title: Prognostic relevance of Masaoka and Müller-Hermelink classification in patients with thymic tumors.
abstract: BACKGROUND
  To compare the prognostic relevance of Masaoka and Müller-Hermelink classifications.
  
  
  METHODS
  We treated 71 patients with thymic tumors at our institution between 1980 and 1997. Complete follow-up was achieved in 69 patients (97%) with a mean follow up-time of 8.3 years (range, 9 months to 17 years).
  
  
  RESULTS
  Masaoka stage I was found in 31 patients (44.9%), stage II in 17 (24.6%), stage III in 19 (27.6%), and stage IV in 2 (2.9%). The 10-year overall survival rate was 83.5% for stage I, 100% for stage IIa, 58% for stage IIb, 44% for stage III, and 0% for stage IV. The disease-free survival rates were 100%, 70%, 40%, 38%, and 0%, respectively. Histologic classification according to Müller-Hermelink found medullary tumors in 7 patients (10.1%), mixed in 18 (26.1%), organoid in 14 (20.3%), cortical in 11 (15.9%), well-differentiated thymic carcinoma in 14 (20.3%), and endocrine carcinoma in 5 (7.3%), with 10-year overall survival rates of 100%, 75%, 92%, 87.5%, 30%, and 0%, respectively, and 10-year disease-free survival rates of 100%, 100%, 77%, 75%, 37%, and 0%, respectively. Medullary, mixed, and well-differentiated organoid tumors were correlated with stage I and II, and well-differentiated thymic carcinoma and endocrine carcinoma with stage III and IV (p < 0.001). Multivariate analysis showed age, gender, myasthenia gravis, and postoperative adjuvant therapy not to be significant predictors of overall and disease-free survival after complete resection, whereas the Müller-Hermelink and Masaoka classifications were independent significant predictors for overall (p < 0.05) and disease-free survival (p < 0.004; p < 0.0001).
  
  
  CONCLUSIONS
  The consideration of staging and histology in thymic tumors has the potential to improve recurrence prediction and patient selection for combined treatment modalities.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Institute of Pathology, University of Berne, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Lardinois
authors.forename: R
authors.initials: R
authors.lastname: Rechsteiner
authors.forename: R H
authors.initials: RH
authors.lastname: Läng
authors.forename: M
authors.initials: M
authors.lastname: Gugger
authors.forename: D
authors.initials: D
authors.lastname: Betticher
authors.forename: C
authors.initials: C
authors.lastname: von Briel
authors.forename: T
authors.initials: T
authors.lastname: Krueger
authors.forename: H B
authors.initials: HB
authors.lastname: Ris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D013945:Thymoma / Q000145:classification* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D013953:Thymus Neoplasms / Q000145:classification* / Q000401:mortality* / Q000473:pathology / Q000601:surgery