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Tumor Recurrence and Survival in Patients Treated for Thymomas and Thymic Squamous Cell Carcinomas: A Retrospective Analysis

From the Institute of Pathology, Departments of Cardiovascular Surgery and Neurology, University of Würzburg, Würzburg; Departments of Cardiovascular Surgery and Neurology, University of Münster, Münster; Department of Neurology, University of Mainz, Mainz; Department of Neurology, University of Regensburg, Regensburg, Germany.

Address reprint requests to Philipp Ströbel, MD, Institute of Pathology, University of Würzburg, Josef-Schneider-Strasse 2, D-97080 Würzburg, Germany; e-mail: path036{at}mail.uni-wuerzburg.de

PURPOSE: Thymic epithelial tumors (TET) are rare epithelial neoplasms of the thymus with considerable histologic heterogeneity. This retrospective study focused on the correlation of WHO-defined TET histotypes with survival and tumor recurrence in a large cohort of patients receiving different modes of treatment.

PATIENTS AND METHODS: Two hundred twenty-eight patients were followed for up to 21 years (median, 60 months; range, 1 to 252 months) after primary surgery. Forty-two patients received adjuvant radiotherapy (mean dose, 53 Gy), and 33 patients recieved adjuvant chemotherapy.

RESULTS: Seventy-six (88%) of 86 patients with WHO type A, AB, and B1 thymomas were treated by surgery alone, with three tumor relapses after 3 to 10 years (median, 3.4 years). Twelve of 67 patients with WHO type B2 and B3 thymomas in Masaoka stages I and II were treated by adjuvant radiotherapy without evidence of tumor recurrence after 1 to 12 years (median, 4 years). Among 75 patients with B2 and B3 thymomas with incomplete resection or a tumor stage III or higher, the recurrence rate was 34% (n = 23) after 0.5 to 17 years (median, 5 years) in patients receiving adjuvant radiochemotherapy, compared to 78% (seven of nine patients) in patients without adjuvant radiochemotherapy. Incomplete tumor resection was associated with a high recurrence rate (65%) and a poor prognosis (P < .01).

CONCLUSION: The long-term outcome of TET patients is related to tumor stage, WHO histotype, completeness of surgical removal, and type of treatment. Prospective trials are warranted to formally address the efficacy of adjuvant therapy in the treatment of localized and advanced malignant TETs.

This work was supported by grant FOR 303/2 (to P.S. and A.M.) of the Deutsche Forschungsgemeinschaft, by grant QLRT-2000-01918 of the European community, the Center for Interdisciplinary Clinical Research at the University of Würzburg (A.M., K.M.-H., R.G., K.V.T.), and by local university research funds.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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