Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database.
- Ruffini E Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy enrico.ruffini@unito.it.
- Detterbeck F Department of Surgery, Section of Thoracic Surgery, Yale University, New Haven, CT, USA.
- Van Raemdonck D Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
- Rocco G Department of Thoracic Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy.
- Thomas P Department of Thoracic Surgery, Aix-Marseille University, Marseille, France.
- Weder W Department of Thoracic Surgery, University Hospital, Zurich, Switzerland.
- Brunelli A Division of Thoracic Surgery, St. Jame's University Hospital, Leeds, UK.
- Evangelista A Unit of Clinical Epidemiology, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy.
- Venuta F Department of Thoracic Surgery, University of Rome SAPIENZA; Policlinico Umberto I; Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy.
- 2014-02-01
Published in:
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 2014
Myasthenia gravis
Neuroendocrine thymic tumours
Staging
Surgery
Thymic carcinoma
Thymoma
Aged
Databases, Factual
Female
Humans
Male
Middle Aged
Myasthenia Gravis
Neoplasm Recurrence, Local
Neoplasm Staging
Neuroendocrine Tumors
Prognosis
Retrospective Studies
Survival Analysis
Thymoma
Thymus Neoplasms
English
OBJECTIVES
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.
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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/ejcts/ezt649
- PMID 24482389
- Persistent URL
- https://sonar.ch/global/documents/141469
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