Prognostic impact of tumour size in completely resected thymic epithelial tumours

Fukui, Takayuki; Fukumoto, Köichi; Okasaka, Toshiki; Kawaguchi, Koji; Nakamura, Shota; Hakiri, Shuhei; Ozeki, Naoki; Hirakawa, Akihiro; Tateyama, Hisashi; Yokoi, Kohei

doi:10.1093/ejcts/ezw178

Cited by 52 publications

(47 citation statements)

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“…However, the patients of the superior mediastinum group had an overall worse prognosis according to our survival analysis, and thus, their thymomas may have been more aggressive in nature. The OS, PFS and DFS in the inferior mediastinum group were largely consistent with previous reports, but those in the superior mediastinum group were worse than what has been previously reported . To our knowledge, this is the first study to characterize the relationship between survival outcomes and the tumor location of thymomas.…”

Section: Discussionsupporting

confidence: 90%

“…The OS, PFS and DFS in the inferior mediastinum group were largely consistent with previous reports, but those in the superior mediastinum group were worse than what has been previously reported. 14,20,34 To our knowledge, this is the first study to characterize the relationship between survival outcomes and the tumor location of thymomas. It is difficult to determine a clear set of prognostic factors for thymomas due to the excellent patient survival.…”

Section: Survival Outcomes Of and Prognostic Factors For Thymomasmentioning

confidence: 99%

“…In fact, many retrospective case series have described its characteristics and assessed different prognostic factors for long‐term survival as well as risk factors for tumor recurrence. While the Masaoka‐Koga staging system, which is based on the extent of tumor invasion, implantation, lymph node and/or hematogenous metastases, is widely accepted as the most important independent prognostic and risk factor for recurrence for thymomas, there is no consensus on the roles of other factors . The International Association for the Study of Lung Cancer (IASLC) Staging Prognostic Factors Committee and International Thymic Malignancy Interest Group (ITMIG) recently proposed a staging system for thymomas and thymic carcinomas (TCs) that was in accordance with their survival outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…While the Masaoka-Koga staging system, which is based on the extent of tumor invasion, implantation, lymph node and/or hematogenous metastases, is widely accepted as the most important independent prognostic and risk factor for recurrence for thymomas, there is no consensus on the roles of other factors. [9][10][11][12][13][14][15] The International Association for the Study of Lung Cancer (IASLC) Staging Prognostic Factors Committee and International Thymic Malignancy Interest Group (ITMIG) recently proposed a staging system for thymomas and thymic carcinomas (TCs) that was in accordance with their survival outcomes. 16 This staging system was approved for the eighth edition of the tumor, nodes, and metastasis (TNM) staging classification by the American Joint Committee on Cancer (AJCC) / the Union for International Cancer Control (UICC) consortium.…”

Section: Introductionmentioning

confidence: 99%

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Tumor location may affect the clinicopathological features and prognosis of thymomas

et al. 2019

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Background The current staging systems do not consider the tumor location of thymomas, and its clinical relevance is poorly understood. This study aimed to evaluate the impact of tumor location on the clinicopathological features and prognosis of thymomas. Methods We performed a retrospective review of patients at our institution who underwent an extended thymectomy for a thymoma from 1976 to 2015. The tumor location was classified as either the superior or inferior mediastinum based on the maximum tumor diameter. The clinicopathological characteristics of the thymoma were also evaluated. Kaplan‐Meier estimates and Cox proportional hazards models were used to analyze the survival outcomes and risk factors for recurrence. Results A total of 194 patients with thymoma were eligible for this study. Compared with the inferior mediastinum group (n = 167), the superior mediastinum group (n = 27) had a higher frequency of myasthenia gravis (MG), advanced Masaoka‐Koga staging, disease progression and recurrence (P < 0.05). The Kaplan‐Meier analysis demonstrated thymomas in the superior mediastinum had worse survival outcomes that included overall survival, progression‐free survival and disease‐free survival (P < 0.05). The multivariate analysis showed tumor location was an independent prognostic factor for all the survival outcomes (P < 0.05). Furthermore, the tumor location (P = 0.004) and Masaoka‐Koga stage (P < 0.001) were the only two independent risk factors for recurrence in the multivariate analysis. Conclusions The clinicopathological features of thymomas on MG, Masaoka‐Koga staging, disease progression, and recurrence were different between locations of superior and inferior mediastinum locations. Thymomas in the superior mediastinum tended to be associated with worse survival and increased recurrence.

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Section: Discussionsupporting

confidence: 90%

Section: Survival Outcomes Of and Prognostic Factors For Thymomasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tumor location may affect the clinicopathological features and prognosis of thymomas

et al. 2019

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“…For example, Fukui et al [18] showed that tumor size is an important indicator. In addition, multivariate analyses by Fu et al [19] identified R0 resection, Masaoka-Koga stage, and postoperative radiotherapy as significant prognostic factors of survival in thymic carcinoma patients.…”

Section: Discussionmentioning

confidence: 99%

Long term oncological outcome of thymoma and thymic carcinoma – an analysis of 235 cases from a single institution

Tseng

Kao

et al. 2017

PLoS ONE

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Background and objectivesThymoma has a variable long-term oncological outcome after surgical resection. Survival and tumor recurrence were analyzed to determine the predisposing factors for tumor recurrence.MethodsA total of 235 patients who underwent surgery for thymoma or thymic carcinoma from December 1997 to March 2013 were analyzed using Masaoka staging system and World Health Organization (WHO) histological classification. Surgical intervention included extended thymothymectomy via median sternotomy and thymomectomy via thoracotomy/ video-assisted thoracoscopic surgery (VATS).ResultsThe median duration of follow-up was 105 months (12–198 months). Among these 235 patients, recurrence was observed in 25 patients (10.7%). according to Masaoka stage I, IIA, IIB, III, IVA, IVB, recurrence rates were 1/65(1.5%), 8/106(7.5%), 1/32(3.1%), 6/20(30.0%), 8/10(80.0%), 1/1(100.0%), respectively. Disease or treatment-related mortality was observed in 13 patients. Overall survival rate was 94.4%. After univariate analysis, predisposing factors for tumor recurrence included Masaoka stage, WHO histologic type, tumor size, adjuvant therapy and margin status.ConclusionsDue to the indolent behavior of thymoma, tumor recurrence appears to be a better assessment of oncological outcome rather than survival. Factors associated with tumor recurrence include Masaoka stage, WHO histologic type, tumor size, adjuvant therapy and margin status.

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Risk factors for developing post‐thymectomy myasthenia gravis in patients with thymoma

et al. 2021

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Background Thymectomy is required for the treatment of thymoma‐associated myasthenia gravis (MG). However, MG may develop only after thymectomy, a condition known as post‐thymectomy MG. This study aimed to investigate the risk factors for post‐thymectomy MG in patients with thymoma. Methods We retrospectively identified 235 patients with thymoma who underwent thymectomy at a single hospital from January 2008 to December 2017: 44 with preoperatively diagnosed MG were excluded, leaving 191 patients in the final analysis. Univariable survival analyses using Cox proportional hazards regression model and Kaplan‐Meier estimate were conducted to identify risk factors for post‐thymectomy MG. Results Post‐thymectomy MG developed in 4.2% (8/191) of the patients with thymoma between 18 days and 108 mo after surgery. Hazard ratios (HRs) of pre‐ and postoperative anti‐acetylcholine receptor antibody (AChR‐Ab) titers were 2.267 (P = .002) and 1.506 (P < .001), respectively. Patients with extended thymectomy had a low chance of post‐thymectomy MG (HR 0.035, P = .007). Larger thymoma (HR, 1.359; P = .005) and type A or AB thymoma according to World Health Organization histological classification (HR, 11.92; P = .021) were associated with higher chances of post‐thymectomy MG. Within the subgroup of preoperatively AChR‐Ab seropositive patients, post‐thymectomy MG developed in 22.2% (6/27). Conclusions Pre‐ and postoperative AChR‐Ab levels should be measured in patients with thymoma. A large thymoma and partial thymectomy appear to be associated with a higher probability of post‐thymectomy MG.

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Prognostic impact of tumour size in completely resected thymic epithelial tumours

Abstract: Patients with tumours >4.0 cm showed significantly worse outcomes in RFS compared with those with smaller tumours. This relationship was also noted in patients with Stage I disease.

Cited by 52 publications

References 18 publications

Tumor location may affect the clinicopathological features and prognosis of thymomas

Tumor location may affect the clinicopathological features and prognosis of thymomas

Long term oncological outcome of thymoma and thymic carcinoma – an analysis of 235 cases from a single institution

Risk factors for developing post‐thymectomy myasthenia gravis in patients with thymoma

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