Supervisors info:
E. Kαθηγητής Ιατρικής Σχολής Περικλής Τόμος , Α. Καθηγήτρια Αναστασία Κοτανίδου , Dr.med. Θωρακοχειρουργός Καλλιόπη Αθανασιάδη
Summary:
Thymomas are rare malignant tumors. They account for about half of anterior
mediastinal tumors. Ηowever,because thymomas involve a wide spectrum of
histological ,biological and oncological characteristics ,not only are there
uniform guidelines concerning the management thereof ,but outcomes after
management and subsequent prognosis have also not been well established .
Thus , the International Thymic Malignancy Interest Group (ITMIG) has attempted
to establish standard definitions and policies for thymoma management . ITMIG
has suggested that freedom-from-recurrence is a better measure than survival in
patients who have successfully undergone curative-intent treatment . Their
reasoning for this was that thymomas progress slowly and thus , many patients
die of causes unrelated to the thymoma . In actuality, only 50% of fatalities
are due to the thymoma or the treatment thereof . Approximately , 20% of deaths
are due to myasthenia gravis , and 10% result from autoimmune disorders
associated with thymoma .
The remaining deaths have attributed to unrelated conditions , including other
malignancies . Accordingly , recurrence may more accurately reflect clinical
outcomes after resection than survival . Therefore , we conducted a
retrospective and prospective study to determine predictors of recurrence and
survival after thymoma recection.
METHODS: Retrospective and prospective study of 90 patients with thymoma from
our institution who underwent thymectomy the period between January 2000 and
December 2013
Results: Of the 90 patients 18 died (20.0%), while 13 patients (14.4%) had
reccurence and lived the rest (65.6%) were alive without recurrence.
The average survival time was 11.0 years (SE = 0,61 years) and the median time
was 5.3 years .
Patients with combined type thymoma were 6.19 times more likely than patients
with thymoma. Also, as the size of the tumor the greater the risk of the
patients. The greater stage MASAOKA patients was greater risk
Furthermore, patients with histology Β2/3 were 3.98 times more risk than
patients with stage A / AB or B1 . Finally, patients who did not surgical
margins were free (R1) were 2.65 times more likely from patients who had
surgical free margins .
Of the 90 patients 16 had recurrence (17.8%) of which the three (18.8%) died.
The relapse rate was 0% (0/10) 0% (0/9), 5.9% (1/17), 14.3 (4/27) and 42.3%
(11/27) for type A, AB, B1, B2 and B3 tumors , respectively.
The recurrence rate according to Masaoka stage was 0% (0/11) ,8.7% (4/46),
35.7% (10/28) and 40% (2/5) to stages I, II, III and
IV,respectively. After
univariate analysis, histological type in WHO (World Health Organization) A,
AB, B1 vs. B2, B3, stage by Masaoka are factors associated with recurrence .
After multivariate analysis, found that by going to a MASAOKA higher stageat
risk for recurrence increased by 3.29 times and patients with WHO histological
type in B2 / B3 were 12.28 timesgreater risk of relapse compared with patients
had histology by WHO A / AB / B1.
CONCLUSION: The histological type in WHO, the stage Masaoka, the tumor size
,the oncologic radicalness of surgery (R1/R0) and the composition of thymoma
are associated with survival.
The histological type by WHO (World Health Organization) A, AB, B1 vs. B2, B3,
and the stage οf Masaoka are independent prognostic factors associated with
recurrence after thymectomy.
Keywords:
Thymomas, Recurrence, Survival, Thymectomy, MASAOKA
