Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database.
OBJECTIVE
A retrospective database was developed by the European Society of Thoracic Surgeons, collecting patients submitted to surgery for thymic tumours to analyse clinico-pathological prognostic predictors.


METHODS
A total of 2151 incident cases from 35 institutions were collected from 1990 to 2010. Clinical-pathological characteristics were analysed, including age, gender, associated myasthenia gravis stage (Masaoka), World Health Organization histology, type of thymic tumour [thymoma, thymic carcinoma (TC), neuroendocrine thymic tumour (NETT)], type of resection (complete/incomplete), tumour size, adjuvant therapy and recurrence. Primary outcome was overall survival (OS); secondary outcomes were the proportion of incomplete resections, disease-free survival and the cumulative incidence of recurrence (CIR).


RESULTS
A total of 2030 patients were analysed for OS (1798 thymomas, 191 TCs and 41 NETTs). Ten-year OS was 0.73 (95% confidence interval 0.69-0.75). Complete resection (R0) was achieved in 88% of the patients. Ten-year CIR was 0.12 (0.10-0.15). Predictors of shorter OS were increased age (P < 0-001), stage [III vs I HR 2.66, 1.80-3.92; IV vs I hazard ratio (HR) 4.41, 2.67-7.26], TC (HR 2.39, 1.68-3.40) and NETT (HR 2.59, 1.35-4.99) vs thymomas and incomplete resection (HR 1.74, 1.18-2.57). Risk of recurrence increased with tumour size (P = 0.003), stage (III vs I HR 5.67, 2.80-11.45; IV vs I HR 13.08, 5.70-30.03) and NETT (HR 7.18, 3.48-14.82). Analysis using a propensity score indicates that the administration of adjuvant therapy was beneficial in increasing OS (HR 0.69, 0.49-0.97) in R0 resections.


CONCLUSIONS
Masaoka stages III-IV, incomplete resection and non-thymoma histology showed a significant impact in increasing recurrence and in worsening survival. The administration of adjuvant therapy after complete resection is associated with improved survival.
Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy enrico.ruffini@unito.it.
Enrico
E
Ruffini
Department of Surgery, Section of Thoracic Surgery, Yale University, New Haven, CT, USA.
Frank
F
Detterbeck
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Dirk
D
Van Raemdonck
Department of Thoracic Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy.
Gaetano
G
Rocco
Department of Thoracic Surgery, Aix-Marseille University, Marseille, France.
Pascal
P
Thomas
Department of Thoracic Surgery, University Hospital, Zurich, Switzerland.
Walter
W
Weder
Division of Thoracic Surgery, St. Jame's University Hospital, Leeds, UK.
Alessandro
A
Brunelli
Unit of Clinical Epidemiology, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy.
Andrea
A
Evangelista
Department of Thoracic Surgery, University of Rome SAPIENZA; Policlinico Umberto I; Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy.
Federico
F
Venuta
D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013945:Thymoma / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D013953:Thymus Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000601:surgery
Myasthenia gravis; Neuroendocrine thymic tumours; Staging; Surgery; Thymic carcinoma; Thymoma