Esra KORKMAZ KIRAKLI, Eda ERDİŞ, Şule KARABULUT GÜL, Hüseyin TEPETAM, Şule KARAMAN, Şimay GÜROCAK, İbrahim BABALIOĞLU, Pelin ALTINOK

Factors Affecting Treatment and Prognosis in Thymomas: A Multi-Center Experience

OBJECTIVEThymomas, a rare malignancy, are located in 95% anterior mediastinum. They are associated with para-neoplastic syndromes, especially myasthenia graves. Although many classifications are used considering the depth of invasion, presence of metastasis, predominant cell type, or immunohistochemical proper-ties in staging, Masoaka classification is commonly used. Surgery is the most effective method in the treatment of thymoma, and neoadjuvant chemotherapy is recommended in advanced stages (III-IV). Adjuvant radiotherapy has proven efficacy in advanced and inoperable patients. In this study, we aimed to evaluate treatment outcomes and factors affecting prognosis in thymoma patients.METHODSPatients with thymoma who were included in this study voluntarily from seven centers between January 2002 and August 2018 were evaluated retrospectively.RESULTSOf the 158 patients with thymoma, 125 patients with complete data were included in this study. The mean age of the patients was 51.84 (18-84), and 72 were male. Myasthenia graves were present in 64 patients. One hundred thirteen patients were operated and 12 were inoperable. One hundred patients were stage 2, 9 were stage 3, and 16 were stage 4. In our study, 3-year survival was 84.4%, and 5-year survival was 74.9%; inoperable patients, surgical margin positivity, advanced disease and radiotherapy dose less than 50.4’Gy were found to be negative factors affecting survival. In patients with myasthenia graves (MG), survival was higher in patients with stage 2B and less. Survival was lower in epithelial type B3 and type C histologic types. Age, sex, and capsule involvement did not seem to affect survival.CONCLUSIONThymoma is a locally controlled disease with long survival and the results of our study are consistent with the literature. The number of patients should be increased to better define prognostic factors.

PDF

___

1. Lewis JE, Wick MR, Scheithauer BW, Bernatz PE, Taylor WF. A clinicopathologic review. Cancer 1987;60(11):2727–43.
2. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981;48(11):2485–92.
3. Scorsetti M, Leo F, Trama A, D’Angelillo R, Serpico D, Macerelli M, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol 2016;99:332–50.
4. Sperling B, Marschall J, Kennedy R, Pahwa P, Chibbar R. Thymoma: A review of the clinical and pathological f indings in 65 cases. Can J Surg 2003;46(1):37–42.
5. Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S; ESMO Guidelines Committee. Thymic epithelial tumours: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26 (Suppl 5):v40–55.
6. Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E. Results of 241 operated cases. Ann Thorac Surg 1991;51:152–6.
7. Wilkins EW Jr, Grillo HC, Scannell JG, Moncure AC, Mathisen DJ. Role of staging in prognosis and management of thymoma. Ann Thorac Surg 1991;51(6):888–92.
8. Regnard JF, Magdeleinat P, Dromer C, Dulmet E, de Montpreville V, Levi JF, et al. Prognostic factors and long-term results after thymoma resection: A series of 307 patients. J Thorac Cardiovasc Surg. 1996 Aug;112(2):376–84.
9. Fuentes P, Leude E, Ruiz C, Bordigoni L, Thomas P, Giudicelli R, et al. Treatment of thymoma: A report of 67 cases. Eur J Cardiothorac Surg 1992;6(4):180–7.
10. Demirci S, Turhan K, Ozsan N, Yalman D, Cakan A, Cok G, et al. Prognostic factors for survival in patients with thymic epithelial tumors. Thorac Cardiovasc Surg 2011;59(3):153–7.
11. Zhu G, He S, Fu X, Jiang G, Liu T. Radiotherapy and prognostic factors for thymoma: A retrospective study of 175 patients. Int J Radiat Oncol Biol Phys 2004;60(4):1113–9.
12. Cohen DJ, Ronnigen LD, Graeber GM, Deshong JL, Jaffin J, Burge JR, et al. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg 1984;87(2):301–7.
13. Marulli G, Margaritora S, Lucchi M, Cardillo G, Granone P, Mussi A, et al. Surgical treatment of recurrent thymoma: is it worthwhile?†. Eur J Cardiothorac Surg 2016;49(1):327–32.
14. Nakahara K, Ohno K, Hashimoto J, Maeda H, Miyoshi S, Sakurai M, et al. Thymoma: result with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg 1988;95(6):1041–7.
15. McCart JA, Gaspar L, Inculet R, Casson AG. Predictors of survival following surgical resection of thymoma. J Surg Oncol 1993;54(4):233–8.
16. Arakawa A, Yasunaga T, Saitoh Y, Uozumi H, Takada C, Baba Y, et al. Radiation therapy of invasive thymoma. Int J Radiat Oncol Biol Phys 1990;18(3):529–34.
17. Shin DM, Walsh GL, Komaki R, Putnam JB, Nesbitt J, Ro JY, et al. A multidisciplinary approach to therapy for unresectable malignant thymoma. Ann Intern Med 1998;129(2):100–4.