Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival

Ried, Michael; Eicher, Maria-Magdalena; Neu, Reiner; Sziklavári, Zsolt; Hofmann, Hans‐Stefan

doi:10.1186/s12957-017-1283-4

Cited by 42 publications

(57 citation statements)

References 32 publications

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“…In our study, a significant correlation of the TNM and M-K staging system with DFS was observed ( p = 0.002 and p = 0.001), showing a substantial equivalence of both staging systems. However, in accordance with previous studies, the analyzed re-staging in the cohort according to the TNM system led to a remarkable shift towards stage I, with a downstaging of Masaoka–Koga stage II and III tumors [ 20 ]. This is due to the fact that the current TNM staging system does not differentiate between encapsulated tumors and tumors invading the thymic tissue or mediastinal fat, all classified in stage I.…”

Section: Discussionsupporting

confidence: 85%

Correlation of Computed Tomography Parameters with Histology, Stage and Prognosis in Surgically Treated Thymomas

Carretta

Viscardi²,

Muriana³

et al. 2020

Medicina

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Background and objectives: The histological classification and staging of thymic tumors remains a matter of debate. The correlation of computed tomography (CT) parameters with tumor histology and stage also still has to be completely assessed. The aim of this study was therefore to analyze the correlation of radiological parameters with histological and staging classifications of thymomas evaluating their prognostic role. Materials and Methods: Data of 50 patients with thymoma submitted to a complete surgical treatment between 2005 and 2015 were retrospectively analyzed. Tumors were classified according to the WHO and Suster and Moran (S&M) histological classifications and to the Masaoka–Koga and tumor, node and metastases (TNM) staging systems. The correlation of CT features with histology and stage and the prognostic role of histopathological and radiological features were assessed. Results: Five-year overall (OS) and disease-free survival (DFS) were 90.3% and 81.1%, respectively. A significant correlation of DFS with the Masaoka–Koga (p = 0.001) and TNM staging systems (p = 0.002) and with the S&M (p = 0.02) and WHO histological classifications (p = 0.04) was observed. CT scan features correlated with tumor stage, histology and prognosis. Moderately differentiated tumors (WHO B3) had a significantly higher incidence of irregular shape and contours (p = 0.002 and p = 0.001, respectively) and pericardial contact (p = 0.036). A larger tumor volume (p = 0.03) and a greater length of pleural contact (p = 0.04) adversely influenced DFS. The presence of pleural (p < 0.001) or lung invasion (p = 0.02) and of pleural effusion (p = 0.004) was associated with a significantly worse OS. Conclusions: Pre-operative CT scan parameters correlate with stage and histology, and have a prognostic role in surgically treated thymomas.

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Section: Discussionsupporting

confidence: 85%

Correlation of Computed Tomography Parameters with Histology, Stage and Prognosis in Surgically Treated Thymomas

Carretta

Viscardi²,

Muriana³

et al. 2020

Medicina

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“…The invasive and non-invasive groups were divided according to stage, III and IV or I and II, and the high-risk and low-risk groups were divided according to type, B2, and B3 or types A, AB, and B1. When a tumor showed multiple histological components, it was classified based on the predominant component (39).…”

Section: Methodsmentioning

confidence: 99%

Relationship Between Computed Tomography Imaging Features and Clinical Characteristics, Masaoka–Koga Stages, and World Health Organization Histological Classifications of Thymoma

et al. 2019

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Objectives: Computed tomography (CT) is an important technique for evaluating the condition and prognosis of patients with thymomas, and it provides guidance regarding treatment strategies. However, the correlation between CT imaging features, described using standard report terms, and clinical characteristics, Masaoka–Koga stages, and World Health Organization (WHO) classifications of patients with thymomas has not been described in detail nor has risk factor analysis been conducted.Methods: Overall, 159 patients with thymomas who underwent preoperative contrast-enhanced CT between September 2011 and December 2018 were retrospectively reviewed. We assessed the clinical information, CT imaging features, and pathological findings for each patient. A total of 89 patients were specially used to evaluate postoperative recurrence or metastasis between September 2011 and December 2015 to obtain an appropriate observation period. The relationship between CT imaging features and clinical characteristics, Masaoka–Koga stage, and WHO histological classification were analyzed, and related risk factors based on CT imaging features were identified.Results: CT imaging features did not significantly differ based on sex or age. Some imaging features demonstrated significant differences between the groups with and without related clinical characteristics. Contour (odds ratio [OR] = 3.711, P = 0.005), abutment ≥50% (OR = 4.277, P = 0.02), and adjacent lung abnormalities (OR = 3.916 P = 0.031) were independent risk factors for relapse or metastasis. Among all imaging features, there were significant differences between stage I/II and III/IV lesions in tumor size, calcification, infiltration of surrounding fat, vascular invasion, pleural nodules, elevated hemidiaphragm, and pulmonary nodules. Tumor size (odds ratio = 1.261, P = 0.014), vascular invasion (OR = 2.526, P = 0.023), pleural nodules (OR = 2.22, P = 0.048), and pulmonary nodules (OR = 3.106, P = 0.006) were identified as independent risk factors. Tumor size, contour, internal density, infiltration of surrounding fat, and pleural effusion significantly differed between low- and high-risk thymomas. Tumor size (OR = 1.183, P = 0.048), contour (OR = 2.288, P = 0.003), internal density (OR = 2.192, P = 0.024), and infiltration of surrounding fat (OR = 2.811 P = 0.005) were independent risk factors.Conclusions: Some CT imaging features demonstrated significant correlations with clinical characteristics, Masaoka–Koga clinical stages, and WHO histological classifications in patients with thymomas. Familiarity with CT features identified as independent risk factors for these related clinical characteristics can facilitate preoperative evaluation and treatment management for the patients with thymoma.

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“…Obwohl sich die beiden Klassifikationen zu großen Teilen decken, bestehen insbesondere im Stadium III große Unterschiede [24]. So werden Tumormanifestationen an gut resezierbaren Strukturen wie dem Perikard oder der mediastinalen Pleura, die nach Masaoka-Koga als Stadium III klassifiziert werden, den niedrigeren TNM-Stadien I und II zugeordnet [25]. Weiter wurde das Stadium III für resektable Tumoren (Stadium IIIA) sowie schlechter bis häufig nicht resektable Tumoren (Stadium IIIB) differenziert (▶ Abb.…”

Section: Stagingunclassified

“…Außerdem zeigte sich, dass Patienten mit einem inkomplett resezierten Stadium-III-Befund ein schlechteres 10-Jahres-Überleben besaßen als inkomplett resezierte Stadium-IV-Tumoren (31 vs. 42 %). Dies deckt sich mit den Ergebnissen einer früheren Arbeit aus unserer Arbeitsgruppe, in der Patienten in TNM-Stadium III sogar ein schlechteres 5-Jahres-Überleben aufwiesen als Patienten des Stadiums IV (Stadium III: 54 % vs. Stadium IV: 70 %) [25]. Möglicherweise kann dieser Unterschied dadurch erklärt werden, dass für Patienten mit pleuraler Metastasierung noch lokale Behandlungsverfahren wie die Pleurektomie/Dekortikation mit anschließender hyperthermer intrathorakaler Chemotherapie (HITOC) zur Verfügung stehen, während die Infiltration zentraler, nicht resektabler Strukturen eine kurative Therapie oftmals limitiert [48].…”

Section: Prognoseunclassified

Erweiterte Resektionsverfahren bei lokal fortgeschrittenen Tumoren des Thymus im Stadium III

2020

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ZusammenfassungDie Therapie lokal fortgeschrittener Tumoren des Thymus bedarf einer differenzierten Diagnostik und multimodalen Vorgehensweise, bestehend aus Operation, Radio- und/oder Chemotherapie. Im Hinblick auf das rezidivfreie Überleben und das Langzeitüberleben stellt auch in diesem Stadium die radikale und vollständige Resektion des Tumors den wichtigsten prognostischen Faktor dar. Das Masaoka-Koga-Stadium III beschreibt das lokal invasive Wachstum von malignen Thymustumoren in die mediastinalen Nachbarstrukturen. Abhängig vom Ausmaß der Tumorinfiltration kann die operative Resektion primär oder nach einer Induktionstherapie durchgeführt werden. In vielen Fällen müssen diese Tumoren jedoch auch als nicht resektabel eingestuft werden, sodass nur eine palliative Radio-/Chemotherapie als Therapieoption bleibt. Vor wenigen Jahren wurde erstmalig eine neue TNM-Klassifikation für maligne Thymustumoren eingeführt, die in vielen Teilen der klassischen Masaoka-Koga-Klassifikation zwar ähnelt, jedoch auch einige therapierelevante Änderungen beinhaltet. So wird hier zwischen den Stadien IIIA und IIIB unterschieden, mit dem Ziel, bei lokal fortgeschrittenen Thymustumoren die Resektabilität differenzierter einschätzen und folglich auch das gesamte Therapiekonzept entsprechend besser planen zu können. Neben Thymus, Thymom, perithymischem Fettgewebe, mediastinaler Pleura (Stadium I) oder Perikard (Stadium II) sollten bei Tumoren des Stadiums III alle infiltrierten Strukturen nach Möglichkeit „en bloc“ entfernt werden. Während bspw. die Lunge, brachiozephale Gefäße oder extraperikardiale Pulmonalgefäße noch reseziert und ggf. rekonstruiert werden können, limitiert die Infiltration der Aorta oder intraperikardialer Pulmonalgefäße häufig eine makroskopisch vollständige Resektion.

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Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival

Cited by 42 publications

References 32 publications

Correlation of Computed Tomography Parameters with Histology, Stage and Prognosis in Surgically Treated Thymomas

Correlation of Computed Tomography Parameters with Histology, Stage and Prognosis in Surgically Treated Thymomas

Relationship Between Computed Tomography Imaging Features and Clinical Characteristics, Masaoka–Koga Stages, and World Health Organization Histological Classifications of Thymoma

Erweiterte Resektionsverfahren bei lokal fortgeschrittenen Tumoren des Thymus im Stadium III

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