Long-term outcomes of surgery for thymic carcinoma: experience of 25 cases at a single institution.

ABSTRACT

BACKGROUND: Thymic carcinoma, a relatively rare entity, often presents as locally advanced disease, and sometimes as distant metastatic disease. The treatment strategy, long-term surgical outcomes and clinical prognostic factors have yet to be fully elucidated. METHODS: Clinical charts of 25 patients who underwent surgery for thymic carcinoma at our institution from 1991 to 2014 were retrospectively reviewed. RESULTS: The Masaoka stage was stage I in three patients (12%), II in eight (32%), III in four (16%), IVa in four (16%), and IVb in six (24%). Histologic subtypes were squamous cell carcinoma in 12 patients, well-differentiated neuroendocrine carcinoma in 5, undifferentiated carcinoma in 3, adenocarcinoma in 1, and others in 4. Three patients had paraneoplastic syndrome including myasthenia gravis, multiple endocrine neoplasia type 1 (MEN1), and Cushing syndrome. Neoadjuvant chemotherapy was administered to five patients (20%). Complete resection was achieved in 17 patients (68%). There were no perioperative deaths. Twelve patients received postoperative therapy. The 5- and 10-year overall survival rates were 76.2 and 63.5%, respectively. The 5- and 10-year survival rates of patients with Masaoka stage I-III were 88.9 and 74.1%, respectively, whereas the 5-year survival rate of stage IV was 50.0%. The 5- and 10-year survival rates of 17 patients who underwent complete resection were 88.9 and 71.1%, respectively. Of the 17 patients with complete resection, 3 patients experienced recurrence including lung and supraclavicular lymph node. CONCLUSION: Even for this highly malignant disease, surgery could contribute to favorable long-term outcomes in the setting of multimodality therapy.