Pier Luigi Filosso1, Xiaopan Yao2, Enrico Ruffini3, Usman Ahmad4, Alberto Antonicelli5, James Huang4, Francesco Guerrera3, Federico Venuta6, Dirk van Raemdonck7, William Travis8, Marco Lucchi9, Andreas Rimner10, Pascal Thomas11, Walter Weder12, Gaetano Rocco13, Frank Detterbeck5, Robert Korst14. 1. Department of Thoracic Surgery, University of Torino, Turin, Italy pierluigi.filosso@unito.it. 2. Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA. 3. Department of Thoracic Surgery, University of Torino, Turin, Italy. 4. Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA. 6. Department of Thoracic Surgery, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico 'Umberto I', University of Rome Sapienza, Rome, Italy. 7. Department of Thoracic Surgery, University Hospitals Leuven Belgium, Leuven, Belgium. 8. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 9. University of Pisa, Pisa, Italy. 10. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 11. Department of Thoracic Surgery, Lung Transplantation & Diseases of the Esophagus Marseille, Aix-Marseille University & Hospitals System of Marseille (AP-HM), Marseille, France. 12. Division of Thoracic Surgery, University Hospital, Zurich, Switzerland. 13. Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy. 14. Valley Health System, Ridgewood, NJ, USA.
Abstract
OBJECTIVES: The latest World Health Organization (WHO) histological classification divides thymic epithelial tumours in thymomas and thymic carcinomas (TCs), the latter also including the neuroendocrine thymic tumours (NETTs). NETTs and other TC histotypes have been described to have a significantly lower survival than thymomas, but these two groups of tumours have rarely been compared directly. Using the European Society of Thoracic Surgeons and the International Thymic Malignancy Interest Group datasets, we wanted to study this issue. METHODS: This is a retrospective multicentre cohort study of patients operated for TC. Outcome measures were overall survival (OS) and recurrence-free survival (RFS). OS was analysed using the Kaplan-Meier method and RFS was assessed using competing risk analysis. The association with clinical and prognostic factors for OS and RFS was evaluated with log-rank test and Gray's test, respectively. RESULTS: A total of 1247 tumours (1042 TCs) were collected between 1984 and 2012. A R0 resection was performed in 363 TCs and in 52 NETTs. The median follow-up was 4.4 years for TCs and 4.1 years for NETTs. Owing to the missing values for survival information, a total of 728 TC patients and 132 NETTs were included in the OS analysis. Among them, 262 TC and 39 NETT patients died. The median OS was 6.6 years for TC and 7.5 years for NETTs. The overall 5-year survival rates were 60% for TC and 68% for NETTs; 10-year survival rates were 40% for TCs and 39% for NETTs (P = 0.19). Five-year RFS was 0.35 and 0.34 for TCs and NETTs (P = 0.36). On multivariate analysis, histology did not influence either OS (P = 0.79) or RFS (P = 0.59). CONCLUSIONS: This represents the largest clinical series of TCs and NETTs collected. Despite the biological aggressiveness of these rare neoplasms, the 5-year survival rate after resection is over 60% and TCs and NETT showed a similar rate of survival and recurrences after surgery.
OBJECTIVES: The latest World Health Organization (WHO) histological classification divides thymic epithelial tumours in thymomas and thymic carcinomas (TCs), the latter also including the neuroendocrine thymic tumours (NETTs). NETTs and other TC histotypes have been described to have a significantly lower survival than thymomas, but these two groups of tumours have rarely been compared directly. Using the European Society of Thoracic Surgeons and the International Thymic Malignancy Interest Group datasets, we wanted to study this issue. METHODS: This is a retrospective multicentre cohort study of patients operated for TC. Outcome measures were overall survival (OS) and recurrence-free survival (RFS). OS was analysed using the Kaplan-Meier method and RFS was assessed using competing risk analysis. The association with clinical and prognostic factors for OS and RFS was evaluated with log-rank test and Gray's test, respectively. RESULTS: A total of 1247 tumours (1042 TCs) were collected between 1984 and 2012. A R0 resection was performed in 363 TCs and in 52 NETTs. The median follow-up was 4.4 years for TCs and 4.1 years for NETTs. Owing to the missing values for survival information, a total of 728 TC patients and 132 NETTs were included in the OS analysis. Among them, 262 TC and 39 NETT patients died. The median OS was 6.6 years for TC and 7.5 years for NETTs. The overall 5-year survival rates were 60% for TC and 68% for NETTs; 10-year survival rates were 40% for TCs and 39% for NETTs (P = 0.19). Five-year RFS was 0.35 and 0.34 for TCs and NETTs (P = 0.36). On multivariate analysis, histology did not influence either OS (P = 0.79) or RFS (P = 0.59). CONCLUSIONS: This represents the largest clinical series of TCs and NETTs collected. Despite the biological aggressiveness of these rare neoplasms, the 5-year survival rate after resection is over 60% and TCs and NETT showed a similar rate of survival and recurrences after surgery.
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