title: A single institutional experience of surgically resected thymic epithelial tumors over 10 years: clinical outcomes and clinicopathologic features.
abstract: Thymic epithelial tumors (TETs) consist of a series of neoplasm that differ morphologically and biologically. Due to its rarity and indolent natural history, large-scale prospective trials have been lacking. This study aimed to evaluate long-term clinical outcomes and clinicopathologic features for TET after surgical resection and adjuvant treatments. One hundred patients who received surgery plus adjuvant radiotherapy +/- chemotherapy for TET (Masaoka stage II-IVa) from 1995 to 2005 were retrospectively reviewed. Masaoka staging systems were adopted, and pathologic results were classified according to World health organization (WHO) histologic classification. After surgery, 55 patients were treated with radiotherapy alone, while 45 with radiotherapy and chemotherapy. The median radiation dose was 50.4 Gy (45-63 Gy) and six cycles of chemotherapy, consisting of doxorubicin, cisplatin, vincristine and cyclophosphamide, were applied every 3-4 weeks. Distributions according to Masaoka stage were as follows; stage II (58 patients), III (21) and IVa (21). According to WHO histology, there were A (3), AB (7), B1 (7), B2 (31), B3 (31) and C (21). With a median follow-up duration of 65 months (8-143 months), the 5-year overall survival (OS) and disease-free survival (DFS) rates were 75.7% (89.2, 67.9 and 52.1% in stage II, III and IVa, respectively) and 70.3% (83, 62.4 and 33.6% in stage II, III and IVa, respectively). In multivariate analysis, prognostic factors for OS were age, WHO histology, Masaoka stage, and recurrence, while pleural involvement, WHO histology, and Masaoka stage had significant impacts on DFS. Adjuvant chemotherapy did not alter survival outcomes and recurrence patterns. Pleura was the most common recurrence site (15 patients, 53.6%), and significantly associated with pleural recurrence-free survival. In conclusion, pleural involvement at diagnosis was the important prognostic factor, in addition to WHO histology and Masaoka stage. To prevent pleural recurrence and prolong survival, innovative therapeutic approaches warrant further investigations.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Byoung Chul
authors.initials: BC
authors.lastname: Cho
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Choi
authors.forename: Joo Hyuk
authors.initials: JH
authors.lastname: Sohn
authors.forename: Moo Suk
authors.initials: MS
authors.lastname: Park
authors.forename: Joon
authors.initials: J
authors.lastname: Chang
authors.forename: Se Kyu
authors.initials: SK
authors.lastname: Kim
authors.forename: Dae Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Kyung Young
authors.initials: KY
authors.lastname: Chung
authors.forename: Chang Geol
authors.initials: CG
authors.lastname: Lee
authors.forename: Joo Hang
authors.initials: JH
authors.lastname: Kim
authors.forename: Nae Choon
authors.initials: NC
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D013945:Thymoma / Q000473:pathology* / Q000628:therapy; D013953:Thymus Neoplasms / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin