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. 2016 Apr;8(4):727-37.
doi: 10.21037/jtd.2016.03.22.

Comparison of the Masaoka-Koga staging and the International Association for the Study of Lung Cancer/the International Thymic Malignancies Interest Group proposal for the TNM staging systems based on the Chinese Alliance for Research in Thymomas retrospective database

Guanghui Liang  1 , Zhitao Gu  1 , Yin Li  1 , Jianhua Fu  1 , Yi Shen  1 , Yucheng Wei  1 , Lijie Tan  1 , Peng Zhang  1 , Yongtao Han  1 , Chun Chen  1 , Renquan Zhang  1 , Keneng Chen  1 , Hezhong Chen  1 , Yongyu Liu  1 , Youbing Cui  1 , Yun Wang  1 , Liewen Pang  1 , Zhentao Yu  1 , Xinming Zhou  1 , Yangchun Liu  1 , Yuan Liu  1 , Wentao Fang  1 ; Members of the Chinese Alliance for Research in Thymomas
Affiliations

Comparison of the Masaoka-Koga staging and the International Association for the Study of Lung Cancer/the International Thymic Malignancies Interest Group proposal for the TNM staging systems based on the Chinese Alliance for Research in Thymomas retrospective database

Guanghui Liang et al. J Thorac Dis. 2016 Apr.

Abstract

Background: To compare the predictive effect of the Masaoka-Koga staging system and the International Association for the Study of Lung Cancer (IASLC)/the International Thymic Malignancies Interest Group (ITMIG) proposal for the new TNM staging on prognosis of thymic malignancies using the Chinese Alliance for Research in Thymomas (ChART) retrospective database.

Methods: From 1992 to 2012, 2,370 patients in ChART database were retrospectively reviewed. Of these, 1,198 patients with complete information on TNM stage, Masaoka-Koga stage, and survival were used for analysis. Cumulative incidence of recurrence (CIR) was assessed in R0 patients. Overall survival (OS) was evaluated both in an R0 resected cohort, as well as in all patients (any R status). CIR and OS were first analyzed according to the Masaoka-Koga staging system. Then, they were compared using the new TNM staging proposal.

Results: Based on Masaoka-Koga staging system, significant difference was detected in CIR among all stages. However, no survival difference was revealed between stage I and II, or between stage II and III. Stage IV carried the highest risk of recurrence and worst survival. According to the new TNM staging proposal, CIR in T1a was significantly lower comparing to all other T categories (P<0.05) and there is a significant difference in OS between T1a and T1b (P=0.004). T4 had the worst OS comparing to all other T categories. CIR and OS were significantly worse in N (+) than in N0 patients. Significant difference in CIR and OS was detected between M0 and M1b, but not between M0 and M1a. OS was almost always statistically different when comparison was made between stages I-IIIa and stages IIIb-IVb. However, no statistical difference could be detected among stages IIIb to IVb.

Conclusions: Compared with Masaoka-Koga staging, the IASLC/ITMIG TNM staging proposal not only describes the extent of tumor invasion but also provides information on lymphatic involvement and tumor dissemination. Further study using prospectively recorded information on the proposed TNM categories would be helpful to better grouping thymic tumors for predicting prognosis and guiding clinical management.

Keywords: Thymoma; prognostic grouping; staging.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves: cumulative recurrence rate of patients with R0 resection in different stage by the Masaoka-Koga staging (log-rank). R0, complete resection.
Figure 2
Figure 2
Kaplan-Meier survival curves: OS of patients with any R resection in different stage by the Masaoka-Koga staging (log-rank). OS, overall survival.
Figure 3
Figure 3
Kaplan-Meier survival curves: Cumulative recurrence rate of TxN0M0 patients with R0 resection in different T stage by the IASLC/ITMIG TNM staging proposal (log-rank). R0, complete resection; IASLC, the International Association for the Study of Lung Cancer; ITMIG, the International Thymic Malignancies Interest Group.
Figure 4
Figure 4
Kaplan-Meier survival curves: overall survival of TxN0M0 patients with R0 resection in different T stage by the IASLC/ITMIG TNM staging proposal (log-rank). R0, complete resection; IASLC, the International Association for the Study of Lung Cancer; ITMIG, the International Thymic Malignancies Interest Group.
Figure 5
Figure 5
Kaplan-Meier survival curves: OS of TxN0M0 patients with R any resection in different T stage by the IASLC/ITMIG TNM staging proposal (log-rank). OS, overall survival; IASLC, the International Association for the Study of Lung Cancer; ITMIG, the International Thymic Malignancies Interest Group.
Figure 6
Figure 6
Kaplan-Meier survival curves: cumulative recurrence rate of patients with R0 resection in different N stage by the IASLC/ITMIG TNM staging proposal (log-rank). IASLC, the International Association for the Study of Lung Cancer; ITMIG, the International Thymic Malignancies Interest Group.
Figure 7
Figure 7
Kaplan-Meier survival curves: OS of patients with R any resection in different N stage by the IASLC/ITMIG TNM staging proposal (log-rank). OS, overall survival; IASLC, the International Association for the Study of Lung Cancer; ITMIG, the International Thymic Malignancies Interest Group.
Figure 8
Figure 8
Kaplan-Meier survival curves: cumulative recurrence/progression rate of patients with R any resection in different M stage by the IASLC/ITMIG TNM staging proposal (log-rank). IASLC, the International Association for the Study of Lung Cancer; ITMIG, the International Thymic Malignancies Interest Group.
Figure 9
Figure 9
Kaplan-Meier survival curves: OS of patients with R any resection in different M stage by the 8th edition TNM staging (log-rank). OS, overall survival.
Figure 10
Figure 10
Kaplan-Meier survival curves: the overall survival of patients with any R resection in different stage by the 8th edition TNM staging (log-rank).
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References

    1. Masaoka A, Monden Y, Nakahara K, et al. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981;48:2485-92. 10.1002/1097-0142(19811201)48:11<2485::AID-CNCR2820481123>3.0.CO;2-R - DOI - PubMed
    1. Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int 1994;44:359-67. 10.1111/j.1440-1827.1994.tb02936.x - DOI - PubMed
    1. Detterbeck F, Youssef S, Ruffini E, et al. A review of prognostic factors in thymic malignancies. J Thorac Oncol 2011;6:S1698-704. 10.1097/JTO.0b013e31821e7b12 - DOI - PubMed
    1. Detterbeck FC, Asamura H, Crowley J, et al. The IASLC/ITMIG thymic malignancies staging project: development of a stage classification for thymic malignancies. J Thorac Oncol 2013;8:1467-73. 10.1097/JTO.0000000000000017 - DOI - PubMed
    1. Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014;9:S65-72. 10.1097/JTO.0000000000000290 - DOI - PubMed

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