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The Journal of Cardiovascular Surgery 2002 April;43(2):269-74

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Clinical and pathologic predictors of survival in patients with thymic tumors

Lequaglie C., Giudice G., Brega Massone P. P., Conti B., Cataldo I.

From the Department of Thoracic Surgery, Istituto Nazionale Tumori, Milano, Italy


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Background. The aim of ­this ­study is to eval­u­ate the ­impact of thy­mec­to­my in ­patients ­with thym­ic neo­plasms and to iden­ti­fy clin­i­cal and his­to­path­o­log­i­cal fac­tors asso­ciat­ed ­with ­improved ­long-­term out­come of sur­gery.
Methods. We treat­ed 74 ­patients ­between February 1987 and July 1993. There ­were 29 ­total and 36 sim­ple thy­mec­to­mies. These ­last cas­es, all non-myas­then­ic, had ­benign thy­mo­mas (n=30) but 6 had thym­ic car­ci­no­mas. Nine ­tumors ­were no-resect­ed (5 thy­mo­mas and 4 thym­ic car­ci­no­mas). Minimum fol­low-up by Department of Thoracic Surgery Istituto Nazionale Tumori was 60 ­months ­after thy­mec­to­my. We divid­ed the spec­i­mens accord­ing to Marino and Muller-Hermelink’s clas­sifi­ca­tion: 54 thy­mo­mas, 18 thym­ic car­ci­no­mas and 2 no-diag­no­sis spec­i­fy thy­mo­mas. There ­were 53 ­stage I, 1 ­stage II, 13 ­stage III, 5 ­stage IVa and 2 ­stage IVb accord­ing to Masaoka.
Results. Forty-six ­patients ­with treat­ed thy­mo­ma ­were ­alive with­out dis­ease at the end of fol­low-up, the remain­ing 8 ­died ­from recur­rence in 6, a new ­tumor in 1 and a ­heart ­attack in the ­last. Of 18 thym­ic car­ci­no­mas 9 ­were ­alive at the end of fol­low-up (1 ­with recur­rence), ­only 4 ­dead ­from recur­rence. The actu­ar­i­al sur­vi­val of ­patients ­with thy­mo­mas was 88.5% at 5 ­years, (73.6% in cor­ti­cal ­type, 85.7% in medul­lary ­type, 93.9% in ­mixed ­type, 100% in pre­dom­i­nant­ly cor­ti­cal ­type). Myasthenia gra­vis ­didn’t influ­ence the sur­vi­val: 87.3 (no MG) vs 90%. Advanced ­stage thy­mo­mas sig­nif­i­cant­ly ­increased the ­risk of ­death ­from ear­ly ­stage I: 32.4 vs 100% at 5 ­years. In thym­ic car­ci­no­ma ­patients ­with ­well-dif­fer­en­tiat­ed thym­ic car­ci­no­ma (­WDTC) ­died ­less ­than oth­ers: the actu­ar­i­al prob­abil­ity of sur­vi­val at 5 ­years was 90 vs 68%.
Conclusions. Thymectomy was the ­best treat­ment to ­long ­term out­come. In our expe­ri­ence, sur­vi­val was relat­ed to his­to­type and to ­local exten­sion of ­tumor.

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