Annals of Surgery
Scientific Papers of the American Surgical Association
Wilkins, Kirsten Bass MD*; Sheikh, Emran MD*; Green, Rennae MD†; Patel, Mayur BA*; George, Simeon BA*; Takano, Manabu MD*; Diener-West, Marie PhD‡; Welsh, James MD§; Howard, Steven MD§; Askin, Frederic MD†; Bulkley, Gregory B. MD, FACS*
From the Departments of *Surgery, †Pathology, ‡Biostatistics, and §Radiation Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
Correspondence: Gregory B. Bulkley, MD, Blalock 685, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287-4685.
Presented at the 119th Annual Meeting of the American Surgical Association, April 15–17, 1999, Hyatt Regency Hotel, San Diego, California.
Accepted for publication April 1999.
Abstract
Objective
To evaluate the Johns Hopkins Hospital experience with 136 thymomas over the past 40 years. This number of patients allowed quantitative estimation of the independent influence of common clinicopathologic risk factors using multivariate analysis.
Summary Background Data
Thymomas vary widely in terms of recurrence and influence on overall survival. Several series have indicated the importance of initial tumor invasion, as well as the extent of surgical resection, as predictors of recurrence and survival after thymoma resection. However, findings have been equivocal when other predictors of prognosis were examined.
Methods
The authors evaluated 136 patients seen at the Johns Hopkins Hospital between 1957 and 1997 with a pathologic diagnosis of thymoma. Demographic information, clinical staging data, surgical and adjuvant treatment details, and patient follow-up data were obtained from the patient record and from detailed patient or family interviews. Microscopic sections of all 136 patients were reviewed by two pathologists blinded to the clinical data. All data were analyzed by multivariate Cox regression analysis, which allowed the quantification of the independent predictive value of 12 putative clinicopathologic prognostic indicators.
Results
Completeness of follow-up was 99%, 99%, and 98% of eligible patients at 5, 10, and 15 years, respectively. Forty percent of the patients had associated myasthenia gravis and 27% had a secondary primary malignancy. Overall patient survival rates were 71%, 56%, 44%, 38%, and 33% at 5, 10, 15, 20, and 25 years, respectively. Overall, the thymoma-related mortality rate was 14%; the nonthymoma-related mortality rate was 26%. Incomplete resection, preoperative absence of myasthenia gravis, and advanced Lattes/Bernatz pathologic class were found to be independent predictors of poorer overall survival.
Conclusions
These findings support a policy of aggressive, complete surgical resection of all thymomas when feasible. Thymoma behaves as a rather indolent tumor, with most deaths from causes unrelated to thymoma or its direct treatment. Clinicians should have an increased awareness of the possibility of second primary malignancies in patients with thymoma.