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Ann Thorac Surg 2000;69:1550-1555
© 2000 The Society of Thoracic Surgeons
a Department of Thoracic and Cardiovascular Surgery, University of Berne, Berne, Switzerland
b Institute of Pathology, University of Berne, Berne, Switzerland
c Division of Pulmonary Medicine, University of Berne, Berne, Switzerland
d Institute of Oncology, University of Berne, Berne, Switzerland
e Clinic of Radio-oncology, University of Berne, Berne, Switzerland
Address reprint requests to Dr Ris, Department of Surgery, University Hospital of Lausanne, Rue du Bugnon 46, CH 1011 Lausanne, Switzerland
e-mail: hris{at}chuv.hospvd.ch
Background. To compare the prognostic relevance of Masaoka and Müller-Hermelink classifications.
Methods. We treated 71 patients with thymic tumors at our institution between 1980 and 1997. Complete follow-up was achieved in 69 patients (97%) with a mean follow up-time of 8.3 years (range, 9 months to 17 years).
Results. Masaoka stage I was found in 31 patients (44.9%), stage II in 17 (24.6%), stage III in 19 (27.6%), and stage IV in 2 (2.9%). The 10-year overall survival rate was 83.5% for stage I, 100% for stage IIa, 58% for stage IIb, 44% for stage III, and 0% for stage IV. The disease-free survival rates were 100%, 70%, 40%, 38%, and 0%, respectively. Histologic classification according to Müller-Hermelink found medullary tumors in 7 patients (10.1%), mixed in 18 (26.1%), organoid in 14 (20.3%), cortical in 11 (15.9%), well-differentiated thymic carcinoma in 14 (20.3%), and endocrine carcinoma in 5 (7.3%), with 10-year overall survival rates of 100%, 75%, 92%, 87.5%, 30%, and 0%, respectively, and 10-year disease-free survival rates of 100%, 100%, 77%, 75%, 37%, and 0%, respectively. Medullary, mixed, and well-differentiated organoid tumors were correlated with stage I and II, and well-differentiated thymic carcinoma and endocrine carcinoma with stage III and IV (p < 0.001). Multivariate analysis showed age, gender, myasthenia gravis, and postoperative adjuvant therapy not to be significant predictors of overall and disease-free survival after complete resection, whereas the Müller-Hermelink and Masaoka classifications were independent significant predictors for overall (p < 0.05) and disease-free survival (p < 0.004; p < 0.0001).
Conclusions. The consideration of staging and histology in thymic tumors has the potential to improve recurrence prediction and patient selection for combined treatment modalities.
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