title: Thymic carcinoma outcomes and prognosis: results of an international analysis.
abstract: OBJECTIVE
  The objectives of this collaborative study were to characterize patients with thymic carcinoma, their treatment patterns, and association with overall survival (OS) and recurrence-free survival (RFS).
  
  
  METHODS
  Clinical, pathologic, treatment, and follow-up information were analyzed. OS and RFS were the primary outcome measures.
  
  
  RESULTS
  In 1042 cases of thymic carcinoma, 42 (5%) patients had pathologic Masaoka stage I, 138 (17%) had stage II, 370 (45%) had stage III, and 274 (33%) had stage IV disease. Overall, 166 patients (22%) underwent induction chemotherapy and 48 (6%) had preoperative radiation therapy. An R0 resection was performed in 447 cases (61%), R1 in 102 cases (14%), and R2 in 184 cases (25%). Squamous cell carcinoma was the predominant histologic subtype (n = 560; 79%). Adjuvant chemotherapy was administered to 237 (31%) patients, and 449 (60%) received adjuvant radiation therapy. The median OS was 6.6 years (95% confidence interval [CI], 5.8-8.3) and the cumulative incidence of recurrence at 5 years was 35% (95% CI, 30%-40%). In univariate analysis, early Masaoka stage, R0 resection, chemotherapy, and radiation therapy were associated with OS. Early Masaoka stage and R0 resection were also associated with RFS. On multivariable analysis, R0 resection and radiation therapy were associated with prolonged OS. Radiation therapy and male gender were associated with prolonged RFS.
  
  
  CONCLUSIONS
  R0 resection and radiation therapy are associated with improved OS, whereas radiation therapy and male gender are associated with longer RFS.
authors.affiliation: Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Usman
authors.initials: U
authors.lastname: Ahmad
authors.affiliation: Department of Biostatistics, Yale University School of Medicine, New Haven, Conn; Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Frank
authors.initials: F
authors.lastname: Detterbeck
authors.affiliation: Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Conn.
authors.forename: Alberto
authors.initials: A
authors.lastname: Antonicelli
authors.affiliation: Department of Thoracic Surgery, School of Medicine, University of Torino, Turin, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.affiliation: Department of Thoracic Surgery, School of Medicine, University of Torino, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: William
authors.initials: W
authors.lastname: Travis
authors.affiliation: Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: Department of Biostatistics, Yale University School of Medicine, New Haven, Conn.
authors.forename: Yilei
authors.initials: Y
authors.lastname: Zhan
authors.affiliation: Division of Thoracic Surgery, Cardiac and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: rimnera@mskcc.org.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rimner
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013934:Thymectomy; D013945:Thymoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome