New WHO histologic classification predicts prognosis of thymic epithelial tumors

Chen, Gang; Marx, Alexander; Chen, Wenhu; Yong, Bai; Puppe, Bernhard; Stroebel, Philipp; Mueller-Hermelink, Hans Konrad

doi:10.1002/cncr.10665

Cited by 355 publications

(328 citation statements)

References 34 publications

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“…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: 79%

“…With the continued perception of benign behavior, it is probable that some patients will not receive due consideration for adjuvant therapy. 21,38,39 Regarding type AB thymoma, the 2004 WHO update states: 'type AB thymomas are generally regarded as clinically benign tumors.' 6 Paradoxically, it also states that up to 25% of AB thymomas can be invasive at diagnosis (stage II or greater).…”

Section: Discussionmentioning

confidence: 99%

“…30,42 In some series, tumor recurrences were more frequent in type AB compared with type A thymoma. 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.…”

Section: Discussionmentioning

confidence: 99%

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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: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…[44][45][46][47][48][49] Some reports have shown that patients with type B3 thymoma have a worse prognosis than those with type B2 thymoma, 44,45 whereas others have reported no significant difference in survival between these 2 groups. [46][47][48][49] The results of the current study indicated no difference in the 10-year OS rates between patients with type B1 þ B2 (89.5%) and type B3 (75.0%) thymomas (P ¼ .30), whereas significant differences (P < .001) were noted between patients with type B1 þ B2 (86% and 85%, respectively) and type B3 (38%) thymomas in a previous report from our institution. 44 A possible reason is the difference in the period of analysis; the analysis of the current study was conducted between 1999 and 2009 for thymoma, whereas that of the previous report was performed between 1962 and 2000.…”

Section: Discussionmentioning

confidence: 99%

Steroid receptor expression in thymomas and thymic carcinomas

Mimae

Tsuta

Takahashi

et al. 2011

Cancer

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BACKGROUND: Although protein expressions of glucocorticoid receptor (GR), estrogen receptors (ERa and ERb), progesterone receptor A (PgR-A), and androgen receptor (AR) were shown to play roles in the growth and differentiation of normal thymus and thymic tumors, to the authors' knowledge their association with patient characteristics and prognosis has yet to be determined. METHODS: A series of 140 thymic epithelial tumors (57 type A þ AB thymomas, 40 type B1 þ B2 thymomas, 6 type B3 thymomas, and 37 thymic carcinomas) were examined for GR, ERa, ERb, PgR-A, and AR expression using immunohistochemistry. In addition, the correlation between expression of these hormone receptors and clinicopathologic factors and overall survival (OS) was assessed. RESULTS: GR and ERb demonstrated a high rate of expression in thymomas and thymic carcinomas (82.9% and 76.4%, respectively), whereas rates of ERa, PgR-A, and AR expression were low (13.6%, 0.71%, and 23.6%, respectively). A significant correlation (P < .05) was found between ERa expression and tumor size and between ERb expression and tumor stage. Multivariate analyses revealed that histologic subtype (P ¼ .0039), tumor stage (P ¼ .0012), and GR expression (P ¼ .0025) were significantly correlated with the 10-year OS rate. CONCLUSIONS: GR and ERb demonstrated high rates of expression in thymomas and thymic carcinomas. Furthermore, multivariate analysis revealed that GR expression was associated with better prognosis in patients with surgically resected thymomas and thymic carcinomas. Cancer 2011;117:4396-

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“…Some studies have demonstrated that the WHO histologic classification reflects the oncologic behavior of thymoma. 40,41 Type A and AB thymomas are benign, and Type B1 and B2 thymomas represent the borderline between benign and malignant thymoma. Conversely, Type B3 thymomas have malignant behavior, and Type C thymomas are more aggressive tumor and must be considered cancerous.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of primary care physicians and their practices associated with mammography rates for older women

Harrison

Janz

Wolfe

et al. 2003

Cancer

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BACKGROUND Mammography screening rates are below national recommendations for older women. Understanding the relation between the characteristics of primary care physicians (PCPs) and mammography rates for older women can help to target screening improvement efforts. METHODS Subjects were 2527 PCPs practicing in Michigan between 1997 and 1998. A cross‐sectional design used Medicare data to identify women age 68 years or older in 1998 whom PCPs treated in 1997–1998 and to determine whether these women had a mammogram between 1996 and1998. Eligible women were Medicare beneficiaries age 65 years or older by 1996, residing in Michigan from 1996 to 1998, without specified comorbidities likely to affect decisions regarding mammography. Correlations and multiple regressions examined the relation between this score and characteristics of both PCPs and their practice populations of older women. RESULTS Mammography rates across physicians' practices ranged from 3–100% (mean = 59%, standard deviation = 17%). Five predictors accounted for 55% of the variance in mammography rates across practices. Higher mammography rates were found to be independently related to physicians who have: a lower mean age for female Medicare patients, a higher mean number of physicians billing for patients' care, a lower mean number of inpatient admissions, obstetrics/gynecology practices, and a higher mean education level in patient's zip code (beta weights ≥ 0.25, P < 0.0001). CONCLUSIONS PCPs vary substantially with regard to mammography rates for older women. Mammography rates vary more with the population of patients in physicians' practices than with commonly measured personal characteristics of physicians. Mammography rates should be adjusted for patient population to target individual PCPs with low mammography rates for interventions. Cancer 2003. © 2003 American Cancer Society.

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New WHO histologic classification predicts prognosis of thymic epithelial tumors

Cited by 355 publications

References 34 publications

WHO types A and AB thymomas: not always benign

WHO types A and AB thymomas: not always benign

Steroid receptor expression in thymomas and thymic carcinomas

Characteristics of primary care physicians and their practices associated with mammography rates for older women

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