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Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database

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Abstract

Purpose

Patients with a thymic epithelial tumor (TET), comprising thymoma, thymic carcinoma (TC), and thymic neuroendocrine neoplasm (TNEN), are rarely encountered. The present study was conducted to determine the recent outcomes of surgical treatment for TET in Japan and clarify the significance of prognostic factors by analyzing a nationwide database created by the Japanese Association for Research on the Thymus (JART).

Methods

The JART database includes records of 2471 thymoma, 285 TC, and 56 TNEN cases surgically treated between 1991 and 2010. At the time of the final follow-up examination, 439 patients had died, with tumor the cause of death in 188. The disease-specific survival was examined using the Kaplan–Meier method, with Cox’s proportional hazards model utilized to determine independent prognostic factors.

Results

The 10-year survival rate according to TNM-based Stage I, II, IIIA, IIIB, IVA, and IVB classification was 98.7%, 76.8%, 85.0%, 68.9%, 66.2%, and 59.8%, respectively. The T factor, M factor, and tumor size were independent prognostic factors in both thymoma and thymic carcinoma cases, while the N factor had tendency to be a prognostic factor in thymoma but not in thymic carcinoma cases. The WHO histological type was an independent factor in thymoma cases.

Conclusion

The significance of pathology and TNM classification as prognostic factors was confirmed.

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Acknowledgements

Thirty-three institutions in Japan provided data for this JART retrospective database project, as follows: Hokkaido Cancer Center, Tsuchiura Kyodo Hospital, Chiba University, National Cancer Center Hospital, National Cancer Center Hospital East, University of Tokyo, Tokyo Medical University, Nippon Medical School, Tokyo Women's Medical University, Juntendo University, Keio University, Tokyo Komagome Hospital, Shizuoka Cancer Center, Niigata University, Nagoya University, Nagoya City University, Seirei Mikatahara General Hospital, Shinshu University, Aichi Medical University, Kyoto University, Osaka University, Osaka Medical Center for Cancer and Cardiovascular Diseases, Kinki Chuo Chest Medical Center, Kobe University, Okayama University, Tokushima University, Ehime University, Shikoku Cancer Center, Fukuoka University, Kyushu University, University of Occupational and Environmental Health, Nagasaki University, and Kumamoto University. The authors are grateful for support of this project by the members of those institutions. The authors would also like to thank Dr. Tsuyoshi Matsumura of Osaka Toneyama Medical Center for assisting with the statistical analysis and helping prepare the manuscript.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, National Hospital Organization (NHO), Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan

    Meinoshin Okumura

  2. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Ichiro Yoshino

  3. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Soichiro Funaki

  4. Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan

    Katsuhiro Okuda

  5. Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

    Shun-ichi Watanabe

  6. Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan

    Masahiro Tsuboi

  7. Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan

    Kimihiro Shimizu

  8. Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Hiroshi Date

  9. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Toyofumi F. Chen-Yoshikawa

  10. Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan

    Jun Nakajima

  11. Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan

    Shinichi Toyooka

  12. Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan

    Hisao Asamura

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  1. Meinoshin Okumura
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Corresponding author

Correspondence to Meinoshin Okumura.

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Conflict of interest

The authors do not have conflicts of interest in relation to this research.

Ethical approval

This study was approved by the Osaka University Hospital Institutional Review Board (#14461-3).

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Supplementary Information

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595_2023_2705_MOESM1_ESM.jpg

Supplementary file1 Supplementary Figure 1. Diagram showing the study population obtained from updated JART database (JPG 73 KB)

Supplementary file2 Supplementary Figure 2. Number of patients according to the year of operation (JPG 60 KB)

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Okumura, M., Yoshino, I., Funaki, S. et al. Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database. Surg Today 53, 1247–1259 (2023). https://doi.org/10.1007/s00595-023-02705-w

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