Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database: trial

Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database

Phase observationalN = 2,030

Population

2,030 patients analysed for OS in the ESTS retrospective thymic database (1,798 thymomas, 191 thymic carcinomas, 41 neuroendocrine thymic tumours)

Design

Retrospective database of the European Society of Thoracic Surgeons (ESTS): 2,151 incident cases from 35 institutions, 1990 to 2010, of patients who had surgery for thymic tumours. Primary outcome OS; secondary outcomes were the proportion of incomplete resections, disease-free survival and the cumulative incidence of recurrence. 2,030 patients were analysed for OS (1,798 thymomas, 191 thymic carcinomas and 41 neuroendocrine thymic tumours). Hazard ratios are from a multivariable analysis; an analysis using a propensity score addressed adjuvant therapy in R0 resections (type of adjuvant therapy not stated in the abstract).

Primary endpoint

Arms

All patients analysed (experimental, n = 2,030): Surgery for a thymic tumour; adjuvant therapy in some patients (radiotherapy, chemotherapy or both; see the adjuvant-therapy result)

People

Ruffini E, ESTS Thymic Working Group

OSHR 1.74 (95% CI 1.18–2.57)OSHR 2.66 (95% CI 1.80–3.92)OSHR 4.41 (95% CI 2.67–7.26)OSHR 0.69 (95% CI 0.49–0.97)

Show the numbers

Results reported for Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database
Endpoint	Analysis	All patients analysed	Control	Effect
R0 resectionPatients in the ESTS database analysis (1,709 complete resections, 88%, per Table 1 of the full text; the abstract does not state the denominator)	finalRuffini 2014	88%	—	—
OSIncomplete (R1-R2) versus complete (R0) resection, multivariable model	finalRuffini 2014	—	—	HR 1.74 (95% CI 1.18–2.57)Observational association from the multivariable model (full text, Table 2: R+ versus R0, univariable HR 3.87, 2.82-5.30; multivariable HR 1.74, 1.18-2.57). The reference group is complete (R0) resection.
OSMasaoka stage III versus stage I (multivariable model)	finalRuffini 2014	—	—	HR 2.66 (95% CI 1.80–3.92)Multivariable model (full text, Table 2); stage I is the reference.
OSMasaoka stage IV versus stage I (multivariable model)	finalRuffini 2014	—	—	HR 4.41 (95% CI 2.67–7.26)Multivariable model (full text, Table 2); stage I is the reference.
OSR0 resections, adjuvant therapy (type not stated) versus none, propensity-score analysis	exploratoryRuffini 2014	—	—	HR 0.69 (95% CI 0.49–0.97)Observational association in a propensity-score analysis of R0 resections. The abstract does not state which adjuvant therapies were included; the full text reports that adjuvant therapy was given to 853 patients and consisted of radiotherapy (566), chemotherapy (44) or both (243). The estimate is not specific to postoperative radiotherapy.

Results reported for Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database
Endpoint	Analysis	All patients analysed	Control	Effect
R0 resectionPatients in the ESTS database analysis (1,709 complete resections, 88%, per Table 1 of the full text; the abstract does not state the denominator)	finalRuffini 2014	88%	—	—
OSIncomplete (R1-R2) versus complete (R0) resection, multivariable model	finalRuffini 2014	—	—	HR 1.74 (95% CI 1.18–2.57)Observational association from the multivariable model (full text, Table 2: R+ versus R0, univariable HR 3.87, 2.82-5.30; multivariable HR 1.74, 1.18-2.57). The reference group is complete (R0) resection.
OSMasaoka stage III versus stage I (multivariable model)	finalRuffini 2014	—	—	HR 2.66 (95% CI 1.80–3.92)Multivariable model (full text, Table 2); stage I is the reference.
OSMasaoka stage IV versus stage I (multivariable model)	finalRuffini 2014	—	—	HR 4.41 (95% CI 2.67–7.26)Multivariable model (full text, Table 2); stage I is the reference.
OSR0 resections, adjuvant therapy (type not stated) versus none, propensity-score analysis	exploratoryRuffini 2014	—	—	HR 0.69 (95% CI 0.49–0.97)Observational association in a propensity-score analysis of R0 resections. The abstract does not state which adjuvant therapies were included; the full text reports that adjuvant therapy was given to 853 patients and consisted of radiotherapy (566), chemotherapy (44) or both (243). The estimate is not specific to postoperative radiotherapy.

Hazard ratio (95% CI) by endpoint. Values below 1 favour the experimental arm.

Data table

Endpoint	HR	95% CI
OS	1.74	1.18–2.57
OS	2.66	1.8–3.92
OS	4.41	2.67–7.26
OS	0.69	0.49–0.97

Appears in

1996 Complete resection and stage as prognostic factors in thymoma

Sources

Ruffini E, Detterbeck F, Van Raemdonck D, Rocco G, Thomas P, Weder W, et al. Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg. 2014;46(3):361-8.
PubMed DOI