Thymomas and Thymic Carcinomas: Prognostic Factors and Multimodal Management

Abstract

Background Thymomas and thymic carcinomas are rare malignant tumors. We report the experience with the resection and multimodal treatment at a single department in Central Europe in the years 2001 to 2010.

Objective We sought to determine prognostic factors in this patient population.

Methods A 10-year retrospective analysis of 84 resections on 72 patients for thymomas/thymic carcinomas or their recurrences was performed.

Results Patients admitted to a single thoracic surgery center presented with Masaoka–Koga stage I (29.2%), II (43.1%), III (13.9%), and IV (13.9%). In approximately 88.9% of cases, a complete resection could be reached. Using overall survival as an outcome measure, the 5-year survival rate was 87%. Of all the cases presented, 9.7% cases showed tumor recurrence and 6.9% cases showed tumor progression. There was decreased survival rate with increasing Masaoka–Koga stage (p = 0.017) and incomplete resection (p < 0.001).

Conclusion Completeness of resection and Masaoka–Koga stage were significant prognostic factors. Multidisciplinary treatments of patients with thymoma or thymic carcinoma result in good patient care, and global efforts with larger number of patients are needed to elucidate more about the biology, diagnosis, and treatment of these tumors.

Keywords

mediastinal tumor - thymus - mediastinum - chemotherapy - radiation therapy - surgery/incisions

• References

• 1 Lara Jr PN. Malignant thymoma: current status and future directions. Cancer Treat Rev 2000; 26 (2) 127-131
• 2 Engels EA. Epidemiology of thymoma and associated malignancies. J Thorac Oncol 2010; 5 (10, Suppl) (4) S260-S265
• 3 Chau N, Kim E, Wistuba I. The multidisciplinary approach to thymoma. J Thorac Oncol 2010; 5 (10) S313-S317
• 4 Huang J, Detterbeck FC, Wang Z, Loehrer Sr PJ. Standard outcome measures for thymic malignancies. J Thorac Oncol 2010; 5 (12) 2017-2023
• 5 Ruffini E, Filosso PL, Mossetti C , et al. Thymoma: inter-relationships among World Health Organization histology, Masaoka staging and myasthenia gravis and their independent prognostic significance: a single-centre experience. Eur J Cardiothorac Surg 2011; 40 (1) 146-153
• 6 Koga K, Matsuno Y, Noguchi M , et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int 1994; 44 (5) 359-367
• 7 Chen G, Marx A, Chen WH , et al. New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China. Cancer 2002; 95 (2) 420-429
• 8 Ströbel P, Marx A, Zettl A, Müller-Hermelink HK. Thymoma and thymic carcinoma: an update of the WHO Classification 2004. Surg Today 2005; 35 (10) 805-811
• 9 Venuta F, Rendina EA, Klepetko W, Rocco G. Surgical management of stage III thymic tumors. Thorac Surg Clin 2011; 21 (1) 85-91 , vii
• 10 Detterbeck FC, Parsons AM. Management of stage I and II thymoma. Thorac Surg Clin 2011; 21 (1) 59-67 , vi–vii
• 11 Kattach H, Hasan S, Clelland C, Pillai R. Seeding of stage I thymoma into the chest wall 12 years after needle biopsy. Ann Thorac Surg 2005; 79 (1) 323-324
• 12 Fujiwara K, Matsumura A, Tanaka H, Ohmori K, Yamamoto S, Iuchi K. [Needle tract implantation of thymoma after transthoracic needle biopsy]. Kyobu Geka 2003; 56 (6) 448-451
• 13 Nagasaka T, Nakashima N, Nunome H. Needle tract implantation of thymoma after transthoracic needle biopsy. J Clin Pathol 1993; 46 (3) 278-279
• 14 Cardillo G, Carleo F, Giunti R , et al. Predictors of survival in patients with locally advanced thymoma and thymic carcinoma (Masaoka stages III and IVa). Eur J Cardiothorac Surg 2010; 37 (4) 819-823
• 15 Schmitt J, Loehrer Sr PJ. The role of chemotherapy in advanced thymoma. J Thorac Oncol 2010; 5 (10) (Suppl. 04) S357-S360
• 16 Fuller CD, Ramahi EH, Aherne N, Eng TY, Thomas Jr CR. Radiotherapy for thymic neoplasms. J Thorac Oncol 2010; 5 (10) (Suppl. 04) S327-S335
• 17 Venuta F, Anile M, Diso D , et al. Thymoma and thymic carcinoma. Eur J Cardiothorac Surg 2010; 37 (1) 13-25
• 18 Ruffini E, Van Raemdonck D, Detterbeck F, Rocco G, Thomas P, Venuta F. European Society of Thoracic Surgeons Thymic Questionnaire Working Group. Management of thymic tumors: a survey of current practice among members of the European Society of Thoracic Surgeons. J Thorac Oncol 2011; 6 (3) 614-623
• 19 Detterbeck F, Giaccone G, Loehrer P, Suster S, Wright C. International thymic malignancy interest group. J Thorac Oncol 2010; 5 (1) 1-2