title: Comparison of outcomes between neuroendocrine thymic tumours and other subtypes of thymic carcinomas: a joint analysis of the European Society of Thoracic Surgeons and the International Thymic Malignancy Interest Group.
abstract: OBJECTIVE
  The latest World Health Organization (WHO) histological classification divides thymic epithelial tumours in thymomas and thymic carcinomas (TCs), the latter also including the neuroendocrine thymic tumours (NETTs). NETTs and other TC histotypes have been described to have a significantly lower survival than thymomas, but these two groups of tumours have rarely been compared directly. Using the European Society of Thoracic Surgeons and the International Thymic Malignancy Interest Group datasets, we wanted to study this issue.
  
  
  METHODS
  This is a retrospective multicentre cohort study of patients operated for TC. Outcome measures were overall survival (OS) and recurrence-free survival (RFS). OS was analysed using the Kaplan-Meier method and RFS was assessed using competing risk analysis. The association with clinical and prognostic factors for OS and RFS was evaluated with log-rank test and Gray's test, respectively.
  
  
  RESULTS
  A total of 1247 tumours (1042 TCs) were collected between 1984 and 2012. A R0 resection was performed in 363 TCs and in 52 NETTs. The median follow-up was 4.4 years for TCs and 4.1 years for NETTs. Owing to the missing values for survival information, a total of 728 TC patients and 132 NETTs were included in the OS analysis. Among them, 262 TC and 39 NETT patients died. The median OS was 6.6 years for TC and 7.5 years for NETTs. The overall 5-year survival rates were 60% for TC and 68% for NETTs; 10-year survival rates were 40% for TCs and 39% for NETTs (P = 0.19). Five-year RFS was 0.35 and 0.34 for TCs and NETTs (P = 0.36). On multivariate analysis, histology did not influence either OS (P = 0.79) or RFS (P = 0.59).
  
  
  CONCLUSIONS
  This represents the largest clinical series of TCs and NETTs collected. Despite the biological aggressiveness of these rare neoplasms, the 5-year survival rate after resection is over 60% and TCs and NETT showed a similar rate of survival and recurrences after surgery.
authors.affiliation: Department of Thoracic Surgery, University of Torino, Turin, Italy pierluigi.filosso@unito.it.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.affiliation: Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.affiliation: Department of Thoracic Surgery, University of Torino, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Usman
authors.initials: U
authors.lastname: Ahmad
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Antonicelli
authors.affiliation: Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, University of Torino, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerrera
authors.affiliation: Department of Thoracic Surgery, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico 'Umberto I', University of Rome Sapienza, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven Belgium, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: van Raemdonck
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Travis
authors.affiliation: University of Pisa, 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, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rimner
authors.affiliation: Department of Thoracic Surgery, Lung Transplantation & Diseases of the Esophagus Marseille, Aix-Marseille University & Hospitals System of Marseille (AP-HM), Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Detterbeck
authors.affiliation: Valley Health System, Ridgewood, NJ, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Korst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000145:classification / Q000401:mortality / Q000601:surgery; D018358:Neuroendocrine Tumors / Q000145:classification / Q000401:mortality* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013945:Thymoma / Q000145:classification / Q000401:mortality* / Q000601:surgery; D013953:Thymus Neoplasms / Q000145:classification / Q000401:mortality* / Q000601:surgery; D055815:Young Adult
keywords: Histology; Surgery; Survival; Thymic carcinoma; Thymic epithelial tumours; Thymic neuroendocrine tumour; Thymus