Comparison of patterns of relapse in thymic carcinoma and thymoma

Huang, James; Rizk, Nabil P.; Travis, William D.; Riely, Gregory J.; Park, Bernard J.; Bains, Manjit S.; Dycoco, Joseph; Flores, Raja M.; Downey, Robert J.; Rusch, Valerie W.

doi:10.1016/j.jtcvs.2009.03.033

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 26-31, July 2009

Comparison of patterns of relapse in thymic carcinoma and thymoma

James Huang, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
- Address for reprints: James Huang, MD, Surgery, Memorial Sloan–Kettering Cancer Center, 1275 York Ave, Room C-868, New York, NY 10021.
Nabil P. Rizk, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
William D. Travis, MD
- Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, NY
Gregory J. Riely, MD, PhD
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan–Kettering Cancer Center, New York, NY
Bernard J. Park, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
Manjit S. Bains, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
Joseph Dycoco, BA
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
Raja M. Flores, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
Robert J. Downey, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY
Valerie W. Rusch, MD
- Thoracic Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY

Received 26 June 2008; received in revised form 23 February 2009; accepted 23 March 2009.

Objective

Thymic carcinomas are considered to be more aggressive than thymomas and carry a worse prognosis. We reviewed our recent experience with the surgical management of thymic tumors and compared the outcomes and patterns of relapse between patients with thymic carcinoma and those with thymoma.

Methods

We performed a single-institution retrospective cohort study. Data included patient demographics, stage, treatment, pathologic findings, and postoperative outcomes.

Results

During the period 1995–2006, 120 patients with thymic tumors underwent surgical intervention, including 23 patients with thymic carcinoma and 97 patients with thymoma, as classified according to the World Health Organization 2004 histologic classification. The overall 5-year survival was significantly different between patients with thymic carcinoma and those with thymoma (thymic carcinoma, 53%; thymoma, 89%; P = .01). Data on relapse were available for 112 patients. The progression-free 5-year survival was also significantly different between patients with thymic carcinoma and those with thymoma (thymic carcinoma, 36%; thymoma, 75%; P < .01). Using multivariate analysis, thymic carcinoma and incomplete resection were found to be independent predictors of progression-free survival. Relapses in patients with thymic carcinoma tended to occur earlier, and occurred significantly more frequently at distant sites than in patients with thymoma (60% vs 13%, P = .01).

Conclusions

Patterns of relapse differ significantly between patients with thymic carcinoma and those with thymoma, with lower progression-free survival, earlier onset, and more distant relapses in patients with thymic carcinoma. Given the greater propensity for distant failures, the inclusion of systemic therapy in the treatment of thymic carcinoma might take on greater importance. Despite significantly higher rates of distant relapse, good overall survival in patients with thymic carcinoma can be achieved.

CTSNet classification: 13, 14

Abbreviations and Acronyms: PET, positron emission tomography, PFS, progression-free survival, SVC, superior vena cava, TC, thymic carcinoma, WHO, World Health Organization