Background
International multicenter retrospective analysis. N=1,042 thymic carcinoma (TC) patients from major centers (MSKCC, Yale, Turin, Pisa, etc.). Squamous cell carcinoma predominant (79%). Analyzed clinical, pathologic, and treatment variables for OS and recurrence-free survival (RFS).
Interventions and follow up
Treatment: Surgical resection ± adjuvant radiotherapy (international multi-institutional treatment patterns)
Primary endpoint: Overall survival by stage and treatment modality
mFollow up: Multi-year (variable across institutions)
Primary endpoint: Overall survival by stage and treatment modality
mFollow up: Multi-year (variable across institutions)
Results
Masaoka stage distribution: Stage I 5%, II 17%, III 45%, IV 33%
R0 resection: 61% of patients
Adjuvant RT (60% of patients): Associated with improved OS (multivariable HR NR) and improved RFS on multivariable analysis
Median OS: 6.6 years (95% CI 5.8–8.3)
5-yr cumulative recurrence: 35%
Independent predictors of OS (multivariable): R0 resection and adjuvant RT
R0 resection: 61% of patients
Adjuvant RT (60% of patients): Associated with improved OS (multivariable HR NR) and improved RFS on multivariable analysis
Median OS: 6.6 years (95% CI 5.8–8.3)
5-yr cumulative recurrence: 35%
Independent predictors of OS (multivariable): R0 resection and adjuvant RT
Adverse events
Reporting: Retrospective — radiation toxicity not systematically reported
Scope: Analysis focused on outcomes and prognostic factors, not detailed toxicity assessment
Scope: Analysis focused on outcomes and prognostic factors, not detailed toxicity assessment
Conclusions
R0 resection and adjuvant RT were independently associated with improved OS and RFS in thymic carcinoma on multivariable analysis. Median OS of 6.6 years in this large international series exceeds historical TC reports; early stage, R0 resection, and adjuvant RT should be treatment goals.
Key Limitations
Retrospective registry pooling across institutions/eras; selection bias (fitter patients receive R0 + RT); inconsistent staging and toxicity capture; HR for RT not reported.
Clinical Context
Largest TC dataset (ITMIG/IASLC) supporting adjuvant RT after resection; informs ESMO thymic malignancy guidance favoring R0 resection plus adjuvant RT in TC.