title: Thymic carcinoma: a cohort study of patients from the European society of thoracic surgeons database.
abstract: BACKGROUND
  Thymic carcinoma is a rare and aggressive thymic neoplasm. The European Society of Thoracic Surgeons developed a retrospective database collecting patients undergoing resection for thymic tumors from 1990 to 2010.
  
  
  METHODS
  Of 2265 patients with thymic tumors, there were 229 thymic carcinomas. Clinicopathological characteristics were analyzed including age, associated paraneoplastic diseases, stage (Masaoka-Koga), World Health Organization histologic subtypes, type of resection (total/subtotal/biopsy/no resection), tumor size, pre/postoperative treatments, and recurrence. Outcome measures included overall survival (OS), freedom from recurrence, and cumulative incidence of recurrence.
  
  
  RESULTS
  A complete resection was achieved in 140 patients (69%). Recurrence occurred in 54 patients (28%). Five- and 10-year OS rates were 0.61 and 0.37. Five- and 10-year freedom from recurrence rates were 0.60 and 0.43. Cumulative incidence of recurrence was 0.21 (3 yr), 0.27 (5 yr), and 0.32 (10 yr). Survival was better after surgical resection versus biopsy/no resection (p < 0.001), after complete resection versus subtotal resection (p < 0.001), and when using Masaoka-Koga system (stages I-II versus III versus IV) (p < 0.001). The use of multidisciplinary treatments resulted in a survival advantage which was significant in the surgery + radiotherapy group (p = 0.02). Incomplete resection (p < 0.0001) and advanced stage (Masaoka-Koga III-IV) (p = 0.02) had a negative impact on OS at multivariable analysis. Administration of adjuvant radiotherapy was beneficial in increasing OS (p = 0.02).
  
  
  CONCLUSIONS
  The results of our study indicate that patients with thymic carcinoma should undertake surgical resection whenever possible; a complete resection and early Masaoka-Koga stage are independent predictors of improved survival; our results also suggest that postoperative radiotherapy is beneficial in improving survival.
authors.affiliation: *Section of Thoracic Surgery, Department of Surgery, University of Torino, Torino, Italy; †Section of Thoracic Surgery, Yale University, New Haven, Connecticut; ‡Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; §Department of Thoracic Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy; ‖Department of Thoracic Surgery, Aix-Marseille University, Marseille, France; ¶Department of Thoracic Surgery, University Hospital, Zurich, Switzerland; #Division of Thoracic Surgery, St. Jame's University Hospital, Leeds, United Kingdom; **Department of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; ††Department of Thoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York; ‡‡3rd Department of Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic; §§Department of thoracic surgery, Hopital Europeen Georges-Pompidou and Hopital Laennec, Paris, France; ‖‖Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy; ¶¶Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Division, Imperial College, London, United Kingdom; ##Department of Thoracic Surgery, Istanbul University, Istanbul Medical School, Istanbul, Turkey; ***Department of Thoracic Surgery, University of Rome SAPIENZA, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.forename: Frank
authors.initials: F
authors.lastname: Detterbeck
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerrera
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Nasser
authors.initials: N
authors.lastname: Altorki
authors.forename: Jan
authors.initials: J
authors.lastname: Schützner
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
authors.forename: Alper
authors.initials: A
authors.lastname: Toker
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult