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

2014; Oxford University Press; Volume: 46; Issue: 3 Linguagem: Inglês

10.1093/ejcts/ezt649

1873-734X

Enrico Ruffini, Frank C. Detterbeck, Dirk Van Raemdonck, Gaetano Rocco, P. Thomas, Walter Weder, Alessandro Brunelli, Andrea Evangelista, Federico Venuta, Ala Khaled, Alex Arame, M. Refai, Caterina Casadio, Paolo Carbognani, Robert J. Cerfolio, Gabriele Donati, Christophoros N. Foroulis, Cengiz Gebitekin, David Gómez de Antonio, Kemp H. Kernstine, Shaf Keshavjee, Bernhard Moser, Cosimo Lequaglie, Moïshe Liberman, Eric Lim, Andrea Nicholson, Loı̈c Lang-Lazdunski, Monique Mancuso, Nasser K. Altorki, Mario Nosotti, Nuria M. Novoa, Geoffrey Brioude, A Oliaro, Pier Luigi Filosso, Salvino Saita, Marco Scarci, J Schützner, Alberto Terzi, Alper Toker, Hans Van Veer, Marco Anile, Erino Angelo Rendina, Luca Voltolini, Wojciech Żurek,

Myasthenia Gravis and Thymoma

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.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).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.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.