Recurrence of Thymoma: Clinicopathological Features, Therapy, and Prognosis

Monden, Yasumasa; Nakahara, Kazunari; Iioka, S; Nanjo, S; Ohno, Kiyoshi; Fujii, Yoshitaka; Hashimoto, Junpei; Kitagawa, Yutaka; Masaoka, Akira; Kawashima, Yasunaru

doi:10.1016/s0003-4975(10)62558-1

Cited by 172 publications

(96 citation statements)

References 30 publications

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“…Although some promote and anticipate a benign clinical course for these tumors, 6,[12][13][14][15][16] others (ourselves included) consider all thymomas as potentially malignant neoplasms. [1][2]10,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Many prior studies have documented malignant behavior in types A and AB thymomas. In our retrospective study of 71 cases of types A and AB thymomas (37 cases with follow-up information available), 18 patients (nine each of types A and AB) developed recurrence and or metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Similar results have been observed in prior studies, in which the better survival in patients with myasthenia had been attributed to earlier diagnosis. 27,51 However, the use of this factor in prognostication has been controversial as some studies have not found an association of survival with myasthenia gravis. 29,52,53 In this current series, types A and AB thymomas had a similar pattern of recurrence/metastasis and thus can be regarded as a single category.…”

Section: Discussionmentioning

confidence: 99%

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WHO types A and AB thymomas: not always benign

Jain

Mehta

Henley³

et al. 2010

Modern Pathology

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The 2004 WHO classification of thymic tumors recognizes five major subtypes of thymomas and thymic carcinoma. Subtypes A and AB thymomas are purported to be benign neoplasms, although prior studies have suggested a potential for malignant behavior. The purpose of this study was to assess the clinical behavior of A and AB thymomas identified from a large institutional pathologic database. A retrospective slide review of 500 thymic epithelial tumors identified 71 (B14%) cases of types A and AB thymomas. Clinical history and follow-up information were obtained through retrospective chart review. There were 38 and 33 cases of types A and AB thymomas, respectively. Complete follow-up data were available in 37 (52%) cases. Eighteen (49%) patients (type A, n ¼ 9 and type AB, n ¼ 9) had evidence of recurrent/metastatic disease at an average of 62 months (range from 6 to 244 months) after initial diagnosis. Survival curves for patients with types A and AB thymomas, with and without recurrences, show a statistically significant difference (P ¼ 0.001 and 0.005, respectively). Analysis of this large cohort confirms the potential for subtypes A and AB thymomas to show malignant behavior. Long-term clinical monitoring, therefore, appears to be justified in these cases. This study also shows the poor correlation between the WHO classification and tumor behavior

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

WHO types A and AB thymomas: not always benign

Jain

Mehta

Henley³

et al. 2010

Modern Pathology

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“…In fact, to our knowledge multiple studies have failed to demonstrate the precise role of adjuvant therapy, especially after radical surgical resection at early stages of disease. Since 1985, adjuvant radiotherapy has been performed by Monden et al, 27 who proposed it even for patients with Stage I disease. The results with this procedure generally were good but not completely satisfactory; after total surgical resection, approximately 5% of the irradiated patients still developed disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

Long‐term disease‐free survival of patients with radically resected thymomas

Mineo

Ambrogi

Mineo

et al. 2005

Cancer

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BACKGROUNDDespite radical surgical resection, thymomas often recur. The objective of the current retrospective study was to investigate the prognostic relevance of the expression of cell‐cycle proteins in these neoplasms to formulate a possible therapeutic surveillance strategy for the prevention of recurrence.METHODSThe authors retrospectively reviewed the main clinicopathologic factors, including the World Health Organization (WHO) classification, of patients with thymoma who had undergone radical surgical resection. Specimens were studied using immunohistochemistry and the expression of cell‐cycle proteins (i.e., p21, p27, and p53) was assessed. Univariate and multivariate analysis of predicting survival prognostic factors were performed.RESULTSThe authors analyzed 88 patients with thymoma who underwent radical surgical resection at the study institution. According to the Masaoka staging system, 41 patients had Stage I disease, 31 patients had Stage II disease, and 16 patients had Stage III disease. There were 24 tumor recurrences (27.3%), 4 of which were local, 16 of which were distant intrathoracic, and 4 of which were extrathoracic. The second radical resection provided a disease‐free survival rate that was similar to the first. Only Masaoka stage (P = 0.001), WHO classification (P=0.001), high expression of p53 (P=0.03), and low expression of p21 (P=0.02) and p27 (P=0.001) were found to be correlated with a reduced disease‐free survival. Low p27 expression was found to be the most significant predictive factor of a short disease‐free survival (P=0.001), especially when associated with low p21 expression and high p53 expression (P=0.0001).CONCLUSIONSLong‐term disease‐free survival in thymoma patients treated with radical surgical resection was found to be correlated with Masaoka stage, WHO classification, and expression of cell‐cycle proteins, with the latter found to be the most significant predictive factor. Functional cooperation between cell‐cycle proteins might constitute another level of regulation in tumor growth. More careful surveillance should be adopted whenever there is negative cell‐cycle protein expression. Cancer 2005. © 2005 American Cancer Society.

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“…We reviewed 11 papers in which patients with stage II or III thymoma both received and did not receive adjuvant radiation therapy after complete resection, thus enabling a comparison between the two groups (Table 5) (40-49). Monden and associates reported that 8% and 24% of patients with postoperative radiotherapy and 29% and 40% of patients without postoperative radiotherapy relapsed in stage II and III thymoma, respectively (40). Another nine papers (12,(42)(43)(44)(45)(46)(47)(48)(49) were unable to demonstrate an advantage over radiation therapy in terms of recurrence including local, pleural dissemination and distant metastasis.…”

Section: ) Radiotherapy A) Postoperative Radiotherapymentioning

confidence: 99%

Optimal therapy for thymoma

Kondo

2008

J. Med. Invest.

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: Thymoma is the most common tumor of the anterior mediastinum. This tumor is associated with unique paraneoplastic syndromes (myasthenia gravis, pure red cell aplasia, hypogammaglobulinemia, and other autoimmune diseases). The rarity of this tumor has somewhat obscured the optimal treatment. Although the histologic classification of thymoma has remained a subject of controversy for many years, the WHO classification system, published in 1999, appeared to be an advance in our understanding of thymoma. The optimal treatment for thymoma depends on its clinical stage. Surgery remains the mainstay of treatment for thymic epithelial tumors. Thymomas also have a high response rate to chemotherapy or radiotherapy. Only surgical resection is performed for patients with stage I (non-invasive) thymoma. The value of postoperative radiotherapy in completely resected stage II or III tumors is questionable. Multimodality therapy involving surgery, chemotherapy and radiotherapy appears to increase the rate of complete resection and survival in advanced (stage III and IV) thymomas. J. Med. Invest. 55 : 17-28,

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Recurrence of Thymoma: Clinicopathological Features, Therapy, and Prognosis

Cited by 172 publications

References 30 publications

WHO types A and AB thymomas: not always benign

WHO types A and AB thymomas: not always benign

Long‐term disease‐free survival of patients with radically resected thymomas

Optimal therapy for thymoma

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