Thymoma—A Clinico-Pathological Long-Term Study with Emphasis on Histology and Adjuvant Radiotherapy Dose

Harnath, Thomas; Marx, Alexander; Ströbel, Philipp; Bölke, Edwin; Willers, Reinhart; Gripp, Stephan

doi:10.1097/jto.0b013e3182745f73

Cited by 30 publications

(24 citation statements)

References 41 publications

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“…9,10 There are no reported prospective studies so far to provide a definitive conclusion on the clinical benefits of adjuvant radiation in stages II and III thymoma patients, and retrospective studies so far have reported mixed results. 11–15 Several reported series by investigators at University of Pennsylvania, 2,5 Memorial Sloan Kettering Cancer Center, 4 Massachusetts General Hospital, 16 and University of Eastern Piedmont in Italy 17 showed no local control benefit of adjuvant radiation in stage II thymoma. Studies at Massachusetts General Hospital found that adjuvant radiation was not independently associated with disease progression on a multivariable analysis of stages II and III patients.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Radiotherapy for Stages II and III Resected Thymoma

Yan

Moseley

et al. 2016

American Journal of Clinical Oncology

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Purpose Role of adjuvant radiation for Masaoka stage II and III thymoma remains controversial. The aim of this study was to evaluate the clinical benefits of radiation therapy for resected stages II and III thymoma. Methods and Materials We retrospectively reviewed the medical records of 175 thymoma patients treated from July 1996 to January 2013 at University of Washington Medical Center; 88 patients with adequate follow-up and who met histologic criteria were included. We evaluated progression-free survival (PFS) and overall survival (OS), and compared these outcomes in patients treated by surgery (S) alone versus surgery plus radiotherapy (S + RT). Cox regression models and log-rank tests were used to compare PFS and OS for S versus S + RT, and they were further assessed by margin-positive versus margin-negative subgroups using Kaplan-Meier curves. Results Among the 88 thymoma patients, 22 were stage II and 18 were stage III. For all stages II and III patients, adjuvant radiation was not identified as a significant predictor for PFS (P = 0.95) or OS (P = 0.63). A positive surgical margin predicted for a worse OS (hazard ratio = 7.1; P = 0.004). Further investigation revealed for resection margin-positive patients; S + RT had higher OS than S alone (P = 0.006). Conclusions For stages II and III thymoma, postoperative adjuvant radiation was not associated with statistically significant differences in PFS or OS in this study. Our results indicated a potential OS benefit of adjuvant RT in patients with positive resection margins, and therefore may be considered in this patient population.

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Section: Discussionmentioning

confidence: 99%

Adjuvant Radiotherapy for Stages II and III Resected Thymoma

Yan

Moseley

et al. 2016

American Journal of Clinical Oncology

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“…Other studies did not find differences in survival between type B3 thymoma or atypical thymoma and other thymomas 45,55 and failed to show an association of WHO or proposed Suster and Moran classification with outcome. 45,56,57 These varying results might have been, at least in part, due to interobserver variation. Indeed, studies reported an only fair to moderate reproducibility of the 2004 WHO classification of TET, with j values ranging between 0.39 and 0.53 or an overall concordance rate of 63% to 70%.…”

Section: Staging Is Prognostically Superior To Histomorphologic Classmentioning

confidence: 99%

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

Roden¹

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor.Objective.-To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described.Data Sources.-Search of literature database (PubMed) and current (2015) World Health Organization classification.Conclusions.-Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.

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“…21,22 Given the interobserver variability in the histopathologic evaluation of thymomas and thymic carcinomas as shown in our and other studies, we sought to investigate whether the suboptimal reproducibility might affect the prognostic value of morphologic classifications. Although in univariate analysis all 3 classifications were significantly associated with OS and DFS independent of the 3 reviewers, in the multivariate analysis, when adjusted for staging, the classifications lost their prognostic significance for 2 of the 3 reviewers and remained significant with only 1 of the reviewers.…”

Section: Discussionmentioning

confidence: 98%

Reproducibility of 3 Histologic Classifications and 3 Staging Systems for Thymic Epithelial Neoplasms and Its Effect on Prognosis

Roden¹,

Yi²,

Jenkins³

et al. 2015

American Journal of Surgical Pathology

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Data regarding the prognostic significance of the histopathologic classifications of thymic epithelial neoplasms are contradictory, perhaps reflecting issues in reproducibility. We studied the effect of reproducibility of 3 histopathologic classifications on prognosis and investigated the interobserver agreement on invasion and its effect on staging and prognosis. A total of 456 patients who underwent surgery for thymic epithelial neoplasm at Mayo Clinic Rochester (1942 to 2008) were staged (modified Masaoka, proposed Moran, proposed IASLC/ITMIG) and independently classified by 3 thoracic pathologists (World Health Organization, proposed Suster & Moran [S&M], and Bernatz). Interobserver agreement was moderate to substantial for all histopathologic classifications (κ values: 0.65, 0.52, 0.74 for World Health Organization, Bernatz, and S&M, respectively). All histopathologic classifications were significant for overall survival (OS) and disease-free survival (DFS) (all reviewers). If adjusted for Masaoka, only Bernatz classification for one reviewer and all histopathologic classifications for another reviewer were significant for OS. Interobserver agreement for invasion was substantial (κ=0.61) and almost perfect for Masaoka, Moran, and IASLC/ITMIG stage (κ values: 0.85, 0.81, and 0.92, respectively). The correlation coefficient for Masaoka and Moran staging was 0.93. Masaoka and IASLC/ITMIG staging were significant for OS and DFS (all reviewers). If adjusted for any histopathologic classification, Masaoka was significant for OS and DFS (all reviewers). In conclusion, reproducibility of histopathologic classifications has some effect on outcome. S&M is the most reproducible classification. Reproducibility of invasion has no effect on the prognostic value of staging. Masaoka, Moran, and IASLC/ITMIG staging are almost perfectly reproducible. The strong correlation between Masaoka and Moran staging suggests similar prognostic strength.

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Thymoma—A Clinico-Pathological Long-Term Study with Emphasis on Histology and Adjuvant Radiotherapy Dose

Abstract: Tumor stage, histology, complete resection, and tumor size had a significant impact on survival. Myasthenia may facilitate early detection and is correlated with superior survival. When postoperative radiotherapy is administered, doses above 50 Gy may improve outcome.

Cited by 30 publications

References 41 publications

Adjuvant Radiotherapy for Stages II and III Resected Thymoma

Adjuvant Radiotherapy for Stages II and III Resected Thymoma

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

Reproducibility of 3 Histologic Classifications and 3 Staging Systems for Thymic Epithelial Neoplasms and Its Effect on Prognosis

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