Prognostic factors of thymomas

Egea, Alfredo Moreno; Albasini, José Luis Aguayo; Paricio, Pascual Parrilla; Pérez, J.; Lax, F. Garcia; Bascuñana, A. Jimenez

doi:10.1016/s0748-7983(95)96787-7

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…[5][6][7][8][9][10][11][13][14][15] Although most of the patients had local symptoms, a significant number were asymptomatic or had the thymoma diagnosed during a routine chest x-ray. The 40% incidence of MG seen here, higher than the 25% to 35% reported in most other series, 14,15,26,27,31,32 is probably because of the large number of patients referred to the Johns Hopkins Hospital primarily for the neurologic management and surgical treatment (thymectomy) of MG per se. 4 The 3% of the patients with associated pure red cell aplasia is comparable to the proportions reported in other series.…”

Section: Discussioncontrasting

confidence: 65%

“…6,8,10,[12][13][14][15]17,21,24,25,27,31,40 We found that the L/B pathologic classification is an independent predictor of overall survival, patients with predominantly epithelial thymoma or thymic carcinoma having a significantly decreased overall survival rate. (The epithelial thymomas and thymic carcinomas were grouped together because of the small number of thymic carcinomas in the series.…”

Section: Discussionmentioning

confidence: 69%

“…Surprisingly, the more modern Müller-Hermelink pathologic grade failed to be a significant independent predictor of overall prognosis, in contrast to the trends reported in other series. 10,15,27,31 However, the Müller-Hermelink grade approached statistical significance as an independent predictor of death secondary to thymoma, with WDTC/thymic carcinoma being associated with decreased survival. Although this and other series indicate that cortical thymomas tend to present at more advanced clinical stages, 10,14,15,18,[21][22][23][24][25][26][27]40 our series does not indicate a worse prognosis in patients with cortical thymomas.…”

Section: Discussionmentioning

confidence: 94%

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Clinical and Pathologic Predictors of Survival in Patients With Thymoma

et al. 1999

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ObjectiveTo evaluate the Johns Hopkins Hospital experience with 136 thymomas over the past 40 years. This number of patients allowed quantitative estimation of the independent influence of common clinicopathologic risk factors using multivariate analysis. Summary Background DataThymomas vary widely in terms of recurrence and influence on overall survival. Several series have indicated the importance of initial tumor invasion, as well as the extent of surgical resection, as predictors of recurrence and survival after thymoma resection. However, findings have been equivocal when other predictors of prognosis were examined. MethodsThe authors evaluated 136 patients seen at the Johns Hopkins Hospital between 1957 and 1997 with a pathologic diagnosis of thymoma. Demographic information, clinical staging data, surgical and adjuvant treatment details, and patient follow-up data were obtained from the patient record and from detailed patient or family interviews. Microscopic sections of all 136 patients were reviewed by two pathologists blinded to the clinical data. All data were analyzed by multivariate Cox regression analysis, which allowed the quantification of the independent predictive value of 12 putative clinicopathologic prognostic indicators. ResultsCompleteness of follow-up was 99%, 99%, and 98% of eligible patients at 5, 10, and 15 years, respectively. Forty percent of the patients had associated myasthenia gravis and 27% had a secondary primary malignancy. Overall patient survival rates were 71%, 56%, 44%, 38%, and 33% at 5, 10, 15, 20, and 25 years, respectively. Overall, the thymoma-related mortality rate was 14%; the nonthymoma-related mortality rate was 26%. Incomplete resection, preoperative absence of myasthenia gravis, and advanced Lattes/Bernatz pathologic class were found to be independent predictors of poorer overall survival. ConclusionsThese findings support a policy of aggressive, complete surgical resection of all thymomas when feasible. Thymoma behaves as a rather indolent tumor, with most deaths from causes unrelated to thymoma or its direct treatment. Clinicians should have an increased awareness of the possibility of second primary malignancies in patients with thymoma.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 94%

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Clinical and Pathologic Predictors of Survival in Patients With Thymoma

et al. 1999

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“…Although complete resection of thymoma has been reported as a significant favourable factor of improved overall survival [1][2][3][4][5][6][7], a portion of thymectomies for locally advanced thymoma end up with incomplete resection with or without neoadjuvant treatments [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. From a surgical point of view, when faced with apparently unresectable thymoma or one which is deemed impossible to completely resect, for example, due to a number of desseminated nodules or great vessel involvement, in an operating room, thoracic surgeons are required to select from two options; debulking surgery versus surgical biopsy only.…”

Section: Introductionmentioning

confidence: 99%

“…From a surgical point of view, when faced with apparently unresectable thymoma or one which is deemed impossible to completely resect, for example, due to a number of desseminated nodules or great vessel involvement, in an operating room, thoracic surgeons are required to select from two options; debulking surgery versus surgical biopsy only. Some of previous observational studies suggested a significant difference in overall survival between patients undergoing debulking surgery and those undergoing surgical biopsy only [2,7,10,11,13,14,16,20,[22][23][24], while others did not [1,[3][4][5][6]9,12,15,17,19]. There is a paucity of published data on the surgical management of unresectable thymoma.…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of debulking surgery versus surgical biopsy for unresectable thymoma†

Hamaji

Kojima

Omasa

et al. 2014

European Journal of Cardio-Thoracic Surgery

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Observational studies on long-term outcomes following debulking surgery or surgical biopsy for unresectable thymoma showed various results. This meta-analysis was designed to determine the effect of debulking surgery against surgical biopsy on overall survival in patients with unresectable thymoma. The PubMed database was queried for studies published in the English language on unresectable thymoma and overall survival. We compared overall survival following surgery in patients undergoing debulking surgery and patients undergoing surgical biopsy for unresectable thymoma. Meta-analysis was performed using the Mantel-Haenszel method, and potential publication bias was evaluated with a funnel plot of precision. No randomized trials on this topic were identified. Thirteen retrospective observational studies containing a sum of 314 patients with information on the number of deaths and person-years were suitable for analysis. Information on Masaoka stages, World Health Organization histology and indications for debulking surgery versus surgical biopsy was lacking in most studies. Diversity of neoadjuvant and adjuvant treatments was noted among the eligible studies. One hundred and seventy-two (54.8%) patients underwent debulking surgery and 142 (45.2%) underwent surgical biopsy. The pooled hazard ratio was 0.451 (95% confidence interval: 0.336-0.605, P < 0.001), favouring patients undergoing debulking surgery compared with patients undergoing surgical biopsy. The funnel plot of precision demonstrated no important publication bias. Our results suggest that debulking surgery for unresectable thymoma may be associated with improved overall survival and be considered for patients with unresectable thymoma.

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