Clinical characteristics, prognostic factors, and long‐term outcomes associated with epithelial malignancies of the thymus: A 20‐year single‐institution experience

Abstract

Background: Thymic epithelial tumors are rare and include thymomas and thymic carcinomas. There is scarce literature characterizing prognostic factors and long-term outcomes in these tumors.Aims: This review aims to describe disease features of thymomas and thymic carcinomas and to report clinical differences among thymoma histological subtypes.Methods and Results: A retrospective chart review was performed at the University of Florida Shands Hospital, a tertiary care academic medical center in Gainesville, Florida, USA. The review included clinical data of adults with thymic epithelial tumors diagnosed between 2001 and 2021. Significant associations among demographics, histology, stage, and outcomes were investigated. Thymoma subgroup analysis was performed using histological subtype and sex. Forty patients with thymoma and seven patients with thymic carcinoma were included in the final analysis. Among those with thymomas, patients with subtype B1, B2, or B3 tumors were younger, had larger tumors, and presented with higher stage disease when compared to those with subtypes A or AB. Tumor recurrence was most common in subtype B2 and B3 tumors (50.0% and 16.7% vs. 0%; p < .01). However, there was no significant difference in overall survival between histologic subtypes. Compared to females, males with thymomas had superior overall survival (103.0 vs. 62.9 months; p = .021) despite presenting with larger tumors (9.8 vs. 5.8 cm; p = .041). Concomitant myasthenia gravis was associated with increased recurrence but not worsened mortality.Compared to thymomas, patients with thymic carcinoma presented with higher-stage disease and had poorer 5-year survival (50.0% vs. 93.1%; p < .01). Conclusion:This study affirmed pathologic stage and resectability as prognostic factors for thymic epithelial tumors. New findings include inferior overall survival in female patients and higher recurrence rates in those with thymomas and concomitant myasthenia gravis.

Survival Outcomes and Prognostic Factors of Thymic Epithelial Tumors a Single Center Experience

“…In current study myasthenia gravis had no statistical significance on OAS (p = 0.32) vs (p = 0.082) in the results of Altshuler et al (19) and (p= 0.062) in the results of Nakajima et al (18) . While other studies showed the significance correlation between myasthenia gravis and OAS p <0.05 (22,26) .…”

“…The surgery had a statistical significance on OAS had p value <0.01 Altshuler et al (19) vs 0.033 in our study. resectability and ability to get R0 with no residual either microscopic or gross residual is a significant survival prognostic factor in Agrafiotis2022…”

“…According to Masoaka staging system, our cases were distributed as follows: stage I (20.6 %), stage II (20.6%), stage III (35.3%), and stage IV (23.5%) that coped with the results of Altshuler et al (19) who reported stage II 22.5% (N:9) and stage IV 23.4% (N: 11).…”

Thymoma; clinical presentations, pathology, and prognostic factors – a surgery point of view

“…Age and overall health are also important prognostic factors. Younger patients and those with good performance status (a measure of general health and ability to carry out daily activities) tend to have better outcomes (43).…”