Treatment and prognosis of primary thymic carcinoma

Surgical resection combined with perioperative chemotherapy for a patient with locally recurrent, previously stage IV thymic small-cell carcinoma: A case report

An 83-year-old Japanese man visited our hospital with dyspnea and general fatigue. Computed tomography (CT) revealed a tumor in the anterior mediastinum, bilateral pleural effusion, pericardial fluid, and multiple liver nodules. We performed a CT-guided tumor biopsy, and the patient was diagnosed with thymic small-cell carcinoma, Masaoka-Koga stage classification IVb. The patient received four cycles of carboplatin and etoposide, and all lesions disappeared on CT. However, after 6 months, CT revealed a recurrent tumor in the anterior mediastinum. After one cycle of rechallenge chemotherapy, we performed extended total thymectomy followed by another three cycles of chemotherapy. More than 2.5 years after the last chemotherapy session, the patient's carcinoma did not recur. Thus, this case suggests that salvage surgery may be a treatment option for local recurrence of thymic carcinoma after complete remission with chemotherapy, even in patients with stage IV cancer.

A Case of Thymic Carcinoma with Bone and Cerebral Metastases Treated with Stereotactic Radiosurgery and Chemotherapy

Patient: Female, 63

Final Diagnosis: Thymic carcinoma

Symptoms: Hip pain

Medication: —

Clinical Procedure: —

Specialty: Oncology

Repeated Localized Treatment for Endobronchial Metastasis of Thymic Carcinoma

Patient: Female, 59

Final Diagnosis: Thymic carcinoma

Symptoms: Dyspnea

Medication: —

Clinical Procedure: Bronchoscopy

Specialty: Oncology

Invasion of the great vessels or atrium predicts worse prognosis in thymic carcinoma

Purpose

We evaluated treatment outcomes of thymic carcinomas to determine prognostic factors for survival.

Materials and Methods

Between May 1988 and May 2009, 41 patients had pathologic diagnosis of thymic carcinoma in Seoul National University Hospital, Seoul, Korea. Of these, 40 patients were followed up to 188 months after treatment. The mean age of all patients was 58.3 years and male to female ratio was 23 to 17.

Results

Among 30 patients who underwent surgical resection, 26 achieved R0 resection and postoperative radiotherapy (PORT) was performed in 22 patients (73%). Various chemotherapeutic regimens were given with local treatment modalities, surgery and/or radiotherapy, in 12 patients. The 5-year locoregional control (LRC), distant metastasis-free survival, progression-free survival (PFS), and overall survival were 79.4%, 53.0%, 42.6%, and 63.6%, respectively. Patients with Masaoka stage I or II showed excellent prognosis of 5-year PFS around 90%. In advanced stages, invasion of the great vessels or atrium by thymic carcinomas was negative prognostic factor for PFS in univariate analysis. Lymph node involvement was statistically significant factor for LRC and PFS. Local or regional recurrence was infrequent after surgical resection followed by PORT, while distant metastasis was the major component of treatment failure.

Conclusion

Complete resection followed by PORT provided remarkable local control without severe acute toxicities in patients with stage II and favorable stage III thymic carcinoma. Invasion of the great vessels or atrium was statistically significant prognostic factor for PFS.

Radiotherapy for thymic neoplasms

The role of radiotherapy in the treatment of thymoma and thymic carcinoma has been evaluated by many investigators over the past two decades. The low incidence of these neoplasms has limited most published studies to small series spanning long time intervals or population-based studies. The exact indications and protocols for the use of radiotherapy as a part of the multidisciplinary approach to thymoma and thymic carcinoma are still unclear. However, a review of recent literature shows potential benefits for certain patients based on stage and grade of disease as well as the extent of surgical resection.

Persistent and Aggressive Treatment for Thymic Carcinoma

OBJECTIVES

The aim of this study is to retrospectively evaluate the role of several therapies, mainly chemotherapy, for thymic carcinoma (TC).

METHODS

From July 1973 to July 2005, 25 patients (15 males and 10 females) with histologically proven TC were treated at our department. The median age of the patients was 59 years, with a range of from 30 to 78 years. According to Masaoka's staging system, there was 1 stage I patient, 3 stage II, 7 stage III, 6 stage IVa, and 8 stage IVb patients. The histological subtype was in all cases squamous cell carcinoma, nonkeratinizing type.

RESULTS

There were 6 complete surgical resections, 1 incomplete resection followed by chemoradiotherapy, 6 with radiotherapy alone, 3 with radiotherapy plus chemotherapy, and 9 with chemotherapy alone as the initial treatment. Eighteen patients were administered second-line therapy. The regimen obtaining the best response rate was doublet chemotherapy consisting of carboplatin (CBDCA) and paclitaxel. The median survival time and survival rate at 5 years for the patients excluding surgical cases with stage I/II disease were 32 months and 31%, respectively.

CONCLUSION

The doublet of CBDCA and paclitaxel thus appears to be a promising regimen for TC and further investigation in a multi-institutional phase II trial is, therefore, strongly called for.

Topoisomerase 2α plays a pivotal role in the tumor biology of stage IV thymic neoplasia

BACKGROUND

Microsatellite studies in histologic types B3 and C thymic neoplasia detected gains on chromosome 17q, which contains the Her-2/neu and its juxtaposed topoisomerase 2alpha (T2alpha) genes. The study aimed to evaluate their impact on tumor biology and survival of advanced thymic neoplasia patients.

METHODS

From 1991 to 2005, 36 consecutive stage IV thymic carcinoma patients were treated, 18 men and 18 women, aged 11 to 84 years. There were 22 thymic carcinoma, 13 type B3, and 1 type B2 thymoma. Patients received treatment consisting of surgical resection, combination chemotherapy with the CAP (cyclophosphamide, Adriamycin, cisplatin) regimen, or radiation therapy potentiated by high-dose weekly 5-fluorouracil infusion. Permutations of these 3 treatment modalities were prescribed as necessary.

RESULTS

T2alpha gene amplification was detected in 4 of 14 thymic carcinoma and 1 of 15 type B3 thymoma. Three thymic carcinoma patients had Her-2/neu coamplification and these 3 patients had rapidly growing tumor and extensive disease at initial diagnosis. CAP was prescribed in 28 patients and 20 patients responded (response rate, 71.4%, 95% confidence interval [CI]: 52.8% to 85%); all responders overexpressed (> or = 10% nuclei positive) the T2alpha protein, whereas 4 nonresponders had very low expression. T2alpha overexpression predicts CAP response, and its absence predicts resistance (P = .001). Overall survival was significantly prolonged if the tumor was resectable (P = .001), of type B3 histology (P = .0039), and had no Her-2 gene amplification (P = .0081).

CONCLUSION

T2alpha and Her-2/neu genes play a pivotal role in the tumor biology, CAP response, and survival of advanced thymic neoplasia patients.

Thymic carcinoma originating from the mid-posterior mediastinum

An unusual thymic carcinoma in a 74-year-old woman is described. Initial chest CT revealed a mass at the mid-posterior mediastinum. Transbronchial fine needle biopsy of the mass failed to provide a definite diagnosis. The mass was treated as a malignant mediastinal tumour, and chemoradiotherapy was performed as initial treatment. The patient died 5 years after receiving primary treatment. The results of postmortem microscopic examination, including immunohistochemical study with CD5 antibody, were consistent with thymic carcinoma. This case is interesting in that the mid-posterior mediastinum is the site where thymic carcinoma is least likely to originate.

Stage IV Thymic Carcinoma: A Study of 20 Patients

BACKGROUND

This study was performed to investigate the clinical factors, tumor characteristics, treatment approach, and prognosis of patients with Stage IV thymic carcinoma (WHO type C).

METHODS

The records of 20 patients with histologically confirmed thymic carcinoma treated between 1988 and 2002 at the Division of Oncology at Taipei Veterans General Hospital were reviewed.

RESULTS

Therapy consisted of surgical debulking, adjuvant radiotherapy, and chemotherapy in six patients (30%), surgical debulking with adjuvant chemotherapy in two patients (10%), surgical debulking with adjuvant radiotherapy in one patient (5%), radiotherapy with adjuvant chemotherapy in eight patients (40%), and chemotherapy alone in three patients (15%). After a median follow-up of 22 months (range, 5-72 months), three patients (15%) were alive. Eighteen patients (90%) experienced disease recurrence after a median of 9 months (range, 2-41 months); 12 (66%) of these patients initially had stage IVa disease, and 6 (33%) had stage IV b disease. Five patients had an undifferentiated type of histology. The median time to progression was 5 months. However, none of these patients was able to receive salvage therapy due to their poor performance status. For those patients with a lymphoepithelioma-like histology, the median survival was 36 months; there was tumor recurrence in five patients and they all received salvage chemotherapy. The median survival time for these five patients was 51 months. For patients with squamous cell type, the median time to progression was 10 months. Five patients received salvage chemotherapy and the median survival was 28 months. There was a significant difference (P < 0.0001) in the median survival between those who received chemotherapy (18 months) after tumor relapse and those who did not (1 month).

CONCLUSIONS

Our results indicate that multidisciplinary treatment, including surgery, radiotherapy, and chemotherapy, is beneficial in treating primary thymic carcinoma. Chemotherapy plays an important role in both primary and relapsed stage IV thymic carcinoma in terms of prolonging the disease-free survival and median survival of patients with lymphoepithelioma-like or squamous cell histology types. For patients with an undifferentiated histology, multidisciplinary treatment or chemotherapy might not be helpful in either primary or relapsed stage IV thymic carcinoma.

Thymoma and Thymic Carcinoma: Therapeutic Approaches

Thymomas and thymic carcinomas, which are rare epithelial tumors arising from the thymus gland, are the most common tumors of the anterior mediastinum. Thymomas are generally encapsulated, slow-growing tumors that have a "bland" histologic appearance. Thymic carcinomas possess more overtly malignant histologic features than thymomas and are more likely to present as invasive or disseminated disease. Surgery is the treatment of choice for localized thymic tumors, with complete resection being the most important prognostic factor. Complete resection also improves survival in locally invasive thymic tumors. Adjuvant postoperative radiation therapy may improve the outcome in patients with invasive disease, although the data are conflicting. Multimodal regimens, including neoadjuvant combination chemotherapy, surgery, and/or postoperative radiation therapy, are recommended for patients with advanced thymomas and thymic carcinomas. Use of octreotide plus prednisone has produced responses in thymomas, but the dosing and schedule have not been clearly defined. Prospective studies have been limited, and, as such, enrollment in clinical trials is encouraged.

Thymic tumors

Thymic tumors include thymic carcinoma, which exhibit aggressive behavior, and thymomas, which manifest a more indolent course. Complete resection is the mainstay of treatment, and there appears to be little benefit to partial resection. Postoperative radiotherapy may be useful in incompletely resected patients. Preoperative chemotherapy appears to increase the rate of complete resection and survival of patients with a stage III or IVa thymoma and should strongly be considered in such cases.

Multimodality Therapy for Thymic Carcinoma (TCA)

SUMMARY

The aim of this study was to correlate the clinicopathologic features and therapeutic approaches with the outcome of patients with thymic carcinoma (TCA), an aggressive, uncommon malignancy of the anterior mediastinum. TCA is morphologically distinct from thymoma, a cytologically bland, often encapsulated, locally invasive, rarely metastatic tumor. The Roswell Park Cancer Institute tumor registry was used to identify patients with TCA or invasive thymic neoplasm of the epithelial type (TNET). Between 1971 and 2001, 22 patients had a pathologic diagnosis of TCA and/or TNET. The mean age at diagnosis was 53 years (range: 19-77), and the male/female ratio was 3:1 (16/6). Initial symptoms were respiratory in about half the patients (10/22). Complete surgical resection was done in five patients. Postoperative cisplatin-based chemotherapy and radiation was administered to seven patients. Pathologic examination showed low grade(n = 14), intermediate grade (n = 7), and high grade (n = 1) TCA. Capsular invasion was present in 83% of the specimens. As of June 2002, nine patients are alive and eight are disease free. The median survival is 44.7 months. Locally invasive disease precluded complete surgical resection in more than half of our cases. Incomplete surgical resection did not preclude long-term survival if multimodality platinum-based therapy was used.

Weekly chemotherapy with cisplatin, vincristine, doxorubicin, and etoposide is an effective treatment for advanced thymic carcinoma

BACKGROUND

Thymic carcinoma is a rare neoplasm that often disseminates or metastasizes. The role of chemotherapy in treating this malignancy is unclear. The purpose of the current study was to determine the efficacy and tolerability of a weekly chemotherapy regimen consisting of cisplatin, vincristine, doxorubicin, and etoposide (CODE) for the treatment of advanced thymic carcinoma.

METHODS

The authors retrospectively reviewed 18 patients with thymic carcinoma who were treated between 1996 and 2002. Twelve of these patients had unresectable advanced diseases and received weekly chemotherapy according to the CODE regimen. The CODE regimen consisted of cisplatin (25 mg/m(2), intravenously [i.v.]; weekly administration), vincristine (1 mg/m(2), i.v.; administered during Weeks 1, 2, 4, 6, and 8), doxorubicin (40 mg/m(2), i.v.; administered during Weeks 1, 3, 5, 7, and 9), and etoposide (80 mg/m(2), i.v.; administered for 3 days during Weeks 1, 3, 5, 7, and 9).

RESULTS

The responses of all 12 patients to the CODE regimen were assessed. A partial response was achieved in 5 patients, and the overall response rate was 42%. Only one patient experienced disease progression. The median progression-free survival period was 5.6 months (range, 2-39 months). The overall survival period ranged from 6 to 79 months, with a median survival period of 46 months. Based on the Kaplan-Meier method, the estimated 1-year and 2-year survival rates were 80% and 58%, respectively. The most common side effects were hematologic toxicities, and only mild nonhematologic toxicities were experienced.

CONCLUSIONS

Weekly chemotherapy treatments according to the CODE regimen were effective and tolerated by patients with advanced thymic carcinoma.

Treatment and prognosis of thymic carcinoma: a retrospective analysis of 40 cases

BACKGROUND

Thymic carcinomas are rare neoplasms, and information regarding the results of treatment and possible prognostic factors in patients with these tumors is limited.

METHODS

The records of 40 patients with histologically confirmed thymic carcinoma who were treated between 1984 and 1998 were reviewed. Twenty-seven patients were treated with surgical resection followed by radiotherapy with or without chemotherapy, and the remaining 13 patients were treated with radiotherapy with or without chemotherapy. The median follow-up time for the 13 surviving patients was 87 months (range, 44-193 months).

RESULTS

The 5-year and 10-year actuarial overall survival rates in all patients were 38% and 28%, respectively. On univariate analysis, complete resection, Karnofsky performance status (KPS), histology, and Masaoka stage at the time of diagnosis were found to have a significant impact on overall survival, whereas on multivariate analysis, complete resection, KPS, and histology were found to be significant prognostic factors. With regard to the degree of resection, 12 of 16 patients (75%) treated with complete resection were alive and free of disease at the time of last follow-up whereas 1 of 24 patients (4%) treated with incomplete resection or biopsy still was alive. Among 12 surviving patients treated with complete resection, 8 with resectable tumors at the time of presentation all had low-grade histology (squamous cell carcinoma) and were treated successfully with complete resection and postoperative radiotherapy with or without adjuvant chemotherapy. The remaining four patients with unresectable tumors at the time of presentation were treated successfully with neoadjuvant chemotherapy, complete resection, and postoperative radiotherapy.

CONCLUSIONS

The results of the current study indicate that multimodal treatment, especially complete resection and postoperative radiotherapy with or without chemotherapy, is a curative therapy for thymic carcinomas.

Chemotherapy for advanced thymic carcinoma: clinical response to cisplatin, doxorubicin, vincristine, and cyclophosphamide (ADOC chemotherapy)

The role of systemic chemotherapy and optimal regimen in thymic carcinoma remains uncertain. We evaluated the clinical responsiveness of ADOC (cisplatin, doxorubicin, vincristine, and cyclophosphamide) chemotherapy for advanced thymic carcinoma that have distant metastatic or unresectable lesions. From 1996 to 2000, we treated eight cases of thymic carcinoma. According to the classification by Masaoka et al., the clinical stage in one case was IVa, whereas the others were IVb. Histologic subtypes were as follows: four cases were squamous cell carcinoma, two cases were undifferentiated, and two were small-cell carcinoma. All patients received 50 mg/m2 of cisplatin and 40 mg/m2 of doxorubicin intravenously on day 1, 0.6 mg/m2 of vincristine intravenously on day 3, and 700 mg/m2 of cyclophosphamide intravenously on day 4, ADOC regimen, respectively, at 3- to 4-week intervals. Six patients obtained a partial response after ADOC chemotherapy and the overall clinical response rate was 75%. There were no life-threatening side effects noted. Cisplatin plus VP-16 chemotherapy (PVP) was performed in three cases before the ADOC regimen, but PVP chemotherapy did not show beneficial effects in two patients. Median survival time was 19 months. ADOC chemotherapy appears to have significant activity against thymic carcinoma.

Primary thymic carcinoma

BACKGROUND

Thymic carcinoma is a malignancy of the anterior mediastinum, always with poor prognosis. Up to the present, very few articles have discussed and evaluated either the clinical or pathologic features or treatments of this tumor. Therefore, we are in a position to analyze our research data to support our belief as follows.

METHODS

From January 1977 until December 1997, we received 614 patients who were diagnosed with anterior mediastinal tumors. Of the 614 patients, 38 patients (6.2%) were diagnosed with thymic carcinoma, including 26 men and 12 women. Data were collected from clinical records and personal interviews with the patients. Classification of these patients' tumor stages was based on the Masaoka staging system.

RESULTS

We proceeded with surgery for 15 of the 38 patients to remove their tumors. Complete resection was done in 8 of these 15 patients (21.0%), whereas debulking was done in the other 7 (18.4%) patients. The mean survival time of all the patients in this study (excluding 3 patients who were lost to follow-up) was 53.0 months, with a median of 24.1 months. The overall cumulative survival rate was 38.6% at 3 years and 27.5% at 5 years. The data in this research show that tumor grading (p = 0.01), resectability (p = 0.02), and stage (p = 0.04) have statistically significant influence on patients' survival.

CONCLUSIONS

The grade, stage, and resectability of the tumor are decisive factors of the effectiveness of either surgery or chemo/radiotherapies in the treatment of thymic carcinoma.

Postoperative radiotherapy in thymic carcinoma: treatment results and prognostic factors

PURPOSE

To analyze the treatment results and prognostic factors of patients with primary thymic carcinoma treated by total or subtotal tumor resection followed by radiotherapy alone.

METHODS AND MATERIALS

Between October 1987 and October 1997, 26 patients with thymic carcinoma were treated with complete or incomplete surgical resection and postoperative adjuvant irradiation without chemotherapy. The radiation was delivered with 10-MV X-ray given 5 days per week at 1.8 to 2 Gy per fraction. Total doses ranged from 40 to 70 Gy. All patients had at least 40 months of follow-up.

RESULTS

The 5-year overall survival rate, local control rate, and distant metastasis-free rate were 77%, 91%, and 57%, respectively. Several prognostic factors, including sex, age, extent of resection (total resection vs. subtotal resection), Masaoka staging (early Stage I + II vs. advanced Stage III + IV), pathology (low-grade vs. high-grade), and postoperative radiation dose (> or =60 Gy vs. <60 Gy), were evaluated in univariate analysis. The Masaoka staging system was the only statistically significant predictor in overall survival rate (p = 0.0482) and distant metastasis-free rate (p = 0.0193).

CONCLUSIONS

The Masaoka staging system is the most important prognostic factor in primary thymic carcinoma patients receiving postoperative radiotherapy alone. For resectable tumors, surgery and postoperative radiotherapy can achieve good local control, but the distant metastatic rate is still high. Further investigation of more effective chemotherapy is needed.

Thymic carcinoma: a report of 13 cases

OBJECTIVE

Thymic carcinoma is a rare thymic neoplasm. It is more invasive and has a poorer prognosis than thymoma. We report our experience in the treatment of 13 thymic carcinomas.

METHODS

Thirteen patients with histologically confirmed thymic carcinoma were treated from June 1989. Six patients underwent surgery, followed by adjuvant therapy. Seven patients underwent neoadjuvant chemotherapy, followed by surgery and post-operative radiotherapy.

RESULTS

The diagnosis of thymic carcinoma was achieved in six cases by a mediastinotomy, in three cases by a ultrasound-guided or a CT-guided fine needle aspiration and in three cases the pre-operative diagnosis was thymoma. In one case we did not have the histological diagnosis. All seven patients treated with neoadjuvant chemotherapy responded. The surgical resection was complete in seven cases. Eight patients are still alive 8-142 months from the diagnosis, and six are disease-free.

CONCLUSIONS

Our experience supports the role of surgery and post-operative radiotherapy in thymic carcinomas. Pre-operative treatment of such neoplasms by multi-drug chemotherapy may improve the resectability and the survival rate.

The multimodality treatment of thymic carcinoma

OBJECTIVES

Thymic carcinoma is a rare neoplasm more invasive and with a poorer prognosis than ordinary thymoma. Complete curative resection is sometimes not possible, but good response rates to chemotherapy are reported in literature. We report our experience with seven cases of thymic carcinoma, who took part to a multimodality treatment including neoadjuvant chemotherapy, surgery and post-operative radiotherapy in our center.

METHODS

Since June 1989, seven previously untreated patients were enrolled. The primary chemotherapy consisted of three courses of cisplatin (P; 75 mg/m(2) i.v., day 1), epidoxorubicin (E; 100 mg/m(2) i.v., day 1) and etoposide (VP16; 120 mg/m(2) i.v., days 1, 3 and 5), every 3 weeks. Surgery was performed following complete hematological recovery. After surgery, all patients underwent radiation therapy to the tumor areas, operatively marked with clips, at doses of 45 (complete resection) or 60 Gy (incomplete resection).

RESULTS

The pre-operative diagnosis of thymic carcinoma was performed in four cases by a mediastinotomy, and in the remaining cases, by an ultrasound-guided (n=2) or a computed tompography-guided (n=1) fine needle aspiration. All patients responded (one completely) to the chemotherapy regimen. Surgical resection was complete in four cases (histological examination negative in one case). Three patients are still alive and well (62-136 months from the diagnosis), two are alive with relapse at 16 and 85 months, one patient died at 86 months from another cause, and one patient died at 18 months from local relapse and lung metastases.

CONCLUSIONS

A pre-operative shrinkage of the thymic carcinoma by means of neoadjuvant multi-drug chemotherapy may improve the resectability, and therefore, the survival rate. Our experience, although preliminary, is encouraging and merits additional study in a multicenter trial with a sufficient number of patients to draw definitive conclusions.

Malignant thymic epithelial tumors: CT-pathologic correlation

OBJECTIVE

The purpose of our study was to describe and compare the CT and pathologic findings of atypical thymoma and thymic carcinoma.

MATERIALS AND METHODS

Twenty-seven consecutive patients (14 men, 13 women ranging in age from 22 to 77 years [mean age, 52 years]) with pathologically proven atypical thymoma (n = 9) and thymic carcinoma (n = 18) constituted the study population. The chest CT findings in each of the 27 patients were reviewed retrospectively in consensus by two chest radiologists. These findings were correlated with pathologic findings.

RESULTS

The tumors were located in the anterior mediastinum, and most tumors had a lobulated margin (24/27, 89%). Atypical thymomas were significantly smaller (mean, 4.7 cm) than thymic carcinomas (mean, 7.2 cm) (p = 0.041) on CT. The findings of invasion of the great vessels, lymph node enlargement, extrathymic metastases, and phrenic nerve palsy were seen only in patients with thymic carcinoma. The frequencies of necrosis, intratumoral calcification, pleural effusion, pleural implants, pericardial effusion, and obliteration of the mediastinal fat plane were not significantly different between atypical thymomas and thymic carcinomas (p > 0.05). Various histologic subtypes were included in thymic carcinoma. The tumor necrosis and calcification seen on CT were confirmed at pathologic examination.

CONCLUSION

When a large thymic tumor appears with invasion of the great vessels, lymph node enlargement, phrenic nerve palsy, or extrathymic metastases on CT, thymic carcinoma rather than atypical thymoma should be considered.

Thymic carcinoma: current staging does not predict prognosis

BACKGROUND

Thymic carcinomas are currently staged by Masaoka classification, a staging system for thymomas. We retrospectively evaluated surgical patients with thymic carcinoma to determine prognostic factors and to evaluate the usefulness of Masaoka staging in this disease.

METHODS

Our computerized tumor registry yielded 118 patients with thymoma. Review of pathologic material revealed 43 cases of thymic carcinoma. Collection of data was by review of hospital and physician charts and telephone contact with patients. Analysis of prognostic factors was performed in patients undergoing complete resection by the method of Kaplan-Meier and Cox proportional hazards regression.

RESULTS

Between 1949 and 1993, 43 patients underwent surgery for thymic carcinoma. Overall survival was 65% at 5 years and 35% at 10 years. Overall recurrence was 65% at 5 years and 75% at 10 years. On univariate analysis, survival was not dependent on age, sex, tumor size, or Masaoka stage but was dependent on innominate vessel invasion. By multivariate analysis, survival was dependent only on innominate vessel invasion.

CONCLUSIONS

Patients with thymic carcinoma have a high rate of recurrence. Tumor invasion of the innominate vessels is associated with a particularly poor prognosis. Although Masaoka staging is useful in staging patients with thymoma, it does not appear to predict outcome for patients with thymic carcinoma.