Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep;46(3):361-8.
doi: 10.1093/ejcts/ezt649. Epub 2014 Jan 30.

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

Enrico Ruffini  1 , Frank Detterbeck  2 , Dirk Van Raemdonck  3 , Gaetano Rocco  4 , Pascal Thomas  5 , Walter Weder  6 , Alessandro Brunelli  7 , Andrea Evangelista  8 , Federico Venuta  9 ; European Association of Thoracic Surgeons (ESTS) Thymic Working Group
Collaborators, Affiliations

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

Enrico Ruffini et al. Eur J Cardiothorac Surg. 2014 Sep.

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.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Study flow diagram of the patient population for analysis of predictors.
Figure 2:
Figure 2:
Curves of time-to-event end points.
Figure 3:
Figure 3:
Forest plot of subgroup analysis for adjuvant vs no adjuvant therapy comparison, adjusted for propensity score (OS). Cox model proportional hazard models with shared frailty. Only R0 patients with available information on adjuvant therapy (n = 1662).
See this image and copyright information in PMC

Comment in

References

    1. Ruffini E, Van Raemdonck D, Detterbeck F, Rocco G, Thomas P, Venuta F European Society of Thoracic Surgeons Thymic Questionnaire Working Group. Management of thymic tumors: a survey of current practice among members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2011;6:614–23. doi:10.1097/JTO.0b013e318207cd74. - DOI - PubMed
    1. Detterbeck F, Youssef S, Ruffini E, Okumura M. A review of prognostic factors in thymic malignancies. J Thorac Oncol. 2011;6(Suppl. 3):S1698–1704. doi:10.1097/JTO.0b013e31821e7b12. - DOI - PubMed
    1. Muller-Hermelink HK, Engel P, Harris N. Tumours of the thymus. In: Travis W, Brambilla E, Muller-Hermelink H, editors. Tumours of the Lung, Thymus, Heart. Pathology and Genetics. Lyon: IARC Press; 2004. pp. 145–98.
    1. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485–92. doi:10.1002/1097-0142(19811201)48:11<2485::AID-CNCR2820481123>3.0.CO;2-R. - DOI - PubMed
    1. Katsahian S, Resche-Rigon M, Chevret S, Porcher R. Analysing multicentre competing risk data with mixed proportional hazards model for the subdistribution. Stat Med. 2006;225:4267–78. doi:10.1002/sim.2684. - DOI - PubMed

MeSH terms