Prognostic and Clinical Relevance of the World Health Organization Schema for the Classification of Thymic Epithelial Tumors

Kim, Dae Joon; Yang, Woo Ick; Choi, Sung Sil; Kim, Kil Dong; Chung, Kwansoo

doi:10.1378/chest.127.3.755

Cited by 140 publications

(152 citation statements)

References 22 publications

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“…6 Their potential for recurrent behavior has been reported in several previous studies. 19,30,35,[40][41][42][43][44] In our study, 16 of 29 patients had invasive tumors. In follow-up, we observed metastatic events from as early as 1 year to as late as 11 years (mean: 62.25 months) from diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients with complete resection can still develop recurrences or die because of disease. 30,31,39,40 This has been suggested to occur more frequently with type AB than with type A tumors. 44 In this study, the primary tumors in 17/18 patients had been completely excised, suggesting that complete resection is not curative in all patients with thymic neoplasms.…”

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: 99%

Section: Discussionmentioning

confidence: 99%

WHO types A and AB thymomas: not always benign

Jain

Mehta

Henley³

et al. 2010

Modern Pathology

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“…Most medullary (WHO A) and mixed histology (WHO AB) tumors appear noninvasive, corresponding to Masaoka stages I and II, whereas cortical (WHO B1, 2 and 3) thymomas appear more invasive and occur more commonly as stage III and IV lesions [1]. No significant difference in survival has been observed between patients with stage I and II disease [7]. Furthermore, type A and AB thymomas were shown to be less frequently associated with myasthenia gravis than tumors of type B [8].…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT is Useful for Pretreatment Assessment of the Histopathologic Type of Thymic Epithelial Tumors

Kim

et al. 2010

Nucl Med Mol Imaging

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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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Prognostic and Clinical Relevance of the World Health Organization Schema for the Classification of Thymic Epithelial Tumors

Cited by 140 publications

References 22 publications

WHO types A and AB thymomas: not always benign

WHO types A and AB thymomas: not always benign

18F-FDG PET/CT is Useful for Pretreatment Assessment of the Histopathologic Type of Thymic Epithelial Tumors

Evidence‐based pathology and the pathologic evaluation of thymomas

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