Tumours of the thymus: A cohort study of prognostic factors from the European Society of Thoracic Surgeons database

Enrico Ruffini, Frank Detterbeck, Dirk van raemdonck, Gaetano Rocco, Pascal Thomas, Walter Weder, Alessandro Brunelli, Andrea Evangelista, Federico Venuta, Khaled AlKattan, Alex Arame, Majed Refai, Caterina Casadio, Paolo Carbognani, Robert Cerfolio, Giovanni Donati, Christophoros N. Foroulis, Cengiz Gebitekin, David Gomez de Antonio, Kemp H. KernstineShaf Keshavjee, Bernhard Moser, Cosimo Lequaglie, Moishe Liberman, Eric Lim, Andrew G. Nicholson, Loic Lang-Lazdunski, Maurizio Mancuso, Nasser Altorki, Mario Nosotti, Nuria M. Novoa, Geoffrey Brioude, Alberto Oliaro, Pier Luigi Filosso, Salvatore Saita, Marco Scarci, Jan Schützner, Alberto Terzi, Alper Toker, Hans Van veer, Marco Anile, Erino Rendina, Luca Voltolini, Wojciech Zurek

Research output: Contribution to journalArticlepeer-review

153 Scopus citations


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.

Original languageEnglish (US)
Article numberezt649
Pages (from-to)361-368
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number3
StatePublished - Sep 2014


  • Myasthenia gravis
  • Neuroendocrine thymic tumours
  • Staging
  • Surgery
  • Thymic carcinoma
  • Thymoma

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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