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Ann Thorac Surg 2006;82:1170
© 2006 The Society of Thoracic Surgeons

Correspondence

A Staging System for Thymic Epithelial Tumors: More Discussion is Required

Tomoki Utsumi, MD, PhD, Meinoshin Okumura, MD, PhD

Department of Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, E-1, Suita-City, Osaka, 565-0871 Japan

(Email: utsumi{at}surg1.med.osaka-u.ac.jp).

To the Editor:

We read with interest the article by Bedini and colleagues [1] proposing a modified staging system for thymic epithelial tumors. We have some comments regarding their proposal, as an update of Masaoka's grading system [2] now seems to be required.

First, they divided patients with pleural implants into two groups based on whether the implants were limited within the anterior to the phrenic nerve or extended beyond that range. However, if pleural implants exist, they may be disseminated throughout the whole thoracic cavity. Even though restricted pleural implants can be macroscopically resected and the prognosis for this group of thymomas may differ from that of thymomas with broad pleural implants, such a difference has not been revealed. Thus, demonstration of the data on which their proposal is based is important.

Next, Masaoka's stage IVa and IVb are combined in their study as Istituto Nazionale Tumori stage group III. It is not advisable to treat these stages as a single group, as our findings demonstrated a significant difference between the survival of patients with Masaoka's stage IVa and that of those with stage IVb [3].

As described in the invited commentary regarding the article [4], we have reported that the prognosis of Masaoka's stage III disease varies significantly depending on the invaded site [5]. For example, the prognosis of Masaoka's stage III patients with only pericardial invasion does not differ from that of those in stages I and II, whereas stage III patients with invasion to the great vessels have a worse prognosis than those with only pericardial invasion. Therefore, we consider that Masaoka's stage III should be divided into at least two groups according to prognosis.

A staging system should be used to determine treatment strategy at the time of diagnosis, and to predict survival and recurrence at surgery. Establishment of a useful TNM staging system is necessary for further improvement in the treatment of the thymic epithelial tumors. The TNM classification proposed by Bedini and colleagues [1] requires more discussion before it can be accepted as the standard staging system from the standpoint of a prognostic factor.


   References
Top
 References
 

  1. Bedini AV, Andreani SM, Tavecchio L, et al. Proposal of a novel system for the staging of thymic epithelial tumors Ann Thorac Surg 2005;80:1994-2001.[Abstract/Free Full Text]
  2. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages Cancer 1981;48:2485-2492.[Medline]
  3. The World Health Organization histologic classification system reflects the oncologic behavior of thymomaa clinical study of 273 patients. Cancer 2002;94:624-632.[Medline]
  4. Kondo K. Invited commentary Ann Thorac Surg 2005;80:2000-2001.[Free Full Text]
  5. Okumura M, Miyoshi S, Takeuchi Y, et al. Results of surgical treatment of thymomas with special reference to the involved organs J Thorac Cardiovasc Surg 1999;117:605-613.[Abstract/Free Full Text]

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Ann. Thorac. Surg. 82: 1170-1171. [Full Text]



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Ann. Thorac. Surg., September 1, 2006; 82(3): 1170 - 1171.
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