Download PDF
Thorac Cardiovasc Surg 2011; 59(3): 153-157
DOI: 10.1055/s-0030-1250657
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Prognostic Factors for Survival in Patients with Thymic Epithelial Tumors

S. Demirci1 , K. Turhan2 , N. Ozsan3 , D. Yalman1 , A. Cakan2 , G. Cok4 , U. Cagirici2 , S. Ozkok1
  • 1Department of Radiation Oncology, Ege University, Izmir, Turkey
  • 2Department of Thoracic Surgery, Ege University, Izmir, Turkey
  • 3Department of Pathology, Ege University, Izmir, Turkey
  • 4Department of Chest Diseases, Ege University, Izmir, Turkey
Further Information

Publication History

received August 9, 2010

Publication Date:
08 April 2011 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: Aim of the study was to identify and evaluate the prognostic efficacy of standard clinicopathological factors of thymic epithelial tumors (TETs) for treatment-related outcomes. Materials and Methods: All patients treated between 1993–2008 at Ege University Faculty of Medicine Departments of Radiation Oncology and Thoracic Surgery were reviewed retrospectively. Results: Forty-seven patients with a median age of 51 (range: 24–72) were identified. Complete resection was performed in 23 (51.1 %), incomplete resection with microscopic residues in 17 (37.8 %), subtotal resection with gross residues in 2 (4.4 %) and biopsy in 5 (11.1 %) patients. Radiotherapy was administered to 39 (83 %) patients. Median follow-up duration was 51 months (range: 3–168 months). Five-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) rates were 93 %, 90 % and 85 % for thymoma and 80 %, 66 % and 72 % for thymic carcinoma patients, respectively. In multivariate analysis, the extent of resection was the only significant prognostic factor for OS (p = 0.001). Conclusions: The most important prognostic factor for overall survival was the extent of resection. Further studies with larger numbers of patients are required to confirm the prognostic factors and to obtain a better understanding of the biological behavior of TETs.

Key words

thymus (incl. thymoma) - radiation therapy - outcomes (includes mortality - morbidity)

References

  • 1 Halperin E C, Perez C A, Brady L W. Perez and Brady's Principles and Practice of Radiation Oncology.. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008: 1110-1131
    Google Scholar
  • 2 Wright C D. Management of thymomas.  Crit Rev Oncol Hematol. 2008;  65 109-120
    CrossrefPubMedGoogle Scholar
  • 3 Gunderson L L, Tepper J E. Clinical Radiation Oncology.. 2nd ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2007: 973-1005
    Google Scholar
  • 4 Hsu H C, Huang E Y, Wang C J, Sun L M, Chen H C. Postoperative radiotherapy in thymic carcinoma: treatment results and prognostic factors.  Int J Radiat Oncol Biol Phys. 2002;  52 801-805
    CrossrefPubMedGoogle Scholar
  • 5 Fuller C D, Housman D M, Thomas C R. Radiotherapy for thymoma and thymic carcinoma.  Hematol Oncol Clin North Am. 2008;  22 489-507
    CrossrefPubMedGoogle Scholar
  • 6 Haniuda M, Morimoto M, Nishimura H et al. Adjuvant radiotherapy after complete resection of thymoma.  Ann Thorac Surg. 1992;  54 311-315
    CrossrefPubMedGoogle Scholar
  • 7 Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan.  Ann Thorac Surg. 2003;  76 878-884 discussion 884
    CrossrefPubMedGoogle Scholar
  • 8 Ruffini E, Mancuso M, Oliaro A et al. Recurrence of thymoma: analysis of clinicopathologic features, treatment, and outcome.  J Thorac Cardiovasc Surg. 1997;  113 55-63
    CrossrefPubMedGoogle Scholar
  • 9 Myojin M, Choi N C, Wright C D et al. Stage III thymoma: pattern of failure after surgery and postoperative radiotherapy and its implication for future study.  Int J Radiat Oncol Biol Phys. 2000;  46 927-933
    CrossrefPubMedGoogle Scholar
  • 10 Venuta F, Rendina E A, Longo F et al. Long-term outcome after multimodality treatment for stage III thymic tumors.  Ann Thorac Surg. 2003;  76 1866-1872 discussion 1872
    CrossrefPubMedGoogle Scholar
  • 11 Zhu G, He S, Fu X, Jiang G, Liu T. Radiotherapy and prognostic factors for thymoma: a retrospective study of 175 patients.  Int J Radiat Oncol Biol Phys. 2004;  60 1113-1119
    CrossrefPubMedGoogle Scholar
  • 12 Awad W I, Symmans P J, Dussek J E. Recurrence of stage I thymoma 32 years after total excision.  Ann Thorac Surg. 1998;  66 2106-2108
    CrossrefPubMedGoogle Scholar
  • 13 Kondo K. Optimal therapy for thymoma.  J Med Invest. 2008;  55 17-28
    CrossrefPubMedGoogle Scholar
  • 14 Mayer R, Beham-Schmid C, Groell R et al. Radiotherapy for invasive thymoma and thymic carcinoma. Clinicopathological review.  Strahlenther Onkol. 1999;  175 271-278
    CrossrefPubMedGoogle Scholar
  • 15 Eng T Y, Fuller C D, Jagirdar J, Bains Y, Thomas Jr C R. Thymic carcinoma: state of the art review.  Int J Radiat Oncol Biol Phys. 2004;  59 654-664
    CrossrefPubMedGoogle Scholar
  • 16 Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages.  Cancer. 1981;  48 2485-2492
    CrossrefPubMedGoogle Scholar
  • 17 Strobel P, Marx A, Zettl A, Muller-Hermelink H K. Thymoma and thymic carcinoma: an update of the WHO Classification 2004.  Surg Today. 2005;  35 805-811
    CrossrefPubMedGoogle Scholar
  • 18 Cox J D, Stetz J, Pajak T F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC).  Int J Radiat Oncol Biol Phys. 1995;  31 1341-1346
    CrossrefPubMedGoogle Scholar
  • 19 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
    CrossrefPubMedGoogle Scholar
  • 20 Fornasiero A, Daniele O, Ghiotto C et al. Chemotherapy of invasive thymoma.  J Clin Oncol. 1990;  8 1419-1423
    PubMedGoogle Scholar
  • 21 National Comprehensive Cancer Network .Clinical Practice Guidelines in Oncology 2009. Online: http://www.thymic.org/wp-content/uploads/2009/03/nccn-guidelines.pdf [accessed November 2010]
    Google Scholar
  • 22 Liu H C, Hsu W H, Chen Y J et al. Primary thymic carcinoma.  Ann Thorac Surg. 2002;  73 1076-1081
    CrossrefPubMedGoogle Scholar
  • 23 Rea F, Marulli G, Girardi R et al. Long-term survival and prognostic factors in thymic epithelial tumours.  Eur J Cardiothorac Surg. 2004;  26 412-418
    CrossrefPubMedGoogle Scholar
  • 24 Kim H K, Choi Y S, Kim J et al. Type B thymoma: is prognosis predicted only by World Health Organization classification?.  J Thorac Cardiovasc Surg. 2010;  139 1431-1435
    CrossrefPubMedGoogle Scholar
  • 25 Chen G, Marx A, Wen-Hu C et al. New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China.  Cancer. 2002;  95 420-429
    CrossrefPubMedGoogle Scholar
  • 26 Wright C D, Wain J C, Wong D R et al. Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size.  J Thorac Cardiovasc Surg. 2005;  130 1413-1421
    CrossrefPubMedGoogle Scholar
  • 27 Okumura M, Ohta M, Tateyama H et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients.  Cancer. 2002;  94 624-632
    CrossrefPubMedGoogle Scholar
  • 28 Nakagawa K, Asamura H, Matsuno Y et al. Thymoma: a clinicopathologic study based on the new World Health Organization classification.  J Thorac Cardiovasc Surg. 2003;  126 1134-1140
    CrossrefPubMedGoogle Scholar
  • 29 Detterbeck F C. Clinical value of the WHO classification system of thymoma.  Ann Thorac Surg. 2006;  81 2328-2334
    CrossrefPubMedGoogle Scholar
  • 30 Kim B K, Cho B C, Choi H J et al. A single institutional experience of surgically resected thymic epithelial tumors over 10 years: clinical outcomes and clinicopathologic features.  Oncol Rep. 2008;  19 1525-1531
    PubMedGoogle Scholar

Dr. Senem Demirci

Department of Radiation Oncology
Ege University
Faculty of Medicine

35100 Izmir

Turkey

Phone: +90 23 23 90 44 76

Fax: +90 23 23 88 42 94

Email: senem.demirci@ege.edu.tr

      >