title: Oncological significance of WHO histological thymoma classification. A clinical study based on 286 patients.
abstract: OBJECTIVE
  The clinical significance of thymoma histology remains controversial because of the numerous histological classifications of thymic epithelial tumors. Universal classification of such tumors was achieved by the World Health Organization (WHO) in 1999. We studied the prognostic significance of this classification.
  
  
  METHODS
  We studied clinical features and postoperative survival in cases of thymoma, but not thymic carcinoma, based on WHO histological classification in 286 patients undergoing surgery between 1958 and 2001.
  
  
  RESULTS
  Tumors were 19 type A, 79 type AB, 59 type B1, 102 type B2, and 27 type B3. The proportion of invasive tumors increased by type--from A to AB, B1, B2, and B3. The great vessels were involved more frequently in type B2 and B3 tumors than in type A, AB, and B1 tumors. The 20-year survival was 100% in type A, 87% in type AB, 91% in type B1, 65% in type B2, and 38% in type B3 tumors. Multivariate analysis showed Masaoka staging and WHO histological classification to be significant independent prognostic factors, while age, gender, myasthenia gravis association, resection completeness and great vessel involvement were not. In stage III patients, 13 of 45 patients with type B2 and B3 tumor died of their tumors, while no tumor deaths occurred in 11 patients with type A, AB, and B1 tumors.
  
  
  CONCLUSIONS
  WHO histological classification realistically reflects the oncological behavior of thymoma.
authors.affiliation: Thoracic Surgery Study Group, Division of General Thoracic Surgery, Department of Surgery, Interventional Medicine (E-1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871, Japan.
authors.forename: Meinoshin
authors.initials: M
authors.lastname: Okumura
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Ohta
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Mori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yasumitsu
authors.forename: Kazuya
authors.initials: K
authors.lastname: Nakahara
authors.forename: Keiji
authors.initials: K
authors.lastname: Iuchi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tada
authors.forename: Hajime
authors.initials: H
authors.lastname: Maeda
authors.forename: Hikaru
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013945:Thymoma / Q000145:classification* / Q000401:mortality / Q000473:pathology; D013953:Thymus Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology; D014944:World Health Organization