Top

Published in:

17-07-2023 | Thymoma | Original Article

Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database

Authors: Meinoshin Okumura, Ichiro Yoshino, Soichiro Funaki, Katsuhiro Okuda, Shun-ichi Watanabe, Masahiro Tsuboi, Kimihiro Shimizu, Hiroshi Date, Toyofumi F. Chen-Yoshikawa, Jun Nakajima, Shinichi Toyooka, Hisao Asamura

Published in: Surgery Today | Issue 11/2023

Abstract

Purpose

Patients with a thymic epithelial tumor (TET), comprising thymoma, thymic carcinoma (TC), and thymic neuroendocrine neoplasm (TNEN), are rarely encountered. The present study was conducted to determine the recent outcomes of surgical treatment for TET in Japan and clarify the significance of prognostic factors by analyzing a nationwide database created by the Japanese Association for Research on the Thymus (JART).

Methods

The JART database includes records of 2471 thymoma, 285 TC, and 56 TNEN cases surgically treated between 1991 and 2010. At the time of the final follow-up examination, 439 patients had died, with tumor the cause of death in 188. The disease-specific survival was examined using the Kaplan–Meier method, with Cox’s proportional hazards model utilized to determine independent prognostic factors.

Results

The 10-year survival rate according to TNM-based Stage I, II, IIIA, IIIB, IVA, and IVB classification was 98.7%, 76.8%, 85.0%, 68.9%, 66.2%, and 59.8%, respectively. The T factor, M factor, and tumor size were independent prognostic factors in both thymoma and thymic carcinoma cases, while the N factor had tendency to be a prognostic factor in thymoma but not in thymic carcinoma cases. The WHO histological type was an independent factor in thymoma cases.

Conclusion

The significance of pathology and TNM classification as prognostic factors was confirmed.

Available only for authorised users

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

Detterbeck FC, Asamura H, Crowley J, Falkson C, Giaccone G, Giroux D, et al. The IASLC/ITMIG thymic malignancies staging project: development of a stage classification for thymic malignancies. J Thorac Oncol. 2013;8(12):1467–73.CrossRefPubMed

Detterbeck FC, Stratton K, Giroux D, Asamura H, Crowley J, Falkson C, et al. The IASLC/ITMIG thymic epithelial tumors staging project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(Suppl 2):S65-72.CrossRefPubMed

Nicholson AG, Detterbeck FC, Marino M, Kim J, Stratton K, Giroux D, Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain, et al. 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(Suppl 2):S73-80.CrossRefPubMed

Kondo K, Van Schil P, Detterbeck FC, Okumura M, Stratton K, Giroux D, Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain, et al. 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(Suppl 2):S81-87.CrossRefPubMed

Union for International Cancer Control. TNM classification of malignant tumors. 8th ed. Oxford, UK: Wiley Blackwell; 2016.

Ruffini E, Rami-Porta R, Huang J, Ahmad U, Appel S, Bille A, IASLC Staging and Prognostic Factors Committee and of the Advisory Boards, et al. The international association for the study of lung cancer thymic epithelial tumor staging project: unresolved issues to be addressed for the next ninth edition of the TNM classification of malignant tumors. J Thorac Oncol. 2022;17(6):838–51.CrossRefPubMed

Detterbeck F, Moran C, Huang J, Suster S, Walsh G, Kaiser L, et al. Which way is Up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. J Thorac Oncol. 2011;6(Supple 3):S1730-1738.CrossRefPubMed

Weis C-A, Yao X, Deng Y, Detterbeck F, Marino M, Nicholson A, et al. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol. 2015;10:367–72.CrossRefPubMedPubMedCentral

10.

Rimner A, Yao X, Huang J, Antonicelli A, Ahmad U, Korst R, 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 retrospective database. J Thorac Oncol. 2016;11:1785–92.CrossRefPubMedPubMedCentral

11.

Ahmad U, Yao X, Detterbeck F, Huang J, Antonicelli A, Filosso PL, et al. Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg. 2015;149:95–101.CrossRefPubMed

12.

Filosso PL, Yao X, Ruffini E, Ahmad U, Antonicelli A, Huang J, et al. Comparison of outcomes between neuroendocrine thymic tumours and other subtypes of thymic carcinomas: a joint analysis of the European society of thoracic surgeons and the international thymic malignancy Interest group. Eur J Cardiothorac Surg. 2016;50:766–71.CrossRefPubMedPubMedCentral

13.

Agatsuma H, Yoshida K, Yoshino I, Okumura M, Higashiyama M, Suzuki K, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg. 2017;104:1047–53.CrossRefPubMed

14.

Nakagawa K, Yokoi K, Nakajima J, Tanaka F, Maniwa Y, Suzuki M, et al. Is thymomectomy alone appropriate for stage I (T1N0M0) thymoma? Results of a propensity-score analysis. Ann Thorac Surg. 2016;101:520–6.CrossRefPubMed

15.

Omasa M, Date H, Sozu T, Sato T, Nagai K, Yokoi K, Japanese Association for Research on the Thymus, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese association for research on the thymus database study. Cancer. 2015;121:1008–16.CrossRefPubMed

16.

Yamada Y, Yoshino I, Nakajima J, Miyoshi S, Ohnuki T, Suzuki M, Japanese Association for Research of the Thymus, et al. Surgical outcomes of patients with stage III thymoma in the Japanese nationwide database. Ann Thorac Surg. 2015;100:961–7.CrossRefPubMed

17.

Okumura M, Yoshino I, Yano M, Watanabe S, Tsuboi M, Yoshida K, et al. Tumour size determines both recurrence-free survival and disease-specific survival after surgical treatment for thymoma. Eur J Cardiothorac Surg. 2019;56:174–81.CrossRefPubMed

18.

Okuda K, Yano M, Yoshino I, Okumura M, Higashiyama M, Suzuki K, et al. Thymoma patients with pleural dissemination: nationwide retrospective study of 136 cases in Japan. Ann Thorac Surg. 2014;97:1743–8.CrossRefPubMed

19.

Nakajima J, Okumura M, Yano M, Date H, Onuki T, Haniuda M, et al. Myasthenia gravis with thymic epithelial tumour: a retrospective analysis of a Japanese database. Eur J Cardiothorac Surg. 2016;49:1510–5.CrossRefPubMed

20.

Hishida T, Asamura H, Yoshida K, Tsuboi M, Yokoi K, Toyooka S, et al. Clinical features and prognostic impact of coexisting autoimmune disease other than myasthenia gravis in resected thymomas: analysis of a Japanese multi-institutional retrospective database. Eur J Cardiothorac Surg. 2021;59:641–9.CrossRefPubMed

21.

Mizuno T, Okumura M, Asamura H, Yoshida K, Niwa H, Kondo K, Japanese Association for Research on Thymus, et al. Surgical management of recurrent thymic epithelial tumors: a retrospective analysis based on the Japanese nationwide database. J Thorac Oncol. 2015;10:199–205.CrossRefPubMed

22.

Hishida T, Nomura S, Yano M, Asamura H, Yamashita M, Ohde Y, Japanese Association for Research on the Thymus (JART), et al. Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese nationwide database study. Eur J Cardiothorac Surg. 2016;49:835–41.CrossRefPubMed

23.

Blumberg D, Port JL, Weksler B, Delgado R, Rosai J, Bains MS, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg. 1995;60:908–14.CrossRefPubMed

24.

Bian D, Zhou F, Yang W, Zhang K, Chen L, Jiang G, et al. Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: a population based study. Oncotarget. 2018;9(15):12273–83.CrossRefPubMedPubMedCentral

25.

Yun JK, Kim HR, Kim DK, Shim YM, Kim YT, Chung KY, et al. Tumor size as a prognostic factor in limited-stage thymic epithelial tumors: a multicenter analysis. J Thorac Cardiovasc Surg. 2021;162:309–17.CrossRefPubMed

Title: Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database
Authors: Meinoshin Okumura
Ichiro Yoshino
Soichiro Funaki
Katsuhiro Okuda
Shun-ichi Watanabe
Masahiro Tsuboi
Kimihiro Shimizu
Hiroshi Date
Toyofumi F. Chen-Yoshikawa
Jun Nakajima
Shinichi Toyooka
Hisao Asamura
Publication date: 17-07-2023
Publisher: Springer Nature Singapore
Keywords: Thymoma
Thymoma
Myasthenia Gravis
Published in: Surgery Today / Issue 11/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-023-02705-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

A low cumulative perioperative prognostic nutritional index predicts poor long-term outcomes in patients with gastric cancer: A single-center retrospective study in Japan

The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan

Two-step arterial reconstruction technique for en bloc resection of a large retroperitoneal liposarcoma involving the common iliac artery

Advantages of robotic gastrectomy for overweight patients with gastric cancer: a comparison study of robotic gastrectomy and conventional laparoscopic gastrectomy

Novel mobilization of the medial approach without changing the position for robotic right hemicolectomy

Elderly lung transplant recipients show acceptable long-term outcomes for lung transplantation: A propensity score-matched analysis