Thirty-Five-Year Follow-Up Analysis of Clinical and Pathologic Outcomes of Thymoma Surgery

Stefano Margaritora, Alfredo Cesario, Giacomo Cusumano, Elisa Meacci, Rolando D'Angelillo, Stefano Bonassi, Giulia Carnassale, Venanzio Porziella, Adele Tessitore, Maria Letizia Vita, Libero Lauriola, Amelia Evoli, Pierluigi Granone

Research output: Contribution to journalArticlepeer-review


Background: The impact of myasthenia gravis on patients with thymoma is still controversial when perioperative and long-term outcomes are analyzed. With the unique opportunity of a 35-year follow-up in a single institution, thymomatous myasthenia gravis cohort, we investigated the influence of early and long-term clinical predictors. Methods: We reviewed a surgical series of 317 (1972 to 2007) patients with thymoma: clinical and pathologic features were analyzed as prognostic factors matched against the short- and long-term survival and recurrence rates. Results: Male to female ratio was 153:164; median age, 49 years. Myasthenia gravis coexisted in 276 patients (87.1%). Thymomas were classified according to the Masaoka (42.0% stage I, 32.2% stage II, 21.5% stage III, and 4.4% stage IV) and the World Health Organization (3.5% type A, 9.5% type AB, 19.2% type B1, 57.7% type B2, 8.2% type B3, and 1.9% thymic carcinoma) staging systems. The resection was complete in 295 patients (93.1%). Operative mortality and morbidity were respectively 1.6% and 7.6%. No differences were recorded in postoperative outcome stratifying for myasthenia gravis or comorbidities. Mean follow-up was 144.7 ± 104.4 months. The overall 5-, 10-, 20-, and 30-year survival rates were 89.9%, 84.1%, 73%, and 58.6%, respectively. The completeness of resection (p <0.001), the Masaoka staging (p = 0.010), and the World Health Organization classification (p <0.001) all significantly influenced the long-term survival (univariate analysis). Only completeness of resection was significantly correlated with a better prognosis (p <0.001) in multivariate analysis. Masaoka staging (p <0.001) and World Health Organization classification (p <0.001) significantly correlated with the disease-free survival in the univariate and multivariate analyses as significant prognostic factors (Masaoka, p <0.001; World Health Organization, p = 0.011). Myasthenia gravis patients showed a better prognosis in terms of long-term survival (p = 0.046) and disease-free survival (p = 0.012) in the univariate analysis. Conclusions: We confirm the evidence that the clinical staging and the histologic classification influence long-term survival. The presence of myasthenia gravis was not significantly related to operative outcome, but prolongs both long-term survival and disease-free survival.

Original languageEnglish
Pages (from-to)245-252
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number1
Publication statusPublished - Jan 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine


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