Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2017 | Research

Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival

Authors: Michael Ried, Maria-Magdalena Eicher, Reiner Neu, Zsolt Sziklavari, Hans-Stefan Hofmann

Published in: World Journal of Surgical Oncology | Issue 1/2017

Abstract

Background

The objective of this study is the evaluation of the Masaoka-Koga and the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) proposal for the new TNM-staging system on clinical implementation and prognosis of thymic malignancies.

Methods

A retrospective study of 76 patients who underwent surgery between January 2005 and December 2015 for thymoma. Kaplan–Meier survival analysis was used to determine overall and recurrence-free survival rates.

Results

Indication for surgery was primary mediastinal tumor (n = 55), pleural manifestation (n = 17), or mediastinal recurrence (n = 4) after surgery for thymoma. Early Masaoka-Koga stages I (n = 9) and II (n = 14) shifted to the new stage I (n = 23). Advanced stages III (Masaoka-Koga: n = 20; ITMIG/IASLC: n = 17) and IV (Masaoka-Koga: n = 33; ITMIG/IASLC: n = 35) remained nearly similar and were associated with higher levels of WHO stages. Within each staging system, the survival curves differed significantly with the best 5-year survival in early stages I and II (91%). Survival for stage IV (70 to 77%) was significantly better compared to stage III (49 to 54%). Early stages had a significant longer recurrence-free survival (86 to 90%) than advanced stages III and IV (55 to 56%).

Conclusions

The proportion of patients with IASLC/ITMIG stage I increased remarkably, whereas the distribution in advanced stages III and IV was nearly similar. The new TNM-staging system presents a clinically useful and applicable system, which can be used for indication, stage-adapted therapy, and prediction of prognosis for overall and recurrence-free survival.

Detterbeck FC, Parson AM. Thymic tumors. Ann Thorac Surg. 2004;77:1860–9.CrossRefPubMed

Venuta F, Anile M, Diso D, et al. Thymoma and thymic carcinoma. Eur J Cardiothoracic Surg. 2010;37:13–25.CrossRef

Ried M, Marx A, Götz A, Hamer O, Schalke B, Hofmann HS. State of the art: diagnostic tools and innovative therapies for treatment of advanced thymoma and thymic carcinoma. Eur J Cardiothorac Surg. 2016;49(6):1545–52.CrossRefPubMed

Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485–92.CrossRefPubMed

Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int. 1994;44(5):359–67.CrossRefPubMed

Rosai J, Sobin L. Histological typing of tumours of the thymus. In: World Health Organization, editor. International histological classification of tumours. Heidelberg: Springer; 1999. p. 1–16.

Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011;6:1710–6.CrossRef

Cardillo G, Carleo F, Giunti R, et al. Predictors of survival in patients with locally advanced thymoma and thymic carcinoma (Masaoka stages III and IVa). Eur J Cardiothoracic Surg. 2010;37:819–23.CrossRef

Filosso PL, Ruffini E, Lausi PO, Lucchi M, Oliaro A, Detterbeck F. Historical perspectives: the evolution of the thymic epithelial tumors staging system. Lung Cancer. 2014;83:126–32.CrossRefPubMed

10.

Detterbeck F, Youssef S, Ruffini E, et al. A review of prognostic factors in thymic malignancies. J Thorac Oncol. 2011;6:S1698–704.CrossRefPubMed

11.

Detterbeck FC, Asamura H, Crowley J, et al. Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain. The IASLC/ITMIG thymic malignancies staging project: development of a stage classification for thymic malignancies. J Thorac Oncol 2013; 8: 1467-1473.

12.

Huang J, Ahmad U, Antonicelli A, et al. International Thymic Malignancy Interest Group International Database Committee and Contributors. Development of the international thymic malignancy interest group international database: an unprecedented resource for the study of a rare group of tumors. J Thorac Oncol 2014; 9: 1573-1578. Erratum in: J Thorac Oncol 2014; 9: 1804.

13.

Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG thymic epithelial tumors staging project: proposal for an evidence-based stage classification-system for the forthcoming (8^th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9:65–72.CrossRef

14.

Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. Hoboken: Wiley-Blackwell; 2016. ISBN: 978-1-119-26357-9

15.

Marx A, Ströbel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9(5):596–611.CrossRefPubMed

16.

Huang J. A new staging system for thymoma—will it improve outcomes? J Thorac Cardiovasc Surg. 2016;151(1):20–2.CrossRefPubMed

17.

Nicholson AG, Detterbeck FC, Marino M, et al. Staging and prognostic factors committee; members of the advisory boards; participating institutions of the Thymic domain. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the T component for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014; 9 (9 Suppl 2): S73-S80.

18.

Bhora FY, Chen DJ, Detterbeck FC, et al. Staging and prognostic factors committee; advisory boards. The ITMIG/IASLC Thymic Epithelial Tumors Staging Project: a proposed lymph node map for thymic epithelial tumors in the forthcoming 8th edition of the TNM classification of malignant tumors. J Thorac Oncol 2014; 9 (9 Suppl 2): S88-S96.

19.

Kondo K, Van Schil P, Detterbeck FC, et al. Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014; 9 (9 Suppl 2): S81-S87.

20.

Liang G, Gu Z, Li Y, et al. Members of the Chinese alliance for research in Thymomas. Comparison of the Masaoka-Koga staging and the International Association for the Study of Lung Cancer/the International Thymic Malignancies Interest Group proposal for the TNM staging systems based on the Chinese Alliance for Research in Thymomas retrospective database. J Thorac Dis. 2016;8(4):727–37.CrossRefPubMedPubMedCentral

21.

Ried M, Neu R, Schalke B, von Süßkind-Schwendi M, Sziklavari Z, Hofmann HS. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg. 2015;10(1):137.CrossRefPubMedPubMedCentral

22.

Spaggiari L, Casiraghi M, Guarize J. Multidisciplinary treatment of malignant thymoma. Curr Opin Oncol. 2012;24:117–22.CrossRefPubMed

23.

Lucchi M, Ambrogi MC, Duranti L, et al. Advanced stage thymomas and thymic carcinomas: results of multimodality treatments. Ann Thorac Surg. 2005;79(6):1840–484.CrossRefPubMed

24.

Rajan A, Giaccone G. Treatment of advanced thymoma and thymic carcinoma. Curr Treatment Options Oncol. 2008;9:277–87.CrossRef

25.

Hwang Y, Park IK, Park S, Kim ER, Kang CH, Kim YT. Lymph node dissection in thymic malignancies: implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol. 2016;11(1):108–14.CrossRefPubMed

26.

Viti A, Bertolaccini L, Terzi A. What is the role of lymph nodal metastases and lymphadenectomy in the surgical treatment and prognosis of thymic carcinomas and carcinoids? Interact Cardiovasc Thorac Surg. 2014;19(6):1054–8.CrossRefPubMed

27.

Fukui T, Fukumoto K, Okasaka T, et al. Clinical evaluation of a new tumour-node-metastasis staging system for thymic malignancies proposed by the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and the International Thymic Malignancy Interest Group. Eur J Cardiothorac Surg. 2016;49(2):574–9.CrossRefPubMed

28.

Ried M, Potzger T, Braune N, et al. Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumors: perioperative management and clinical experience. Eur J Cardiothorac Surg. 2013;43(4):801–7.CrossRefPubMed

29.

Marulli G, Lucchi M, Margaritora S, et al. Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers. Eur J Cardiothorac Surg. 2011;39(3):1–7.CrossRef

30.

Ruffini E, Detterbeck F, Van Raemdonck D, et al. Thymic carcinoma: a cohort study of patients from the European society of thoracic surgeons database. J Thorac Oncol. 2014;9(4):541–8.CrossRefPubMed

31.

Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stage II and III thymoma—an analysis of the International Thymic Malignancies Interest Group (ITMIG) retrospective database. J Thorac Oncol. 2016;23 Epub ahead of print

Title: Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival
Authors: Michael Ried
Maria-Magdalena Eicher
Reiner Neu
Zsolt Sziklavari
Hans-Stefan Hofmann
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2017
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-017-1283-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Audit of mammography requests in Abakaliki, South-East Nigeria

Correlation between lymphatic endothelial markers and lymph node status or N-staging of colorectal cancer

Association of lymph node involvement with the prognosis of pathological T1 invasive non-small cell lung cancer

New laparoscopic procedure for left-sided pancreatic cancer—artery-first approach laparoscopic RAMPS using 3D technique

Comparison of the outcomes between thoracoscopic and laparoscopic esophagectomy via retrosternal and prevertebral lifting paths by the same surgeon

Cytotoxic effect of different treatment parameters in pressurized intraperitoneal aerosol chemotherapy (PIPAC) on the in vitro proliferation of human colonic cancer cells