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Eur J Cardiothorac Surg. 2015 Jul;48(1):48-54. doi: 10.1093/ejcts/ezu368. Epub 2014 Sep 21.

Does the World Health Organization histological classification predict outcomes after thymomectomy? Results of a multicentre study on 750 patients.

Author information

1
Department of Thoracic Surgery, University of Torino, Torino, Italy.
2
Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, S. Andrea Hospital, Rome, Italy.
3
Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico "Umberto I", Rome, Italy.
4
Catholic University 'Sacred Heart' Rome, Rome, Italy.
5
San Giovanni Battista Hospital, Service of Pathology, Torino, Italy.
6
'Amedeo Avogadro' University Novara, Italy Unit of Thoracic Surgery, Novara, Italy.
7
University of Pisa, Pisa, Italy.
8
Unit of Cancer Epidemiology and CPO Piedmont, San Giovanni Battista Hospital, Italy.
9
Department of Thoracic Surgery, University of Torino, Torino, Italy pierluigi.filosso@unito.it.

Abstract

OBJECTIVES:

The World Health Organization (WHO) thymoma histological classification clinical value remains a controversy. In this study, we evaluated its prognostic significance in patients with thymoma treated with radical intent.

METHODS:

Six high-volume Italian Thoracic Surgery Institutions collaborated with their own retrospective anonymized datasets. Demographic, clinical, pathological and treatment data were examined. A WHO histological classification (WHO-HC) collapsed scheme (A/AB and B1/B2 types merged) was proposed and compared with the traditional one. Predictors of survival were assessed using a Cox model with shared frailty. Competing-risk regression models were performed to identify the association between individual factors and freedom from recurrence.

RESULTS:

Between 1990 and 2011, 750 thymomas were operated on in participating centres. Myasthenia gravis was observed in 363 (48%) patients. A complete resection was achieved in 676 (91%) cases. One hundred and nine patients (15%) had a WHO-HC A type, 166 (22%) AB, 179 (24%) B1, 158 (21%) B2 and 135 (18%) B3. The rate of 5-year OS and cumulative incidence of recurrence for all cases was 91% and 0.11, respectively. Five-year survival rates by WHO-HC in the collapsed scheme were A/AB 93%, early-B 90% and advanced-B 85%. Masaoka stage only was demonstrated to be an independent predictor for survival and recurrence. The WHO-collapsed scheme showed a trend in influencing recurrence overall survival development (hazard ratio: 1.32; P = 0.16).

CONCLUSIONS:

Our results show evidence of lack of significance by WHO-HC in influencing prognosis, even though the proposed collapsed scheme revealed a fair stratification of risk to relapses and better correlation with patients' clinical characteristics.

KEYWORDS:

Histology; Recurrence; Surgery; Survival; Thymoma; WHO classification

PMID:
25246487
DOI:
10.1093/ejcts/ezu368
[Indexed for MEDLINE]

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