• Najib Safieddine, Geoffrey Liu, Kris Cuningham, Tsao Ming, David Hwang, Anthony Brade, Andrea Bezjak, Stefan Fischer, Wei Xu, Sassan Azad, Marcelo Cypel, Gail Darling, Kazu Yasufuku, Andrew Pierre, Marc de Perrot, Tom Waddell, and Shaf Keshavjee.
• *Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital; †Department of Medical Oncology; ‡Department of Pathology; §Department of Radiation Oncology; and ‖Department of Biostatistics, Princess Margaret Cancer Centre at UHN, University of Toronto, Toronto, ON, Canada.
• J Thorac Oncol. 2014 Jul 1;9(7):1018-22.

IntroductionTo determine long-term outcome and risk factors for recurrence after thymectomy.MethodsPatients 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.ResultsOf 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.ConclusionResectable 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.

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