Analysis of the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Taiji ^1,2,3 , GUO Ling ¹ , GONG Ruoyan ⁴ , TANG Qianlong ^1,2 , XIANG Run ¹ , DAI Wei ¹ , XIE Shaohua ¹ , ZHOU Ke ³ , XIE Tianpeng ¹ ,  LI Qiang ¹

1. Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, 610041, P. R. China;
2. Chengdu Medical College, Chengdu, 610500, P. R. China;
3. Department of General Surgery, Muchuan County People's Hospital, Leshan, 614000, Sichuan, P. R. China;
4. School of Public Health, Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding?author：

LI Qiang, Email: liqiang@sichuancancer.org

Keywords：

Thymoma; treatment method; survival time; recurrence and metastasis; influencing factors; prognosis

DOI：

10.7507/1007-4848.202210098

Video：

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Objective To analyze the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis. Methods Thymoma patients who received treatment in Sichuan Cancer Hospital from March 2015 to March 2021 were collected. Clinical data of the patients were analyzed using Kaplan-Meier and Cox regression analyses. Results A total of 177 patients were included. There were 89 males and 88 females aged 17-88 (52.3±13.0) years, including 160 surgical patients and 17 non-surgical patients. There were 160 patients survived, 17 died of thymoma, and 5 had recurrence and metastasis. Overall, the 1-year, 3-year and 5-year progression-free survival rates were 94.4%, 88.7%, 88.1%, respectively; the 1-year, 3-year and 5-year overall survival rates were 94.9%, 91.5%, 91.0%, respectively. The Kaplan-Meier analysis showed that World Health Organization classification, clinical symptoms, Masaoka-Koga staging, treatment methods and surgery were statistically associated with progression-free survival; clinical symptoms, age, treatment methods and surgery were statistically associated with overall survival (P<0.05). Patients with younger age (P=0.018), without clinical symptoms (P=0.039), and with surgical treatment (P=0.004) had higher overall survival rates; those patients undergoing surgery had a higher progression-free survival rate (P=0.002). Conclusion Age, clinical symptoms and surgical treatment are independent factors influencing the prognosis of patients with thymoma.

Citation： XIE Taiji, GUO Ling, GONG Ruoyan, TANG Qianlong, XIANG Run, DAI Wei, XIE Shaohua, ZHOU Ke, XIE Tianpeng, LI Qiang. Analysis of the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1407-1414. doi: 10.7507/1007-4848.202210098 Copy

1.	den Bakker MA, Roden AC, Marx A, et al. Histologic classification of thymoma: A practical guide for routine cases. J Thorac Oncol, 2014, 9(9 Suppl 2): S125-S130.
2.	Pokorná K, Kojecky V. Thymoma-disease of many faces. Vnitr Lek, 2021, 67(4): 240-243.
3.	中國醫師協會腫瘤多學科診療專業委員會. 中國胸腺上皮腫瘤臨床診療指南(2021版). 中華腫瘤雜志, 2021, 43(4): 395-404.
4.	Ko?er B, Kaplan T, Günal N, et al. Long-term survival after R0 resection of thymoma. Asian Cardiovasc Thorac Ann, 2018, 26(6): 461-466.
5.	Kamata S, Ishida I, Suzuki Y, et al. Single-center evaluation of prognostic factors for thymoma treated by surgery: A retrospective study. J Cardiothorac Surg, 2021, 16(1): 8.
6.	Narm KS, Lee CY, Do YW, et al. Limited thymectomy as a potential alternative treatment option for early-stage thymoma: A multi-institutional propensity-matched study. Lung Cancer, 2016, 101: 22-27.
7.	Bian D, Zhou F, Yang W, et al. Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: A population based study. Oncotarget, 2018, 9(15): 12273-12283.
8.	Mou H, Liao Q, Hou X, et al. Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988-2013). Int J Radiat Biol, 2018, 94(5): 495-502.
9.	Tseng YC, Tseng YH, Kao HL, et al. Long term oncological outcome of thymoma and thymic carcinoma—An analysis of 235 cases from a single institution. PLoS One, 2017, 12(6): e0179527.
10.	Cata JP, Lasala JD, Williams W, et al. Myasthenia gravis and thymoma surgery: A clinical update for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth, 2019, 33(9): 2537-2545.
11.	Zhang J, Liu L, Wang G, et al. Whether thymoma patients in myasthenia crisis could benefit from immediate resection of tumor compared with selective surgery after stabilization of MC. Ann Thorac Cardiovasc Surg, 2019, 25(1): 64-65.
12.	Cacho-Díaz B, Salmerón-Moreno K, Lorenzana-Mendoza NA, et al. Myasthenia gravis as a prognostic marker in patients with thymoma. J Thorac Dis, 2018, 10(5): 2842-2848.
13.	Padda SK, Yao X, Antonicelli A, et al. Paraneoplastic syndromes and thymic malignancies: An examination of the International Thymic Malignancy Interest Group retrospective database. J Thorac Oncol, 2018, 13(3): 436-446.
14.	談宇龍, 王安, 陸周一, 等. 468例胸腺瘤患者的臨床病理特征及預后的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2021, 28(12): 1427-1431.
15.	Shen Y, Ru L, Yu M, et al. The differential diagnosis value of MSCT in WHO simplified pathological classification of thymic epithelial tumors. J Med Imaging, 2020, 30(2): 217-220.
16.	Yuan ZY, Gao SG, Mu JW, et al. Long-term outcomes of 307 patients after complete thymoma resection. Chin J Cancer, 2017, 36(1): 46.
17.	Ettinger DS, Riely GJ, Akerley W, et al. Thymomas and thymic carcinomas: Clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2013, 11(5): 562-576.
18.	Benveniste MFK, Betancourt Cuellar SL, Carter BW, et al. Thymic epithelial neoplasms: Tumor-node-metastasis staging. Radiol Clin North Am, 2021, 59(2): 183-192.
19.	Zhu L, Zhang J, Marx A, et al. Clinicopathological analysis of 241 thymic epithelial tumors-experience in the Shanghai Chest Hospital from 1997-2004. J Thorac Dis, 2016, 8(4): 718-726.
20.	Weis CA, Yao X, Deng Y, et al. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol, 2015, 10(2): 367-372.
21.	Marx A, Hohenberger P, Hoffmann H, et al. The autoimmune regulator AIRE in thymoma biology: Autoimmunity and beyond. J Thorac Oncol, 2010, 5(10 Suppl 4): S266-S272.
22.	Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: Modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int, 1994, 44(5): 359-367.
23.	Shen J, Tie H, Xu A, et al. Inter-relationship among myasthenia gravis, WHO histology, and Masaoka clinical stage and effect on surgical methods in patients with thymoma: A retrospective cohort study. J Thorac Dis, 2018, 10(5): 2981-2990.
24.	Lim YJ, Kim E, Kim HJ, et al. Survival impact of adjuvant radiation therapy in Masaoka stage Ⅱto Ⅳthymomas: A systematic review and meta-analysis. Int J Radiat Oncol Biol Phys, 2016, 94(5): 1129-1136.
25.	Hamaji M, Allen MS, Cassivi SD, et al. The role of surgical management in recurrent thymic tumors. Ann Thorac Surg, 2012, 94(1): 247-254.
26.	Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 99: 332-350.
27.	朱曉磊, 朱自江, 龐瑤, 等. 胸腺瘤的外科治療和預后分析. 中華胸部外科電子雜志, 2018, 5(2): 107-112.
28.	李知衡, 許建萍. 胸腺腫瘤的內科治療進展. 癌癥進展, 2020, 18(22): 2272-2276, 2315.
29.	Thomas A, Rajan A, Berman A, et al. Sunitinib in patients with chemotherapy-refractory thymoma and thymic carcinoma: An open-label phase 2 trial. Lancet Oncol, 2015, 16(2): 177-186.
30.	Ko R, Shukuya T, Okuma Y, et al. Prognostic factors and efficacy of first-line chemotherapy in patients with advanced thymic carcinoma: A retrospective analysis of 286 patients from NEJ023 study. Oncologist, 2018, 23(10): 1210-1217.
31.	Grosch H, Hoffmann H, Weis CA, et al. Thymus cancers: A clinical observation. Pathologe, 2016, 37(1): 91-105.
32.	Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stageⅡandⅢthymoma—An analysis of the International Thymic Malignancies Interest Group retrospective database. J Thorac Oncol, 2016, 11(10): 1785-1792.
33.	Ruffini E, Detterbeck F, Van Raemdonck D, et al. Tumours of the thymus: A cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg, 2014, 46(3): 361-368.

1. den Bakker MA, Roden AC, Marx A, et al. Histologic classification of thymoma: A practical guide for routine cases. J Thorac Oncol, 2014, 9(9 Suppl 2): S125-S130.
2. Pokorná K, Kojecky V. Thymoma-disease of many faces. Vnitr Lek, 2021, 67(4): 240-243.
3. 中國醫師協會腫瘤多學科診療專業委員會. 中國胸腺上皮腫瘤臨床診療指南(2021版). 中華腫瘤雜志, 2021, 43(4): 395-404.
4. Ko?er B, Kaplan T, Günal N, et al. Long-term survival after R0 resection of thymoma. Asian Cardiovasc Thorac Ann, 2018, 26(6): 461-466.
5. Kamata S, Ishida I, Suzuki Y, et al. Single-center evaluation of prognostic factors for thymoma treated by surgery: A retrospective study. J Cardiothorac Surg, 2021, 16(1): 8.
6. Narm KS, Lee CY, Do YW, et al. Limited thymectomy as a potential alternative treatment option for early-stage thymoma: A multi-institutional propensity-matched study. Lung Cancer, 2016, 101: 22-27.
7. Bian D, Zhou F, Yang W, et al. Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: A population based study. Oncotarget, 2018, 9(15): 12273-12283.
8. Mou H, Liao Q, Hou X, et al. Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988-2013). Int J Radiat Biol, 2018, 94(5): 495-502.
9. Tseng YC, Tseng YH, Kao HL, et al. Long term oncological outcome of thymoma and thymic carcinoma—An analysis of 235 cases from a single institution. PLoS One, 2017, 12(6): e0179527.
10. Cata JP, Lasala JD, Williams W, et al. Myasthenia gravis and thymoma surgery: A clinical update for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth, 2019, 33(9): 2537-2545.
11. Zhang J, Liu L, Wang G, et al. Whether thymoma patients in myasthenia crisis could benefit from immediate resection of tumor compared with selective surgery after stabilization of MC. Ann Thorac Cardiovasc Surg, 2019, 25(1): 64-65.
12. Cacho-Díaz B, Salmerón-Moreno K, Lorenzana-Mendoza NA, et al. Myasthenia gravis as a prognostic marker in patients with thymoma. J Thorac Dis, 2018, 10(5): 2842-2848.
13. Padda SK, Yao X, Antonicelli A, et al. Paraneoplastic syndromes and thymic malignancies: An examination of the International Thymic Malignancy Interest Group retrospective database. J Thorac Oncol, 2018, 13(3): 436-446.
14. 談宇龍, 王安, 陸周一, 等. 468例胸腺瘤患者的臨床病理特征及預后的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2021, 28(12): 1427-1431.
15. Shen Y, Ru L, Yu M, et al. The differential diagnosis value of MSCT in WHO simplified pathological classification of thymic epithelial tumors. J Med Imaging, 2020, 30(2): 217-220.
16. Yuan ZY, Gao SG, Mu JW, et al. Long-term outcomes of 307 patients after complete thymoma resection. Chin J Cancer, 2017, 36(1): 46.
17. Ettinger DS, Riely GJ, Akerley W, et al. Thymomas and thymic carcinomas: Clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2013, 11(5): 562-576.
18. Benveniste MFK, Betancourt Cuellar SL, Carter BW, et al. Thymic epithelial neoplasms: Tumor-node-metastasis staging. Radiol Clin North Am, 2021, 59(2): 183-192.
19. Zhu L, Zhang J, Marx A, et al. Clinicopathological analysis of 241 thymic epithelial tumors-experience in the Shanghai Chest Hospital from 1997-2004. J Thorac Dis, 2016, 8(4): 718-726.
20. Weis CA, Yao X, Deng Y, et al. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol, 2015, 10(2): 367-372.
21. Marx A, Hohenberger P, Hoffmann H, et al. The autoimmune regulator AIRE in thymoma biology: Autoimmunity and beyond. J Thorac Oncol, 2010, 5(10 Suppl 4): S266-S272.
22. Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: Modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int, 1994, 44(5): 359-367.
23. Shen J, Tie H, Xu A, et al. Inter-relationship among myasthenia gravis, WHO histology, and Masaoka clinical stage and effect on surgical methods in patients with thymoma: A retrospective cohort study. J Thorac Dis, 2018, 10(5): 2981-2990.
24. Lim YJ, Kim E, Kim HJ, et al. Survival impact of adjuvant radiation therapy in Masaoka stage Ⅱto Ⅳthymomas: A systematic review and meta-analysis. Int J Radiat Oncol Biol Phys, 2016, 94(5): 1129-1136.
25. Hamaji M, Allen MS, Cassivi SD, et al. The role of surgical management in recurrent thymic tumors. Ann Thorac Surg, 2012, 94(1): 247-254.
26. Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 99: 332-350.
27. 朱曉磊, 朱自江, 龐瑤, 等. 胸腺瘤的外科治療和預后分析. 中華胸部外科電子雜志, 2018, 5(2): 107-112.
28. 李知衡, 許建萍. 胸腺腫瘤的內科治療進展. 癌癥進展, 2020, 18(22): 2272-2276, 2315.
29. Thomas A, Rajan A, Berman A, et al. Sunitinib in patients with chemotherapy-refractory thymoma and thymic carcinoma: An open-label phase 2 trial. Lancet Oncol, 2015, 16(2): 177-186.
30. Ko R, Shukuya T, Okuma Y, et al. Prognostic factors and efficacy of first-line chemotherapy in patients with advanced thymic carcinoma: A retrospective analysis of 286 patients from NEJ023 study. Oncologist, 2018, 23(10): 1210-1217.
31. Grosch H, Hoffmann H, Weis CA, et al. Thymus cancers: A clinical observation. Pathologe, 2016, 37(1): 91-105.
32. Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stageⅡandⅢthymoma—An analysis of the International Thymic Malignancies Interest Group retrospective database. J Thorac Oncol, 2016, 11(10): 1785-1792.
33. Ruffini E, Detterbeck F, Van Raemdonck D, et al. Tumours of the thymus: A cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg, 2014, 46(3): 361-368.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis

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