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Prognosis and Surveillance of Thymic Neoplasms

    https://doi.org/10.1142/9789813236332_0030Cited by:0 (Source: Crossref)
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    Abstract:

    The prognosis for thymic epithelial malignancies is stage-dependent with a large multi-institutional experience from Japan reporting 5-year survival rates in 1,320 patients of 100%, 98.4%, 88.7%, 70.6%, and 52.8% for Masaoka stages I, II, III, IVa, and IVb, respectively. Furthermore, Magi, et al. reported 10-year disease-free survival rates in 241 patients of 74%, 71%, 50%, and 29% for stage I, II, III, and IV disease, respectively. The single most important prognostic factor is complete (R0) surgical resection, which has been associated with an 82% 7-year overall survival rate while incomplete resection and biopsy have only a 71% and 26% survival, respectively. Survival following complete resection has been similar in patients with both noninvasive and invasive tumors. While the presence of myasthenia gravis was once felt to be a poor prognostic factor, it actually may lead to earlier detection due to myasthenic symptoms. Patients rarely still develop myasthenic crisis, which leads to significant postoperative morbidity and even mortality. Data regarding survival based on World Health Organization (WHO) histologic subtype is inconclusive but may be prognostic in some situations. Postoperative adjuvant radiation (PORT) may improve the prognosis in patients with regional tumor spread (91% vs 86%; p = 0.12), but according to SEER registry data (1975–2003) patients with completely resected localized disease may actually fare worse with PORT (91% vs 98%; p = 0.03). PORT following incomplete surgical resection has associated local control rates of 35% to 74%. Furthermore 5-year survival rates range from 50% to 70% for stage III and 20% to 50% for stage IVa tumors following surgery and PORT. The prognosis for more advanced tumors, i.e,. unresectable stage III and IV thymomas, depends on responsiveness to multimodality therapy typically including preoperative (induction) chemotherapy, surgery, and PORT. In small institutional series, reported complete and overall response rates were as high as 25% and 92%, respectively, with a 7-year disease-free survival of 83%. Others document a disease-free survival as low as 43% at 8 years despite a complete (R0) resection rate of 39% following induction chemotherapy. The prognosis with new targeted therapies remains to be determined.