Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database

Eur J Cardiothorac Surg. 2014 Sep;46(3):361-8. doi: 10.1093/ejcts/ezt649. Epub 2014 Jan 30.

Abstract

Objectives: A retrospective database was developed by the European Society of Thoracic Surgeons, collecting patients submitted to surgery for thymic tumours to analyse clinico-pathological prognostic predictors.

Methods: A total of 2151 incident cases from 35 institutions were collected from 1990 to 2010. Clinical-pathological characteristics were analysed, including age, gender, associated myasthenia gravis stage (Masaoka), World Health Organization histology, type of thymic tumour [thymoma, thymic carcinoma (TC), neuroendocrine thymic tumour (NETT)], type of resection (complete/incomplete), tumour size, adjuvant therapy and recurrence. Primary outcome was overall survival (OS); secondary outcomes were the proportion of incomplete resections, disease-free survival and the cumulative incidence of recurrence (CIR).

Results: A total of 2030 patients were analysed for OS (1798 thymomas, 191 TCs and 41 NETTs). Ten-year OS was 0.73 (95% confidence interval 0.69-0.75). Complete resection (R0) was achieved in 88% of the patients. Ten-year CIR was 0.12 (0.10-0.15). Predictors of shorter OS were increased age (P < 0-001), stage [III vs I HR 2.66, 1.80-3.92; IV vs I hazard ratio (HR) 4.41, 2.67-7.26], TC (HR 2.39, 1.68-3.40) and NETT (HR 2.59, 1.35-4.99) vs thymomas and incomplete resection (HR 1.74, 1.18-2.57). Risk of recurrence increased with tumour size (P = 0.003), stage (III vs I HR 5.67, 2.80-11.45; IV vs I HR 13.08, 5.70-30.03) and NETT (HR 7.18, 3.48-14.82). Analysis using a propensity score indicates that the administration of adjuvant therapy was beneficial in increasing OS (HR 0.69, 0.49-0.97) in R0 resections.

Conclusions: Masaoka stages III-IV, incomplete resection and non-thymoma histology showed a significant impact in increasing recurrence and in worsening survival. The administration of adjuvant therapy after complete resection is associated with improved survival.

Keywords: Myasthenia gravis; Neuroendocrine thymic tumours; Staging; Surgery; Thymic carcinoma; Thymoma.

MeSH terms

  • Aged
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myasthenia Gravis / diagnosis
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Neuroendocrine Tumors / classification
  • Neuroendocrine Tumors / diagnosis
  • Neuroendocrine Tumors / surgery
  • Prognosis
  • Retrospective Studies
  • Survival Analysis
  • Thymoma / classification
  • Thymoma / diagnosis
  • Thymoma / surgery
  • Thymus Neoplasms / classification*
  • Thymus Neoplasms / diagnosis*
  • Thymus Neoplasms / surgery