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Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers Marulli G; Lucchi M; Margaritora S; Cardillo G; Mussi A; Cusumano G; Carleo F; Rea FEur J Cardiothorac Surg 2011[Mar]; 39 (3): e1-7OBJECTIVE: Radical surgery is the cornerstone of treatment for thymic tumors, but a complete surgical resection in stage III is not always achievable; and recurrence of disease is not rare. We reviewed the results of four centers with large experience in multimodality treatment of stage III thymic tumors. METHODS: Between 1980 and 2009, 249 patients (137 males: 112 females; median age 50 years) with stage III thymic tumors underwent surgery. Myasthenia gravis (MG) was present in 110 (44.2%) patients. A total of 94 (37.7%) patients received induction chemotherapy and 205 (82.7%) had adjuvant treatments. RESULTS: Thirty-day mortality was 0.8%. A total of 203 (81.6%) had R0, 26 (10.4%) R1 and 20 (8%) R2 resection. World Health Organization (WHO) histotype was: A in 2.4%, AB in 15.3%, B1 in 16.5%, B2 in 31.3%, B3 in 22.1%, and thymic carcinoma in 12.4%. The R0 rate was lower in patients who received induction chemotherapy (p=0.04), in B1-B2-thymic carcinoma histotypes (p = 0.05), and in patients without MG (p = 0.04). Overall 10-year survival rate was 64%; tumor-related and disease-free survival were 76% and 74%, respectively. At univariate analysis, R2 resection (p < 0.0001), recurrence of disease (p < 0.0001), absence of MG (p = 0.0009), thymic carcinoma (p = 0.002), age more than 50 years (p = 0.01), and vascular invasion (p < 0.0001) were predictors of poor survival. At multivariate analysis, type of resection (p < 0.0001), vascular involvement (p = 0.007), and recurrent disease (p < 0.0001) were independent predictors of prognosis. During follow-up, 43 (21.2%) patients developed recurrence. Patients with recurrence, who underwent redo surgery (n = 24), showed a similar survival to patients without recurrence. CONCLUSIONS: Multimodality treatment of stage III thymic tumors achieved good survival. Radical surgery, even at recurrence, seems to be the most important prognostic factor.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Blood Vessels/pathology[MESH]|Chemotherapy, Adjuvant[MESH]|Epidemiologic Methods[MESH]|Female[MESH]|Humans[MESH]|Italy/epidemiology[MESH]|Male[MESH]|Middle Aged[MESH]|Neoadjuvant Therapy[MESH]|Neoplasm Invasiveness[MESH]|Neoplasm Staging[MESH]|Prognosis[MESH]|Radiotherapy, Adjuvant[MESH]|Reoperation[MESH]|Thymoma/mortality/pathology/*surgery/therapy[MESH]|Thymus Neoplasms/mortality/pathology/*surgery/therapy[MESH]|Treatment Outcome[MESH]|Young Adult[MESH] |
