OS (P = .350). A subgroup analysis of stage III thymoma showed no factor associated with the efficacy of PORT. CONCLUSIONS: In this study, PORT did not increase RFS or OS for stage II or III thymoma but increased RFS for stage II and III thymic carcinoma.

Clinical analysis of subxiphoid vs. lateral approaches for treating early anterior mediastinal thymoma.

Objective: To investigate the clinical efficacy of the subxiphoid approach for early anterior mediastinal thymoma and evaluate its advantages over the lateral intercostal approach. Methods: A total of 345 patients with early anterior mediastinal thymoma were retrospectively analyzed from January 2016 to December 2020 in the First Affiliated Hospital of Soochow University. Out of these, 99 patients underwent subxiphoid video-assisted thoracoscopic thymectomy and 246 patients underwent transthoracic video-assisted thoracoscopic thymectomy. We compared the intraoperative conditions (such as operation time and intraoperative blood loss), postoperative conditions [such as postoperative pleural drainage volume, extubation time, postoperative hospital stay, and postoperative visual analogue scale (VAS) pain score], and postoperative complications (such as death, pneumonia, delayed wound healing, cardiac arrhythmia, and phrenic nerve injury) of the two groups and analyzed the clinical advantages of the subxiphoid approach for treating early anterior mediastinal thymoma. Results: There was no significant difference between the two groups in terms of general clinical features, operation time, and postoperative complications (P > 0.05).However, there was a significant difference in terms of intraoperative blood loss, postoperative pleural drainage volume, tube extubation time, postoperative hospital stay, postoperative VAS pain score, and postoperative analgesics (a significantly decreased flurbiprofen axetil amount) (P < 0.05). Conclusion: Compared with the lateral intercostal thoracic approach, the subxiphoid approach had advantages in terms of intraoperative blood loss, postoperative hospital stay, tube extubation time, postoperative pleural drainage volume, postoperative VAS pain score, and analgesics dosage. It could provide a better view of the bilateral pleural cavities and more thorough thymectomy and superior cosmesis, and it proved to be a safe and feasible minimally invasive surgical method.

Invasive thymoma - Which patients benefit from post-operative radiotherapy?

BACKGROUND: The aim of this study is to identify patients with thymoma who should receive post-operative radiotherapy. METHODS: The Surveillance, Epidemiology, and End Results database was queried for stage IIB-IV thymoma patients diagnosed during 1988-2015. We analyzed the prognostic implications of various clinical-pathological factors by comparing the outcomes of those who received surgery with and without post-operative radiotherapy. RESULTS: A total of 1120 patients were identified; 62% received post-operative radiotherapy and 38% underwent surgery alone. In a propensity-matched cohort of 812 patients, no survival difference was seen in World Health Organization A, AB, B1, B2, or B3 tumors with the addition of post-operative radiotherapy to surgery (p>0.05). Post-operative radiotherapy also did not improve survival over surgery alone for tumors ≥ or < less than the 4 cm, 7 cm, 10 cm, and 13 cm cutoffs, all p>0.05. Post-operative radiotherapy was an independent, positive prognostic indicator only in the subgroup with stage III disease and in those receiving chemotherapy in addition to post-operative radiotherapy, both p<0.05. CONCLUSIONS: Patients with stage III thymoma are most likely to benefit from the addition of post-operative radiotherapy to surgical treatments. Tumor size or World Health Organization histology alone should not be criteria for determining the need for post-operative radiotherapy in locally advanced thymoma. Masaoka-Koga stage, which has traditionally been used to help make such decisions, appears to be the most reliable determinant of the use of post-operative radiotherapy.

Surgical and Oncological Outcomes in Locally Advanced Thymoma.

This study aimed at reporting the surgical management of locally advanced thymoma (Masaoka stages III and IVA) and evaluating the factors predicting the survival. This is a retrospective analysis of patients operated for locally advanced thymoma from March 2012 to December 2019 in a thoracic surgery center in India. An analysis of all perioperative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Out of total 54 patients, 42 (77.8%) had stage III and 12 (22.2%) had stage IVA. Upfront surgery was done in 34 (63%) patients, and induction chemotherapy was given in 20 (37%) patients. Pericardium was the commonest structure resected (79.6%) followed by the lung (51.8%), phrenic nerve (48.1%), major vascular structures (40.7%), parietal pleura (22.2%), diaphragm (9.2%), and right atrial appendage (1.8%). Forty-seven (87%) cases had complete (R0) resection, and the remaining 7 (12.9%) cases had incomplete (R1/R2) resection. There were no perioperative deaths (< 90 days). The median follow-up was 58 months. Overall survival (OS) and disease-free survival (DFS) at 5 years were 77.8% and 75.9%. Higher age (> 60 years), incomplete surgical resection, type B histology, and "> 3" structures resected with tumor were the poor prognostic factors for survival. An aggressive surgical approach, by an experienced team of cardiac and thoracic surgeons, aimed at complete resection is vitally important and can achieve excellent surgical and oncological outcomes even in locally advanced thymomas.

Fibrous bands associated with higher Masaoka stage and poor recurrence-free survival in patients with thymoma.

BACKGROUND: Fibrous bands (FBs) are one of the histological features in tumors which can be confirmed by hematoxylin and eosin (H&E)-stained slides. FBs have been reported to correlate with malignancy in various tumors. This study aimed to investigate whether the presence of FBs is associated with malignancy in thymoma. METHODS: A total of 123 consecutive patients with thymoma who underwent microscopically complete resections from January 2000 to December 2018 were enrolled into this study. H&E-stained slides of all thymoma patients were re-examined. Study patients were classified into two groups: with FBs (n = 36) and without FBs (n = 87). Clinicopathological characteristics, overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Furthermore, multivariate analyses were performed to identify whether the presence of FBs was associated with higher Masaoka stage and poor prognosis in patients with thymoma. RESULTS: The Masaoka stage was found to be higher and recurrence more likely in thymoma patients with FBs than in those without. RFS was significantly poorer in thymoma patients with FBs than in those without, although no significant difference was observed in OS between them. The presence of FBs was significantly associated with higher Masaoka stage in the multivariate analysis using logistic regression. Additionally, the presence of FBs was an independent prognostic factor for poor RFS in multivariate analysis using Cox's proportional hazards model. CONCLUSIONS: The presence of FBs in patients with thymoma was associated with higher Masaoka stage, higher recurrence rate, and poorer RFS. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Fibrous bands (FBs) are bands of fibrosis dividing tumors into different-sized irregular islands. The presence of FBs is associated with higher Masaoka stage and poor recurrence-free survival in patients with thymoma. WHAT THIS STUDY ADDS: The presence of fibrous bands might be associated with the malignant behavior of thymoma. Confirming the presence or absence of FBs may result in personalized medication for patients with thymoma.

Risk Factors for the Exacerbation of Myasthenic Symptoms After Surgical Therapy for Myasthenia Gravis and Thymoma.

Extended thymectomy is employed for patients with myasthenia gravis (MG) and/or thymoma with elevated serum antiacetylcholine receptor antibody (AchR) titers. However, MG symptoms occasionally worsen in post-thymectomy patients. We explored the risk factors for exacerbation of MG symptoms after surgical therapy for patients with MG and/or thymoma with an elevated AchR titer. We retrospectively analyzed 90 patients suffering from MG and/or thymoma with an elevated AchR titer who underwent thymectomy in our institute. Patients were classified into Improved, Unchanged, and Exacerbated groups by assessing their postoperative myasthenic symptoms, amount of medication, and incidence of myasthenic crisis. Risk factors for postoperative exacerbation of myasthenic symptoms were assessed by comparing the Exacerbated with the Improved and Unchanged groups. Of the 90 patients, 29 were classified into the Improved group, 47 into the Unchanged group, and 14 into the Exacerbated group. The presence of thymoma and Masaoka stage were significantly different between the Exacerbated and Improved/Unchanged groups. Although preoperative AchR titers did not significantly differ among the groups, the perioperative AchR titers in the Exacerbated group were significantly higher than those in the other groups (P = 0.003). A multiple logistic regression analysis with stepwise forward selection showed that advanced-stage thymoma was a risk factor for postoperative exacerbation of myasthenic symptoms (P = 0.007). Patients with advanced-stage thymoma have a relative risk for exacerbation of myasthenic symptoms after surgical therapy.

Rarity among the rare-large and invasive thymoma, a case report and review.

Thymomas are rare tumors of the thymic epithelium with an incidence of 1.5 cases in a million, with a wide spectrum of morphological, pathologic characteristics, and clinical presentations. Despite its benign histological appearance, it can invade nearby structures or metastasize hence clinicians need to have a high index of suspicion for early diagnosis. The natural history of the disease is seldom predictable and ranges anywhere from indolent to aggressive malignant course. In this review, we report a case of invasive thymoma in a patient whose presenting complaint was intermittent chest pain x 2 years that had gone undiagnosed. Complete surgical resection is the cornerstone of treatment in early presentation, but with the case of our patient who presented with a locally advanced thymoma treatment, her treatment options were challenging and had to be a multimodal approach with a combination of surgery, chemotherapy and radiation therapy to reduce the chances of recurrence and improve survival. Given the rarity of this presentation, the clinicopathological characteristics that influence the survival of patients with these tumors are still under debate, and guidelines for management for advanced disease are yet to be defined hence warranting our review on this discussion.

Role of Surgery in the Treatment of Masaoka Stage IVa Thymoma.

PURPOSE: To analyze the role of surgery in patients with Masaoka stage IVa thymoma treated with multimodality therapy. METHODS: Of 191 patients undergoing surgery for thymoma in our department between January 2002 and December 2015, 39 (20.4%) had Masaoka stage IVa. Histopathological tumor type, myasthenic status of the Osserman-Genkins score, Masaoka stage at the first surgery, neoadjuvant treatment, number and type of surgeries, and survival rates were recorded. RESULTS: Thymoma B2 was the most common histopathological tumor type (n = 16, 41%). Twenty-six (66.7%) patients underwent primary surgeries for Masaoka stage IVa thymoma, whereas nine (23.1%) underwent secondary surgeries and four (10.3%) underwent tertiary surgeries for pleural or pericardial recurrences. Median survival was 132 ± 25 (82-181; 95% confidence interval [CI]) months. Overall 3-, 5-, and 10-year survival rates were 93%, 93%, and 56%, respectively. CONCLUSION: Surgical treatment should be considered as a completion modality to oncological therapy and has the potential to provide long-term survival of Masaoka stage IVa in patients with thymoma. The type of surgery should be determined based on the invasiveness of the lesion.

Intravoxel incoherent motion diffusion-weighted MR imaging parameters predict pathological classification in thymic epithelial tumors.

We evaluated the performance of intravoxel incoherent motion (IVIM) parameters for preoperatively predicting the subtype and Masaoka stage of thymic epithelial tumors (TETs). Seventy-seven patients with pathologically confirmed TETs underwent a diffusion weighted imaging (DWI) sequence with 9 b values. Differences in the slow diffusion coefficient (D), fast perfusion coefficient (D*), and perfusion fraction (f) IVIM parameters, as well as the multi b-value fitted apparent diffusion coefficient (ADCmb), were compared among patients with low-risk (LRT) and high-risk thymomas (HRT) and thymic carcinomas (TC), and between early stage (stages I and II) and advanced stage (stages III and IV) TET patients. ADCmb, D, and D* values were higher in the LRT group than in the HRT or TC group, but did not differ between the HRT and TC groups. The mean ADCmb, D, and D* values were higher in the early stage TETs group than the advanced stage TETs group. The f values did not differ among the groups. These results suggest that IVIM DWI could be used to preoperatively predict subtype and Masaoka stage in TET patients.

Multimodality treatment of stage II thymic tumours.

BACKGROUND: Complete resection for stage II thymic tumors can be easily accomplished even if the capsula and adjacent mediastinal tissue are macroscopically involved; however, also at this stage, recurrence may occur, particularly for B2, B3 and thymic carcinoma. The criteria for the administration of adjuvant therapy remain controversial and it is unclear whether patients at this stage may benefit from it. We reviewed a series of patients at this stage receiving adjuvant chemo-radiotherapy (chemo-RT) based on histology. METHODS: Eighty-eight consecutive patients with stage II thymic tumors were reviewed; 59 patients (67%) with B thymoma or thymic carcinoma received adjuvant treatment with mediastinal irradiation (40-55 Gy), chemotherapy (CH) (PAC regimen) or a combination of both. RESULTS: Complete resection was achieved in all patients. Fifty-four patients (61%) received post-operative chemo-RT, 2 (2%) patients received adjuvant CH only and 3 (3%) post-operative RT only; they all had B2, B3 histology or thymic carcinoma. The median follow up was 107±83 months. 5-year and 10-year survival were 96%±2% and 83.4%±5%. Recurrence was observed in 5 patients (5.7%). Disease-free 5 and 10-year survival was 94%±2% and 92%±3% respectively. Five patients (5.7%) had recurrence. CONCLUSIONS: The administration of adjuvant chemo-RT to patients with stage II type B thymoma and thymic carcinoma contributes to reduce the recurrence rate and to increase long-term survival.

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma.

Thymoma remains the most common primary anterior mediastinal neoplasm. Surgical resection remains central to the treatment of thymoma, with thoracoscopic thymectomy (TT) being increasingly performed. This present review article aimed to summarize current studies comparing TT and open thymectomy (OT). Recently, most patients with Masaoka stage I-II thymoma have been receiving TT. This procedure is associated with a significantly shorter post-operative hospital stay, decreased intraoperative blood loss, and fewer complications compared with OT. Recurrence rates of thymoma after TT range from 0% to 6.7%, and the 5-year disease-free survival (DFS) ranges from 83.3% to 96%. The oncological outcomes of TT are comparable to that of OT. Masaoka stage and the World Health Organization (WHO) type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy.

Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese Nationwide Database Study.

OBJECTIVES: Thymic carcinoma is a rare thymic malignancy. The purpose of this study was to evaluate the prognostic impact of clinicopathological variables and perioperative therapy for surgically treated thymic carcinoma using a nationwide database. METHODS: Of 2835 patients with surgically treated thymic epithelial tumours collected from 32 Japanese institutions, a total of 306 patients with thymic carcinomas, excluding neuroendocrine tumours, were enrolled in this retrospective study. Multivariable Cox regression analyses were performed for overall (OS) and recurrence-free survival (RFS) after R0 resection. RESULTS: Of 306 patients, 228 (75%) patients presented with Masaoka stage III-IV. Squamous cell carcinoma was the most common histological type (n = 216, 71%). R0 resection was performed in 181 (61%) patients, R1 in 46 (16%), R2 sub-total (≥80% tumour resection) in 43 (14%) and R2 non-resection in 27 (9%). The 5-year OS rate was 61%. Prognostic factors for OS were Masaoka stage and resection status. R0 resection was associated with most improved OS; however, both R1 and R2 sub-total resection resulted in superior OS compared with R2 non-resection [hazard ratio (95% confidence interval) for R0, R1 and R2 sub-total, 0.27 (0.15-0.48), 0.40 (0.22-0.74) and 0.38 (0.20-0.72), respectively]. Histological type and perioperative therapy did not affect OS, whereas tumour size and postoperative radiotherapy were associated with improved RFS after R0 resection. CONCLUSIONS: R0 resection is essential for prolonged OS for surgically treated thymic carcinoma, but maximal debulking surgery might be beneficial and worth evaluating for advanced disease deemed difficult for R0 resection. The benefit of postoperative radiotherapy after R0 resection should also be evaluated prospectively.

Clinical pathological characteristics and prognosis of 468 thymoma patients / 中国胸心血管外科临床杂志

@#Objective    To assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis. Methods    A total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed. Results    The amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%,  respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). Conclusion    WHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.

Treatment and prognosis of Masaoka stage 3 thymic carcinoma: a retrospective study of 32 cases.

PURPOSE: The aim of this study was to investigate the treatment and prognostic factors in patients with Masaoka stage 3 thymic carcinoma. METHODS: A retrospective review was conducted of the medical records of patients with Masaoka stage 3 thymic carcinoma between 2000 and 2012 in our institution. Clinical characteristics and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. RESULTS: Thirty-two patients with Masaoka stage 3 thymic carcinoma, operated on in Zhejiang Cancer Hospital, were identified between 2000 and 2012. Among 32 patients, 24 achieved R0 resection. The most common histological subtypes were squamous cell carcinoma (n=15, 46.8%), followed by undifferentiated carcinoma (n=12, 37.5%), and other tumors (n=5, 15.7%). The 5-year disease-free survival and overall survival rates were 56.8% and 61.5%, respectively. Patients with incomplete resection had a significantly worse disease-free survival and overall survival as compared to complete resection with univariate analyses (P-value 0.006 and 0.034, respectively). Multivariate analysis revealed that complete resection was statistically associated with disease-free survival but not overall survival (P-value 0.025 and 0.076, respectively). CONCLUSION: Our results indicated that complete resection could impact the disease-free survival of patients with stage 3 thymic carcinoma.

Thymic epithelial tumors: a clinicopathologic study of 249 cases from a single institution.

The WHO histological classification for thymic epithelial tumors of 2004 edition is widely used, but its prognostic value is still controversial. In the present study we collected 249 Chinese patients with thymic epithelial tumors from West China Hospital of Sichuan University since 1999-2009 to assess the prognosis relating to tumor stages, histological classifications, MG and adjuvant therapy. There were 18 cases of type A (7.2%), 97 of type AB (39.0%), 22 of type B1 (8.8%), 63 of type B2 (25.3%), 16 of type B3 (6.5%) thymomas and 33 of thymic carcinomas (13.3%). According to the Massaoka staging, there were 107 patients in stage I (43%), 73 patients in stage II (29.3%), 50 patients in stage III (20.1%) and 19 in stage IV (7.6%). 101 patients (40.6%) complicated with MG, the incidence of MG was highest in type B3 thymomas, then in B2, none of thymic carcinomas complicated with MG. Cox regression analysis showed the Masaoka stage was the most important prognostic factor. Besides of staging, WHO histological classification was also an independent prognostic factor. The age, gender, MG and adjuvant therapy have no significant influence to the prognosis of the patients.

The presence of extrathoracic metastasis is more prognostic of survival than Masaoka stage (IVa/IVb) in metastatic thymic epithelial tumor: a retrospective cohort study.

PURPOSE: Our aim in this study was to identify independent prognostic factors for overall survival (OS) in order to explain the heterogeneity of OS in patients with metastatic thymic epithelial tumor (TET). METHODS: Sixty-one consecutive patients with histologic diagnosis of Masaoka stage IV TET between January 1980 and March 2009 were analyzed at a single institution. Masaoka stage IVa was defined as pleural or pericardial dissemination, and IVb as lymphogenous or hematogenous metastasis. Metastasis outside the thoracic cage was defined as extrathoracic metastasis. To identify prognostic factors, relationships between clinicopathologic factors and outcomes were analyzed. RESULTS: Of the 61 patients, 30 (49.2%) had thymoma, 28 (45.9%) had thymic carcinoma, and the remaining 3 (4.9%) had an unclear histologic subtype. The Masaoka stage was IVa in 27 patients (44.3%) and IVb in 34 patients (55.7%). Significant independent adverse prognostic factors for OS were histologic subtype and extrathoracic metastasis (hazard ratio [HR]=3.09 and 6.03, 95% CI: 1.41-6.74 and 1.89-19.30, p=0.005 and 0.002, respectively). The presence of extrathoracic metastasis was also an independent prognostic factor for decreased progression-free survival time (PFS) (HR=6.62, 95% CI: 1.19-24.17, p=0.004). The only significant criterion for prognostic discrimination was the presence of extrathoracic metastasis in metastatic TET. CONCLUSIONS: Significant independent prognostic factors for lower OS were the histologic subtype of thymic carcinoma and the presence of extrathoracic metastasis. A new concept of extrathoracic metastasis might provide additional information for the understanding of metastatic TET.

Outcomes and prognostic factors of surgically treated thymic carcinoma / 中国胸心血管外科临床杂志

@#Objective     To evaluate the influence of resection status, pathological type, pathological stage and postoperative adjuvant therapy on prognosis of surgically treated thymic carcinoma. Methods     In this retrospective study, 56 patients with surgically treated thymic carcinoma in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2005 to December 2015 were enrolled. There were 30 males and 26 females aged 52.1±11.5 years ranging from 22 to 81 years. The survival curve was performed by Kaplan-Meier method. The prognostic factors affecting overall survival (OS) and disease-free survival (DFS) were analyzed by one-way analysis of variance (ANOVA). Results     R0 resection was performed in 37 patients (67.9%), and other resections in 19 (32.1%); 13 patients suffered thymic carcinoma with Masaoka stage Ⅰ-Ⅱ, 26 Ⅲ, and 17 Ⅳ. Low-grade thymic carcinoma was found in 42 patients, and high-grade in 14. Postoperative radiotherapy, chemotherapy and chemoradiotherapy were performed on 17, 12 and 18 patients respectively and 9 patients were untreated. Forty-one patients was followed up for 1 to 10 years, and the follow-up rate was 73%. The 1-, 3- and 5-year OS rates were 93%, 74% and 61%, respectively. Resection status and pathological stage affected OS. Postoperative radiotherapy after R0 resection affected DFS, but did not affect OS. Conclusion     Most patients with thymic carcinoma after surgery can survive for a long period, and R0 resection is the most important prognostic factor of thymic carcinoma. Postoperative radiotherapy after R0 resection in patients with Masaoka stage Ⅱ-Ⅲ is recommended.