Pier Luigi Filosso1, Francesco Guerrera2, Angelo Erino Rendina3, Giulia Bora2, Enrico Ruffini2, Domenico Novero4, Luigi Ruco5, Domenico Vitolo6, Marco Anile7, Mohsen Ibrahim3, Caterina Casadio8, Ottavio Rena8, Alberto Terzi9, Paraskevas Lyberis2, Alberto Oliaro2, Federico Venuta7. 1. University of Torino, Department of Thoracic Surgery, Torino, Italy. Electronic address: pierluigi.filosso@unito.it. 2. University of Torino, Department of Thoracic Surgery, Torino, Italy. 3. University of Rome Sapienza, Fondazione Eleonora Lorillard Spencer Cenci, S. Andrea Hospital, Rome, Italy. 4. San Giovanni Battista Hospital, Unit of Pathology, Torino, Italy. 5. University of Rome Sapienza, Unit of Pathology, S. Andrea Hospital, Rome, Italy. 6. University of Rome Sapienza, Policlinico Umberto I, Department of Pathology, Rome, Italy. 7. University of Rome Sapienza, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico Umberto I, Rome, Italy. 8. "Amedeo Avogadro University", Unit of Thoracic Surgery, Novara, Italy. 9. "Santa Croce e Carle Hospital", Unit of Thoracic Surgery, Cuneo, Italy.
Abstract
OBJECTIVE: Thymic carcinoma (TC) is a rare and invasive mediastinal tumor, with poor prognosis. Most of the previous published papers are single-institution based, reporting small series of patient, sometimes including palliative resection. This study collected patients with TC treated in 5 high-volume Italian Thoracic Surgery Institutions. METHODS: A multicenter retrospective study of patients operated for TC between 2000 and 2011 was conducted. Exclusion criteria were: Neuroendocrine thymic neoplasms, debulking/palliative resection and tumor biopsy. Cause specific survival (CSS) was the primary endpoint. RESULTS: Four hundred and seventy-eight patients underwent surgery for thymic malignancies: 40 of them (8.4%) had TC. Eleven (27.5%) received induction chemotherapy because of their radiological invasiveness. A complete resection (R0) was achieved in 36 (90%; 9/11 submitted to induction chemotherapy). Adjuvant radio/chemotherapy was offered to 37 patients, according to the type of surgical resection and tumor invasiveness. Three, 5 and 10-year survival rates were 79%, 75% and 58%. Recurrences developed in 10 patients. R0 resection (p<0.0003) and absence of tumor recurrences (p=0.03) resulted significant prognostic factors at univariate analysis. Independent CSS predictor was the achievement of a complete resection (p<0.05). CONCLUSIONS: TC is a rare and invasive mediastinal tumor. A multimodal approach is indicated especially in TC invasive forms. The achievement of a complete surgical resection is fundamental to improve survival.
OBJECTIVE:Thymic carcinoma (TC) is a rare and invasive mediastinal tumor, with poor prognosis. Most of the previous published papers are single-institution based, reporting small series of patient, sometimes including palliative resection. This study collected patients with TC treated in 5 high-volume Italian Thoracic Surgery Institutions. METHODS: A multicenter retrospective study of patients operated for TC between 2000 and 2011 was conducted. Exclusion criteria were: Neuroendocrine thymic neoplasms, debulking/palliative resection and tumor biopsy. Cause specific survival (CSS) was the primary endpoint. RESULTS: Four hundred and seventy-eight patients underwent surgery for thymic malignancies: 40 of them (8.4%) had TC. Eleven (27.5%) received induction chemotherapy because of their radiological invasiveness. A complete resection (R0) was achieved in 36 (90%; 9/11 submitted to induction chemotherapy). Adjuvant radio/chemotherapy was offered to 37 patients, according to the type of surgical resection and tumor invasiveness. Three, 5 and 10-year survival rates were 79%, 75% and 58%. Recurrences developed in 10 patients. R0 resection (p<0.0003) and absence of tumor recurrences (p=0.03) resulted significant prognostic factors at univariate analysis. Independent CSS predictor was the achievement of a complete resection (p<0.05). CONCLUSIONS: TC is a rare and invasive mediastinal tumor. A multimodal approach is indicated especially in TC invasive forms. The achievement of a complete surgical resection is fundamental to improve survival.
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