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Background: There are few data on factors predicting recurrence of completely resected thymic carcinoma. This study analyzed prognosticators for recurrence and postrecurrence survival., Methods: Eighty-two patients with surgically treated thymic carcinoma were reviewed between June 1988 and March 2013, and 54 who underwent complete resection were enrolled. Sex, age, myasthenia gravis, tumor histologic classification, Masaoka staging, characteristics of locoregional invasion and recurrence, and the treatment for recurrence were collected. Continuous variables between groups were compared using Student's t test, and categorical variables were compared using the χ2 test, Fisher's exact test, or Spearman rank correlation. Survival analysis was performed using the Kaplan-Meier and log-rank test. Statistical significance was set at a probability value of less than 0.05., Results: A total of 54 patients underwent complete resection for thymic carcinoma, 21 of whom had recurrent diseases and 33 of whom remained disease-free. Patients without recurrent disease had a significantly better 5-year overall survival of 79% than 26% of those who had recurrent disease (p=0.000). Masaoka staging and tumor invasion of the superior vena cava were significantly associated with recurrence-free survival in the univariate analysis (p=0.047 and 0.019, respectively). In the multivariate analysis for survival, tumor invasion into the superior vena cava was the only prognostic variable for recurrence-free survival (p=0.047). Patients who underwent surgical intervention followed by chemotherapy for recurrent diseases had the best progression-free survival after recurrence (p=0.000)., Conclusions: Superior vena cava invasion as well as Masaoka staging was significantly associated with recurrence-free survival in patients with completely resected thymic carcinoma. In patients with recurrent disease, surgical resection should be attempted for localized disease because it might provide some benefit for progression-free survival., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Patients with thymoma may have a predisposition toward extrathymic neoplasia. To understand the lifetime risk and incidence of extrathymic neoplasia in patients with thymoma, we evaluated extrathymic neoplasms diagnosed either before or after the diagnosis of thymoma., Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) cancer database and identified patients with thymoma and extrathymic neoplasms. We collected demographic and treatment data, calculated the incidence of each extrathymic neoplasm (adjusting for age), and compared the incidence of extrathymic neoplasm in patients with thymoma with the age-adjusted incidence in the SEER database general population., Results: Of 2,171 patients with thymoma in the SEER database, 306 (14.1%) had extrathymic primary cancers. Extrathymic neoplasms were diagnosed before the diagnosis of thymoma in 88 patients and after the diagnosis of thymoma in 206 patients. In 12 patients, separate extrathymic neoplasms were diagnosed both before and after thymoma diagnosis. The incidence of extrathymic cancers in patients with thymoma (8,224 per 100,000 persons) was significantly higher than in the SEER general population (459 per 100,000 persons; p<0.001). The standardized incidence ratio for extrathymic cancer was also significantly increased, in particular for lymphomas, leukemias, esophageal cancer, and lung cancer. Increased age at diagnosis (p<0.001), longer survival after diagnosis (p<0.001), and male sex (p=0.041)-but not radiation therapy or surgery-were significant risk factors for the development of extrathymic cancers in patients with thymoma., Conclusions: The incidence of extrathymic neoplasia is significantly higher in patients with thymoma than in the general population and occurs both before and after the diagnosis of thymoma., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The prognostic factors in thymic epithelial tumors (TET) are investigated within a 27-year period in 104 patients submitted to surgical and pathologic complete resection of TET with a mean age of 53 +/- 14.6 years and a male to female ratio of 0.73., Methods: The medical records of all patients were reviewed and six variables that could affect the short-term and long-term survival were entered into a Cox regression model. Follow-up was obtained from medical records and telephone contacts up to September 2004 or until the patient's death., Results: Overall 5-year and 10-year survival was 83% and 78%, respectively. Univariate Cox regression analysis showed that long survival was affected by the age of the patient at the time of operation, the response of myasthenia gravis to the operation, the tumor recurrence, the histologic type according to the World Health Organization (WHO) classification, and the Masaoka stage. Multivariate analysis revealed that recurrence of the tumor (p = 0.001), Masaoka stages II or III (p < 0.001), elder age of the patient at the time of operation (p = 0.045), and presence of the WHO histologic types B2 or B3 (p = 0.05) were bad prognostic factors., Conclusions: Recurrence of the tumor, the Masaoka staging, the WHO histologic type, and the age of the patient at the time of operation were the most important prognosticators for patients with TET submitted to complete resection of their tumor.

Background: The thymus or thymoma plays a role in the pathogenesis of myasthenia gravis (MG). Although previous studies have reported that the presence of MG in thymoma patients is an indicator of poor prognosis, recent reports have shown that the presence of MG no longer influences the prognosis or indicates a more favorable prognosis in thymoma patients., Methods: To clarify the difference in tumor behavior between thymoma with MG and that without MG, we compiled 1,089 thymomas treated between 1990 and 1994 from 115 institutes in Japan and analyzed the clinical characteristics of thymoma with MG compared with thymoma without MG., Results: MG was associated with 270 cases (24.8%) of thymoma. The total resection cases comprised 94.6% and 91.4%, and the recurrent cases comprised 6.4% and 8.3% in the groups with and without MG, respectively. The 5-year survival rates for thymoma with and without MG in stage III were 85.7% and 89.3%, respectively; and those in stage IV were 85.1% and 63.9%, respectively. The prognosis of thymoma with MG in stage IV tended to be better than that of thymoma without MG (p = 0.0523). The thymoma with MG group had fewer stage IVb thymomas than did the thymoma without MG group (15% vs 34%). The resectability rate in the thymoma with MG group was higher than that in the thymoma without MG group (60% vs 38%)., Conclusions: Thymoma with MG is equally or less malignant than that without MG. The infrequency of stage IVb thymomas and the high resectability rate had an influence on the favorable prognosis of stage IV thymoma with MG.

Background: Myasthenia gravis is by far the most common paraneoplastic syndrome of thymomas. There is little information regarding the influence of clinical variables and thymoma-associated factors on biologic development of myasthenia gravis. The aim of the study was to determine independent predictors of clinical outcome in thymoma with myasthenia gravis., Methods: We studied 108 patients with thymoma-associated myasthenia gravis undergoing removal of the mediastinal mass between 1967 and 2000. Clinical and pathologic variables associated with clinical outcome of myasthenia were assessed by multivariate Cox regression analysis., Results: Patients were followed for a mean period of 10 years (9 months to 33 years). A total of 38 patients died (35.2%), in 14 cases (37%) because of myasthenia gravis and in 6 (16%) because of recurrence of thymoma. With respect to clinical outcome of myasthenia gravis, at the end of the follow-up period, the rate of remission was 16% (n = 17). Of the 91 patients in whom remission was not achieved, 55 had no symptoms with immunosuppressive medication and 36 had symptoms with medication., Conclusions: In patients with thymoma-associated myasthenia gravis, well-differentiated thymic carcinoma (Müller-Hermelink system), age more than 55 years, and interval from the onset of symptoms to thymectomy of less than 1 year were found to be independent predictors of nonremission of myasthenia gravis after thymectomy.