Higher Masaoka Stage Research Articles

Prognostic factors for overall survival after surgical resection in patients with thymic epithelial tumors: A systematic review and meta-analysis.

Background:Thymic epithelial tumors (TETs) originate in the thymic epithelial cell, including thymoma and thymic carcinoma. Surgical resection is the first choice for most patients. However, some studies have shown that the factors affecting the prognosis of these patients are not consistent. To evaluate prognostic factors in patients with surgically resected thymic epithelial tumors, we performed a meta-analysis.Methods:We searched the Chinese biomedical literature database, Pubmed, Embase, Cochrane Library and other electronic databases. Studies including postoperative overall survival (OS) and predictors of TETs were included. We made a comprehensive analysis the hazard ratios (HRs) through a single proportional combination. HRs were combined using single proportion combinations.Results:The meta-analysis included 11,695 patients from 26 studies. The pooled OS was 84% at 5 years and 73% at 10 years after TETs operation. The age as continuous-year (HR 1.04, 95% confidence interval (CI) 1.02–1.04), incomplete resection (HR 4.41, 95% CI 3.32–5.85), WHO histologic classification (B2/B3 vs A/AB/B1 HR 2.76, 95% CI 1.25–6.21), Masaoka Stage (stage III/IV vs I/II HR 2.74, 95% CI 2.12–3.55,) were the poor prognostic factors.Conclusions:For patients with TETs after surgical resection, advanced age, incomplete resection, WHO classification B2/B3, and higher Masaoka stage are risk factors for poor prognosis.

Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma.

The goal of this study was to compare the early and intermediate surgical outcomes, including the survival of those with and without myasthenic thymoma, following robotic thymectomy. This is a retrospective analysis of prospectively maintained data of 111 patients who underwent robotic thymectomy for thymoma over 7 years in a thoracic surgery centre in India. We performed a comparative analysis of demographics, intraoperative variables and postoperative outcomes including survival of those with and without myasthenic thymoma. Of 111 patients, 68 patients were myasthenic and 43 were non-myasthenic. The need to resect surrounding structures and conversions was greater in the myasthenic group (P = 0.02, P = 0.04). Postoperative complications were significantly higher in the myasthenic group (P = 0.02). No differences were observed in intensive care unit stay, the need for postoperative ventilation and the hospital stay. On correlation, a higher Masaoka stage [odds ratio 1.96, 95% confidence interval (CI) 1.22-3.15] and an aggressive World Health Organization histological diagnosis (odds ratio 1.58, 95% CI 1.10-2.26) were more likely in patients with myasthenia gravis. A total of 7 deaths (6.3%) occurred during the median follow-up of 4.2 years, 5 among those with myasthenic thymoma and 2 among patients with non-myasthenic thymoma. Due to the small number of deaths, there is insufficient evidence to draw any conclusion about the effect of myasthenia gravis on survival after surgery (hazard ratio 0.51, 95% CI 0.09-2.71; P = 0.43). The presence of myasthenia with thymoma is associated with more adjacent structure resection, higher postoperative complications and more conversions. The use of robotic surgery for thymoma resection in patients with myasthenia could not overcome the early postoperative problems related to myasthenia gravis.

Fibrous bands associated with higher Masaoka stage and poor recurrence-free survival in patients with thymoma.

BackgroundFibrous bands (FBs) are one of the histological features in tumors which can be confirmed by hematoxylin and eosin (H&E)‐stained slides. FBs have been reported to correlate with malignancy in various tumors. This study aimed to investigate whether the presence of FBs is associated with malignancy in thymoma.MethodsA total of 123 consecutive patients with thymoma who underwent microscopically complete resections from January 2000 to December 2018 were enrolled into this study. H&E‐stained slides of all thymoma patients were re‐examined. Study patients were classified into two groups: with FBs (n = 36) and without FBs (n = 87). Clinicopathological characteristics, overall survival (OS), and recurrence‐free survival (RFS) were compared between the two groups. Furthermore, multivariate analyses were performed to identify whether the presence of FBs was associated with higher Masaoka stage and poor prognosis in patients with thymoma.ResultsThe Masaoka stage was found to be higher and recurrence more likely in thymoma patients with FBs than in those without. RFS was significantly poorer in thymoma patients with FBs than in those without, although no significant difference was observed in OS between them. The presence of FBs was significantly associated with higher Masaoka stage in the multivariate analysis using logistic regression. Additionally, the presence of FBs was an independent prognostic factor for poor RFS in multivariate analysis using Cox's proportional hazards model.ConclusionsThe presence of FBs in patients with thymoma was associated with higher Masaoka stage, higher recurrence rate, and poorer RFS.Key pointsSignificant findings of the studyFibrous bands (FBs) are bands of fibrosis dividing tumors into different‐sized irregular islands. The presence of FBs is associated with higher Masaoka stage and poor recurrence‐free survival in patients with thymoma.What this study addsThe presence of fibrous bands might be associated with the malignant behavior of thymoma. Confirming the presence or absence of FBs may result in personalized medication for patients with thymoma.

Prognostic and clinicopathological roles of programmed death-ligand 1 (PD-L1) expression in thymic epithelial tumors: A meta-analysis.

BackgroundProgrammed death‐ligand 1 (PD‐L1) is one of the immune checkpoint proteins, and plays an important role in the progression and microenvironment of cancer. PD‐L1 expression has been associated with poor survival in many cancers. Several studies have also shown an association between PD‐L1 expression and the prognosis of patients with thymic epithelial tumors (TETs). In this study, we systematically evaluated the prognostic and clinicopathological roles of PD‐L1 expression in TETs.MethodsWe searched the literature through PubMed, Embase and Cochrane library and chose the eligible studies, and subsequently performed a meta‐analysis to evaluate the prognostic and clinicopathological roles of PD‐L1 expression in TETs.ResultsSix of the 75 articles found in the literature were selected. PD‐L1 expression was significantly related to unfavorable overall survival (hazard ratio 1.52, 95% confidence interval [CI]: 1.01–2.30, P = 0.046) in TETs. PD‐L1 expression was significantly associated with male gender (odds ratio [OR] 1.55, 95% CI: 1.08–2.22, P = 0.017) and higher Masaoka stage (OR 3.93, 95% CI: 2.44–6.32, P < 0.001).ConclusionsPD‐L1 expression was correlated with unfavorable prognosis in TETs, indicating PD‐L1 expression could help determine the prognosis of TET patients.

Superior Vena Cava Resection in Locally Advanced Thymoma-Surgical and Survival Outcomes.

This study was aimed at reporting the surgical management of superior vena cava invasion in patients with locally advanced thymoma and to evaluate surgical and survival outcomes. This is a retrospective analysis of 12 patients operated for superior vena cava resection for locally advanced thymoma over 8years in a thoracic surgery centre in India. An analysis of peri-operative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Intra-operatively, superior vena cava (SVC) alone was involved in 3 (25%) cases, SVC with BCV involvement was there in 8 cases (66.7%) and in 1 patient, the SVC involvement extended into the right atrium also. In all cases, the tumour was resected en bloc with the involved part of SVC. Repair with primary closure was sufficient in 2 cases (16.6%) in view of < 1/3rd of circumferential involvement. However, in remaining 10 cases, SVC was replaced with PTFE graft (single graft in 6 cases, Y-graft in 2 cases and twin grafts in 2 cases). No peri-operative deaths. Overall survival (OS) at 1, 3 and 5years was 100%, 91.6% and 83.3%, respectively. Myasthenia gravis and higher Masaoka stage (IV A) of the disease were poor predictors of survival. Superior vena cava resection and reconstruction is a feasible and oncologically superior option in invasive thymoma with SVC involvement. This challenging surgical procedure should only be attempted by an experienced team of thoracic and cardiac surgeons at high-volume centre to achieve best outcomes.

Clinical Characteristics and Outcomes for Patients With Thymic Carcinoma: Evaluation of Masaoka Staging

Thymic carcinomas are rare cancers with limited data regarding outcomes, particularly for those patients with advanced disease. We identified patients with thymic carcinomas diagnosed between 1993 and 2012. Patient characteristics, recurrence-free survival (RFS), and overall survival (OS) were analyzed. One hundred twenty-one patients with thymic carcinomas were identified. Higher Masaoka stage was associated with worse OS and RFS (5-year OS of 100%, 81%, 51%, 24%, and 17% for stage I, II, III, IVa, and IVb respectively, p < 0.001 and 5-year RFS of 80%, 28%, and 7% for stage I/II, III, and IV respectively, p < 0.001). Patients with stage IVb lymph node (LN) only disease had a better 5-year OS as compared with patients with distant metastasis (24% versus 7%, p = 0.025). Of the 61 patients with stage IVb disease, 22 of 29 patients (76%) with LN-only disease underwent curative intent resection versus 3 of 32 patients (9%) with distant metastasis. Twenty-two patients with LN involvement were treated with multimodality therapy. Three (14%) remain free of disease with long-term follow-up (range, 3.4+ years- to 6.8+ years). We describe the clinical features of a large series of patients with thymic carcinoma in North America. The Masaoka staging system effectively prognosticated OS and RFS. Patients with stage IVb LN-only disease had significantly better OS as compared with patients with distant metastasis with a subset of patients sustaining long-term RFS with multimodality therapy. If validated, these data would support a revised staging system with subclassification of stage IVb disease into two groups.

Prognostic Factors for Cure, Recurrence and Long-Term Survival After Surgical Resection of Thymoma

To determine long-term outcome and risk factors for recurrence after thymectomy. Patients who underwent thymectomy (n = 262) for a thymic tumor (1986-2010) were identified from a prospective database. Patients were classified according to World Helath Organization (WHO) histologic classification, Masaoka staging system, and completeness of resection. Risk factors for recurrence: WHO histology, tumor size, Masaoka stage and completeness of resection were analyzed. Of 262 patients, 51% were female, median age was 55 years, and 39% had myasthenia gravis. Median follow-up was 7.5 years, median tumor size was 5.4 cm, and Masaoka stage distribution was: I (25%), II (47%), III (17%), IV (4%), and (7%) not classified. Of 200 patients classified under the WHO system, there were (7%) type A, (22%) type AB, and (71%) type B; 83% had complete resection. One-hundred and sixty-nine patients received adjuvant radiotherapy, eight adjuvant chemoradiotherapy and 14 neoadjuvant chemoradiotherapy. Overall survival was 95% at 5 years, 91% at 10 years and 91% at 15 years. Recurrence occurred in 12 patients and disease-related death in four patients. Five patients underwent re-resection for recurrence with survival of 2-15 years. Only Masaoka stage and tumor size were associated with statistically significant risk of recurrence on multivariate analysis. Resectable thymoma is associated with excellent prognosis. Aggressive resection of recurrent disease yielded excellent long-term results. Higher Masaoka stage is associated with a greater chance of incomplete resection. Higher Masaoka stage and increasing tumor size are independent factors associated with recurrence.

It is feasible to operate on pathological Masaoka stage I and II thymoma patients with video-assisted thoracoscopy: analysis of factors for a successful resection

The objectives of this study were to evaluate the feasibility of video-assisted thoracoscopic (VATS) thymoma resection and to analyze the factors contributing to a successful perioperative period. Fifty-one patients with thymoma underwent VATS with the aim of thymoma resection. Four patients underwent minithoracotomy [due to technical difficulties, including small chest cavity, high body mass index (BMI), and disintegration of the capsule] and three patients underwent sternotomy (due to invasion of major vascular structures). The seven open-converted patients and seven other patients who underwent complete VATS thymoma resection but experienced prolonged hospital stay (≥7 days) formed Group B (n = 14), namely, the unsuccessful group, while successful VATS thymoma resection patients formed Group A (n = 37). The groups were compared with each other in terms of the characteristics of patients, tumors, and perioperative period. Patients' characteristics, tumor size, WHO histologic type, and complications were similar in both Groups A and B (p > 0.05). Patients with Masaoka stage I and II thymomas were significantly more frequent in Group A (p < 0.01). Tumor size was a statistically insignificant variable for the determination of a successful VATS thymoma resection (p = 0.3). Masaoka stage and the size of the thymoma did not have any correlation with each other (p > 0.05). The size of the thymoma was not observed to be correlated with Masaoka stage and it was not noted to be an important factor in successful VATS thymoma resection. A higher Masaoka stage (III and IVa) was found to be the only variable that predicted unsuccessful situations. Thus, Masaoka stage, rather than the size of the thymoma, should be the main concern for the surgeon.