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. Kernstine & 24 others Shaf 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 journalArticle

68 Citations (Scopus)

Abstract

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
Volume46
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Thymus Neoplasms
Thymoma
Cohort Studies
Databases
Survival
Neuroendocrine Tumors
Recurrence
Histology
Propensity Score
Myasthenia Gravis
Incidence
Disease-Free Survival
Neoplasms
Therapeutics
Confidence Intervals

Keywords

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

ASJC Scopus subject areas

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

Cite this

Ruffini, E., Detterbeck, F., van raemdonck, D., Rocco, G., Thomas, P., Weder, W., ... Zurek, W. (2014). Tumours of the thymus: A cohort study of prognostic factors from the European Society of Thoracic Surgeons database. European Journal of Cardio-thoracic Surgery, 46(3), 361-368. [ezt649]. https://doi.org/10.1093/ejcts/ezt649

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

In: European Journal of Cardio-thoracic Surgery, Vol. 46, No. 3, ezt649, 2014, p. 361-368.

Research output: Contribution to journalArticle

Ruffini, E, Detterbeck, F, van raemdonck, D, Rocco, G, Thomas, P, Weder, W, Brunelli, A, Evangelista, A, Venuta, F, AlKattan, K, Arame, A, Refai, M, Casadio, C, Carbognani, P, Cerfolio, R, Donati, G, Foroulis, CN, Gebitekin, C, de Antonio, DG, Kernstine, KH, Keshavjee, S, Moser, B, Lequaglie, C, Liberman, M, Lim, E, Nicholson, AG, Lang-Lazdunski, L, Mancuso, M, Altorki, N, Nosotti, M, Novoa, NM, Brioude, G, Oliaro, A, Filosso, PL, Saita, S, Scarci, M, Schützner, J, Terzi, A, Toker, A, Van veer, H, Anile, M, Rendina, E, Voltolini, L & Zurek, W 2014, 'Tumours of the thymus: A cohort study of prognostic factors from the European Society of Thoracic Surgeons database', European Journal of Cardio-thoracic Surgery, vol. 46, no. 3, ezt649, pp. 361-368. https://doi.org/10.1093/ejcts/ezt649
Ruffini, Enrico ; Detterbeck, Frank ; van raemdonck, Dirk ; Rocco, Gaetano ; Thomas, Pascal ; Weder, Walter ; Brunelli, Alessandro ; Evangelista, Andrea ; Venuta, Federico ; AlKattan, Khaled ; Arame, Alex ; Refai, Majed ; Casadio, Caterina ; Carbognani, Paolo ; Cerfolio, Robert ; Donati, Giovanni ; Foroulis, Christophoros N. ; Gebitekin, Cengiz ; de Antonio, David Gomez ; Kernstine, Kemp H. ; Keshavjee, Shaf ; Moser, Bernhard ; Lequaglie, Cosimo ; Liberman, Moishe ; Lim, Eric ; Nicholson, Andrew G. ; Lang-Lazdunski, Loic ; Mancuso, Maurizio ; Altorki, Nasser ; Nosotti, Mario ; Novoa, Nuria M. ; Brioude, Geoffrey ; Oliaro, Alberto ; Filosso, Pier Luigi ; Saita, Salvatore ; Scarci, Marco ; Schützner, Jan ; Terzi, Alberto ; Toker, Alper ; Van veer, Hans ; Anile, Marco ; Rendina, Erino ; Voltolini, Luca ; Zurek, Wojciech. / Tumours of the thymus : A cohort study of prognostic factors from the European Society of Thoracic Surgeons database. In: European Journal of Cardio-thoracic Surgery. 2014 ; Vol. 46, No. 3. pp. 361-368.
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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

Y1 - 2014

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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