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. 2017 Dec 2;15(1):214.
doi: 10.1186/s12957-017-1283-4.

Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival

Michael Ried  1 , Maria-Magdalena Eicher  2 , Reiner Neu  2 , Zsolt Sziklavari  3 , Hans-Stefan Hofmann  2   3
Affiliations

Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival

Michael Ried et al. World J Surg Oncol. .

Abstract

Background: The objective of this study is the evaluation of the Masaoka-Koga and the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) proposal for the new TNM-staging system on clinical implementation and prognosis of thymic malignancies.

Methods: A retrospective study of 76 patients who underwent surgery between January 2005 and December 2015 for thymoma. Kaplan-Meier survival analysis was used to determine overall and recurrence-free survival rates.

Results: Indication for surgery was primary mediastinal tumor (n = 55), pleural manifestation (n = 17), or mediastinal recurrence (n = 4) after surgery for thymoma. Early Masaoka-Koga stages I (n = 9) and II (n = 14) shifted to the new stage I (n = 23). Advanced stages III (Masaoka-Koga: n = 20; ITMIG/IASLC: n = 17) and IV (Masaoka-Koga: n = 33; ITMIG/IASLC: n = 35) remained nearly similar and were associated with higher levels of WHO stages. Within each staging system, the survival curves differed significantly with the best 5-year survival in early stages I and II (91%). Survival for stage IV (70 to 77%) was significantly better compared to stage III (49 to 54%). Early stages had a significant longer recurrence-free survival (86 to 90%) than advanced stages III and IV (55 to 56%).

Conclusions: The proportion of patients with IASLC/ITMIG stage I increased remarkably, whereas the distribution in advanced stages III and IV was nearly similar. The new TNM-staging system presents a clinically useful and applicable system, which can be used for indication, stage-adapted therapy, and prediction of prognosis for overall and recurrence-free survival.

Keywords: Masaoka-Koga; Staging system; TNM staging; Thymic carcinoma; Thymoma.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by our Institutional Review Board (University Hospital Regensburg), which waived the requirement for an individual patient consent because only routine patient data were used for this retrospective analysis.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The number of patients in each subgroup is presented as well as the 5-year survival rate [%]. a Significant differences in survival were documented with respect to three groups of Masaoka-Koga stages. Stage III patients had a lower survival than patients with stage IV. b Survival curves with respect to the proposed IASLC/ITMIG stages showed also significant differences
Fig. 2
Fig. 2
Recurrence-free survival curves for patient subgroups according to the three stage groupings. There were significant differences between stage I + II compared to stage III or stage IV with respect to the Masaoka-Koga (a) and the proposed IASLC/ITMIG (b) staging system. Recurrence-free survival was nearly similar between stage III and stage IV
See this image and copyright information in PMC

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