Long-term survival and prognostic factors in thymic epithelial tumours☆

Rea, Federico; Marulli, Giuseppe; Girardi, Rodolfo; Bortolotti, Luigi; Favaretto, Adolfo; Galligioni, Alessandra; Sartori, F

doi:10.1016/j.ejcts.2004.04.041

Cited by 143 publications

(151 citation statements)

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“…41,44 Masaoka stage is a good predictor of aggressive behavior, 10,35,38,44 although recurrences have been documented even with early stage disease. 10,45,46 The proportion of patients with recurrence was higher in stages III and IV compared with patients in stages I and II. 38,45 As most of the recurrent cases in this study were stage I or II at diagnosis, it was not useful in predicting the behavior of these tumors.…”

Section: Discussionmentioning

confidence: 98%

“…10,45,46 The proportion of patients with recurrence was higher in stages III and IV compared with patients in stages I and II. 38,45 As most of the recurrent cases in this study were stage I or II at diagnosis, it was not useful in predicting the behavior of these tumors. In an analysis of 1320 thymic tumors, Kondo and Monden 47 found total resection as the most significant predictive factor.…”

Section: Discussionmentioning

confidence: 98%

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WHO types A and AB thymomas: not always benign

Jain

Mehta

Henley³

et al. 2010

Modern Pathology

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The 2004 WHO classification of thymic tumors recognizes five major subtypes of thymomas and thymic carcinoma. Subtypes A and AB thymomas are purported to be benign neoplasms, although prior studies have suggested a potential for malignant behavior. The purpose of this study was to assess the clinical behavior of A and AB thymomas identified from a large institutional pathologic database. A retrospective slide review of 500 thymic epithelial tumors identified 71 (B14%) cases of types A and AB thymomas. Clinical history and follow-up information were obtained through retrospective chart review. There were 38 and 33 cases of types A and AB thymomas, respectively. Complete follow-up data were available in 37 (52%) cases. Eighteen (49%) patients (type A, n ¼ 9 and type AB, n ¼ 9) had evidence of recurrent/metastatic disease at an average of 62 months (range from 6 to 244 months) after initial diagnosis. Survival curves for patients with types A and AB thymomas, with and without recurrences, show a statistically significant difference (P ¼ 0.001 and 0.005, respectively). Analysis of this large cohort confirms the potential for subtypes A and AB thymomas to show malignant behavior. Long-term clinical monitoring, therefore, appears to be justified in these cases. This study also shows the poor correlation between the WHO classification and tumor behavior

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

WHO types A and AB thymomas: not always benign

Jain

Mehta

Henley³

et al. 2010

Modern Pathology

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“…46,[48][49][50] For instance, studies have shown significantly worse survival of B3 thymoma versus types A through B2 thymoma, 51 types A and AB thymoma, 52 or types A, AB, and B1 thymoma. 53 Recently, a study by Weis et al 54 evaluating 4221 thymomas submitted to the ITMIG retrospective database (including cases between 1983 and 2012) also showed that the WHO classification of thymomas was significantly associated with overall survival in univariate analysis, and although not all thymoma types differed from each other significantly, B3 thymomas had a worse overall survival in R0 resected patients than B1 thymomas. However, after adjusting for age, stage, and resection status, the WHO classification was no longer significant for overall survival.…”

Section: Staging Is Prognostically Superior To Histomorphologic Classmentioning

confidence: 99%

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

Roden¹

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor.Objective.-To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described.Data Sources.-Search of literature database (PubMed) and current (2015) World Health Organization classification.Conclusions.-Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.

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“…14,16,17,[29][30][31][32][33][34][35][36][37][38][39][40] What Levels of 'Best Evidence' Are Currently Available?…”

Section: Resultsmentioning

confidence: 99%

Evidence‐based pathology and the pathologic evaluation of thymomas

Marchevsky

Gupta

McKenna

et al. 2008

Cancer

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BACKGROUND.The clinical validity and applicability of the World Health Organization (WHO) histopathologic classification of thymomas (‘classification’) has been questioned. Evidence‐based pathology promotes the use of systematic reviews and analysis of data with meta‐analysis rather than subjective reviews of the literature.METHODS.The authors performed a review of the English literature from 1999 to the present to identify ‘best evidence’ regarding the use of the ‘classification.’ The data were analyzed with meta‐analysis software.RESULTS.To the authors' knowledge, only Level‐3 or ‐4 evidence published in retrospective cases series is currently available regarding the use of the ‘classification.’ Meta‐analysis demonstrated that only 3 WHO categories of thymomas are associated with significant survival differences: A/AB/B1, B2, and B3. It also indicated significant heterogeneity with regard to the results published in different studies. To the authors' knowledge there is no current evidence to determine whether thymoma types are significant prognostic features for patients previously stratified by stage.CONCLUSIONS.There is a lack of randomized clinical trials evaluating the prognosis of patients with thymomas and the effects of various treatment modalities. The WHO classification of thymomas needs revision and could most likely be simplified into fewer classes with significant prognostic value. Future studies are needed to evaluate the prognostic and/or predictive value for thymoma patients previously stratified by stage. The latter information is important to help select those patients who may benefit from neoadjuvant chemotherapy or postoperative radiotherapy and other modalities. Cancer 2008. © 2008 American Cancer Society.

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Long-term survival and prognostic factors in thymic epithelial tumours☆

Abstract: The WHO histologic classification seems to be the most significant prognostic factor reflecting the invasiveness of the thymic tumour. Completeness of resection and Masaoka stage I and II assure a better survival. Unresectable recurrence of thymic tumour predicted a worse prognosis.

Cited by 143 publications

References 24 publications

WHO types A and AB thymomas: not always benign

WHO types A and AB thymomas: not always benign

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

Evidence‐based pathology and the pathologic evaluation of thymomas

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