title: Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery.
abstract: BACKGROUND
  The impact of myasthenia gravis on patients with thymoma is still controversial when perioperative and long-term outcomes are analyzed. With the unique opportunity of a 35-year follow-up in a single institution, thymomatous myasthenia gravis cohort, we investigated the influence of early and long-term clinical predictors.
  
  
  METHODS
  We reviewed a surgical series of 317 (1972 to 2007) patients with thymoma: clinical and pathologic features were analyzed as prognostic factors matched against the short- and long-term survival and recurrence rates.
  
  
  RESULTS
  Male to female ratio was 153:164; median age, 49 years. Myasthenia gravis coexisted in 276 patients (87.1%). Thymomas were classified according to the Masaoka (42.0% stage I, 32.2% stage II, 21.5% stage III, and 4.4% stage IV) and the World Health Organization (3.5% type A, 9.5% type AB, 19.2% type B1, 57.7% type B2, 8.2% type B3, and 1.9% thymic carcinoma) staging systems. The resection was complete in 295 patients (93.1%). Operative mortality and morbidity were respectively 1.6% and 7.6%. No differences were recorded in postoperative outcome stratifying for myasthenia gravis or comorbidities. Mean follow-up was 144.7 +/- 104.4 months. The overall 5-, 10-, 20-, and 30-year survival rates were 89.9%, 84.1%, 73%, and 58.6%, respectively. The completeness of resection (p < 0.001), the Masaoka staging (p = 0.010), and the World Health Organization classification (p < 0.001) all significantly influenced the long-term survival (univariate analysis). Only completeness of resection was significantly correlated with a better prognosis (p < 0.001) in multivariate analysis. Masaoka staging (p < 0.001) and World Health Organization classification (p < 0.001) significantly correlated with the disease-free survival in the univariate and multivariate analyses as significant prognostic factors (Masaoka, p < 0.001; World Health Organization, p = 0.011). Myasthenia gravis patients showed a better prognosis in terms of long-term survival (p = 0.046) and disease-free survival (p = 0.012) in the univariate analysis.
  
  
  CONCLUSIONS
  We confirm the evidence that the clinical staging and the histologic classification influence long-term survival. The presence of myasthenia gravis was not significantly related to operative outcome, but prolongs both long-term survival and disease-free survival.
authors.affiliation: Division of General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cesario
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cusumano
authors.forename: Elisa
authors.initials: E
authors.lastname: Meacci
authors.forename: Rolando
authors.initials: R
authors.lastname: D'Angelillo
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonassi
authors.forename: Giulia
authors.initials: G
authors.lastname: Carnassale
authors.forename: Venanzio
authors.initials: V
authors.lastname: Porziella
authors.forename: Adele
authors.initials: A
authors.lastname: Tessitore
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Vita
authors.forename: Libero
authors.initials: L
authors.lastname: Lauriola
authors.forename: Amelia
authors.initials: A
authors.lastname: Evoli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Granone
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors