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The impact of thymoma histotype on prognosis in a worldwide database.

Weis CA, Yao X, Deng Y, Detterbeck FC, Marino M, Nicholson AG, Huang J, Ströbel P, Antonicelli A, Marx A, Contributors to the ITMIG Retrospective Databa - J Thorac Oncol (2015)

Bottom Line: They are significantly more frequent in Europe and the United States than Asia.There are no differences in gender distribution.Multivariate analysis reveals an impact of age, stage, and resection status on survival and recurrence, whereas for histology there is only a significant impact on recurrence.

View Article: PubMed Central - PubMed

Affiliation: *Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; †Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; ‡Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; §Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; ║Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; ¶Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and #Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany.

ABSTRACT

Introduction: The rarity of thymomas and lack of multi-institutional studies have hampered therapeutic progress for decades. To overcome this, the members of the International Thymic Malignancy Interest Group created a worldwide retrospective database. This database was analyzed regarding the demographic and geographic distribution of thymomas and the impact of different variables on survival and recurrence.

Methods: This study analyzed 4221 thymomas diagnosed between 1983 and 2012 with World Health Organization histotype information from the International Thymic Malignancy Interest Group database. Associations to survival and recurrence were studied by univariate and multivariate analyses.

Results: Type B2 thymoma is the most common (28%) and type A the least common (12%) histotypes. They are significantly more frequent in Europe and the United States than Asia. Type A and AB occur at significantly higher age than other thymomas (64 and 57 years, respectively). There are no differences in gender distribution. Stage is lower in type A (90% in stages I-II) and AB than B1 to B3 thymomas (38% of type B3 in stage III). In univariate analysis, recurrence is significantly less frequent among stage I/II tumors, in type A and AB (recurrence rates, 1-2%) than B1 to B3 thymomas (2-7%). Multivariate analysis reveals an impact of age, stage, and resection status on survival and recurrence, whereas for histology there is only a significant impact on recurrence.

Conclusion: New findings are (1) geographic differences such as a lower incidence of type A and B2 thymoma in Asia; and (2) impact of stage and histology, the latter partially limited to early stage disease, on recurrence.

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Relative frequency of thymoma histotypes by center volume and geographic region. A, Frequency of thymoma subtypes, ordered by size of center and geographic region. B, The frequency of thymoma subtypes by region and by high- and low-volume centers. “High volume centers” are those contributing more than 50% of the total cases per region. WHO, World Health Organization.
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Figure 2: Relative frequency of thymoma histotypes by center volume and geographic region. A, Frequency of thymoma subtypes, ordered by size of center and geographic region. B, The frequency of thymoma subtypes by region and by high- and low-volume centers. “High volume centers” are those contributing more than 50% of the total cases per region. WHO, World Health Organization.

Mentions: There is remarkable variability in the proportion of WHO histotypes reported from individual centers: In Figure 2A, the centers are ordered by center volume to assess whether this is associated with center experience; no consistent trend is apparent. The results suggested a difference according to geographic regions; to assess this further, we grouped the centers according to the region (Fig. 2B). The frequency of type A thymoma is similar in Europe (15%) and the United States (14%), but significantly lower in Asia (6%, adjusted p < 0.0001). Type AB thymoma is more frequent in Asia (27%) than Europe (23%) and the United States (18%, adjusted p = 0.0002). Type B2 thymoma is similar in Europe (31%) and the United States (32%), but significantly lower in Asia (20%, adjusted p < 0.0001). Type B3 thymoma is more frequent in Asia (32%) than Europe (15%) and the United States (16%, adjusted p < 0.0001). The frequencies of type B1 thymoma (16–20%) are not significantly different between geographic regions.


The impact of thymoma histotype on prognosis in a worldwide database.

Weis CA, Yao X, Deng Y, Detterbeck FC, Marino M, Nicholson AG, Huang J, Ströbel P, Antonicelli A, Marx A, Contributors to the ITMIG Retrospective Databa - J Thorac Oncol (2015)

Relative frequency of thymoma histotypes by center volume and geographic region. A, Frequency of thymoma subtypes, ordered by size of center and geographic region. B, The frequency of thymoma subtypes by region and by high- and low-volume centers. “High volume centers” are those contributing more than 50% of the total cases per region. WHO, World Health Organization.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4318643&req=5

Figure 2: Relative frequency of thymoma histotypes by center volume and geographic region. A, Frequency of thymoma subtypes, ordered by size of center and geographic region. B, The frequency of thymoma subtypes by region and by high- and low-volume centers. “High volume centers” are those contributing more than 50% of the total cases per region. WHO, World Health Organization.
Mentions: There is remarkable variability in the proportion of WHO histotypes reported from individual centers: In Figure 2A, the centers are ordered by center volume to assess whether this is associated with center experience; no consistent trend is apparent. The results suggested a difference according to geographic regions; to assess this further, we grouped the centers according to the region (Fig. 2B). The frequency of type A thymoma is similar in Europe (15%) and the United States (14%), but significantly lower in Asia (6%, adjusted p < 0.0001). Type AB thymoma is more frequent in Asia (27%) than Europe (23%) and the United States (18%, adjusted p = 0.0002). Type B2 thymoma is similar in Europe (31%) and the United States (32%), but significantly lower in Asia (20%, adjusted p < 0.0001). Type B3 thymoma is more frequent in Asia (32%) than Europe (15%) and the United States (16%, adjusted p < 0.0001). The frequencies of type B1 thymoma (16–20%) are not significantly different between geographic regions.

Bottom Line: They are significantly more frequent in Europe and the United States than Asia.There are no differences in gender distribution.Multivariate analysis reveals an impact of age, stage, and resection status on survival and recurrence, whereas for histology there is only a significant impact on recurrence.

View Article: PubMed Central - PubMed

Affiliation: *Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; †Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; ‡Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; §Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; ║Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; ¶Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and #Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany.

ABSTRACT

Introduction: The rarity of thymomas and lack of multi-institutional studies have hampered therapeutic progress for decades. To overcome this, the members of the International Thymic Malignancy Interest Group created a worldwide retrospective database. This database was analyzed regarding the demographic and geographic distribution of thymomas and the impact of different variables on survival and recurrence.

Methods: This study analyzed 4221 thymomas diagnosed between 1983 and 2012 with World Health Organization histotype information from the International Thymic Malignancy Interest Group database. Associations to survival and recurrence were studied by univariate and multivariate analyses.

Results: Type B2 thymoma is the most common (28%) and type A the least common (12%) histotypes. They are significantly more frequent in Europe and the United States than Asia. Type A and AB occur at significantly higher age than other thymomas (64 and 57 years, respectively). There are no differences in gender distribution. Stage is lower in type A (90% in stages I-II) and AB than B1 to B3 thymomas (38% of type B3 in stage III). In univariate analysis, recurrence is significantly less frequent among stage I/II tumors, in type A and AB (recurrence rates, 1-2%) than B1 to B3 thymomas (2-7%). Multivariate analysis reveals an impact of age, stage, and resection status on survival and recurrence, whereas for histology there is only a significant impact on recurrence.

Conclusion: New findings are (1) geographic differences such as a lower incidence of type A and B2 thymoma in Asia; and (2) impact of stage and histology, the latter partially limited to early stage disease, on recurrence.

Show MeSH
Related in: MedlinePlus