TY - JOUR
T1 - Tumours of the thymus
T2 - A cohort study of prognostic factors from the European Society of Thoracic Surgeons database
AU - Ruffini, Enrico
AU - Detterbeck, Frank
AU - van raemdonck, Dirk
AU - Rocco, Gaetano
AU - Thomas, Pascal
AU - Weder, Walter
AU - Brunelli, Alessandro
AU - Evangelista, Andrea
AU - Venuta, Federico
AU - AlKattan, Khaled
AU - Arame, Alex
AU - Refai, Majed
AU - Casadio, Caterina
AU - Carbognani, Paolo
AU - Cerfolio, Robert
AU - Donati, Giovanni
AU - Foroulis, Christophoros N.
AU - Gebitekin, Cengiz
AU - de Antonio, David Gomez
AU - Kernstine, Kemp H.
AU - Keshavjee, Shaf
AU - Moser, Bernhard
AU - Lequaglie, Cosimo
AU - Liberman, Moishe
AU - Lim, Eric
AU - Nicholson, Andrew G.
AU - Lang-Lazdunski, Loic
AU - Mancuso, Maurizio
AU - Altorki, Nasser
AU - Nosotti, Mario
AU - Novoa, Nuria M.
AU - Brioude, Geoffrey
AU - Oliaro, Alberto
AU - Filosso, Pier Luigi
AU - Saita, Salvatore
AU - Scarci, Marco
AU - Schützner, Jan
AU - Terzi, Alberto
AU - Toker, Alper
AU - Van veer, Hans
AU - Anile, Marco
AU - Rendina, Erino
AU - Voltolini, Luca
AU - Zurek, Wojciech
PY - 2014/9
Y1 - 2014/9
N2 - 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.
AB - 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.
KW - Myasthenia gravis
KW - Neuroendocrine thymic tumours
KW - Staging
KW - Surgery
KW - Thymic carcinoma
KW - Thymoma
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U2 - 10.1093/ejcts/ezt649
DO - 10.1093/ejcts/ezt649
M3 - Article
C2 - 24482389
AN - SCOPUS:84904719163
SN - 1010-7940
VL - 46
SP - 361
EP - 368
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 3
M1 - ezt649
ER -