title: Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers.
abstract: OBJECTIVE
  Radical surgery is the cornerstone of treatment for thymic tumors, but a complete surgical resection in stage III is not always achievable; and recurrence of disease is not rare. We reviewed the results of four centers with large experience in multimodality treatment of stage III thymic tumors.
  
  
  METHODS
  Between 1980 and 2009, 249 patients (137 males: 112 females; median age 50 years) with stage III thymic tumors underwent surgery. Myasthenia gravis (MG) was present in 110 (44.2%) patients. A total of 94 (37.7%) patients received induction chemotherapy and 205 (82.7%) had adjuvant treatments.
  
  
  RESULTS
  Thirty-day mortality was 0.8%. A total of 203 (81.6%) had R0, 26 (10.4%) R1 and 20 (8%) R2 resection. World Health Organization (WHO) histotype was: A in 2.4%, AB in 15.3%, B1 in 16.5%, B2 in 31.3%, B3 in 22.1%, and thymic carcinoma in 12.4%. The R0 rate was lower in patients who received induction chemotherapy (p=0.04), in B1-B2-thymic carcinoma histotypes (p = 0.05), and in patients without MG (p = 0.04). Overall 10-year survival rate was 64%; tumor-related and disease-free survival were 76% and 74%, respectively. At univariate analysis, R2 resection (p < 0.0001), recurrence of disease (p < 0.0001), absence of MG (p = 0.0009), thymic carcinoma (p = 0.002), age more than 50 years (p = 0.01), and vascular invasion (p < 0.0001) were predictors of poor survival. At multivariate analysis, type of resection (p < 0.0001), vascular involvement (p = 0.007), and recurrent disease (p < 0.0001) were independent predictors of prognosis. During follow-up, 43 (21.2%) patients developed recurrence. Patients with recurrence, who underwent redo surgery (n = 24), showed a similar survival to patients without recurrence.
  
  
  CONCLUSIONS
  Multimodality treatment of stage III thymic tumors achieved good survival. Radical surgery, even at recurrence, seems to be the most important prognostic factor.
authors.affiliation: Division of Thoracic Surgery, Cardio-Thoracic and Vascular Sciences Department, University of Padova, Padova, Italy. beppemarulli@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cusumano
authors.forename: Francesco
authors.initials: F
authors.lastname: Carleo
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult