{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:54:36Z","timestamp":1775868876084,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>The Masoka\u2010Koga and tumor node metastases staging systems for thymoma are based on structures involved, but the prognostic role of the number of infiltrated\/involved structures is still debated. We analyzed the prognostic role of involved structures and their combinations in locally advanced thymomas patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data on 174 surgically treated locally advanced thymoma patients from 1\/01\/1990 to 31\/12\/2015 were reviewed. Clinical and pathological characteristic, involved structures, number of involved structures and different combinations were correlated to cancer specific survival (CSS) using Kaplan\u2013Meier product\u2010limit method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five and 10\u2010year CSS was 92% and 87%. Masaoka Stage 3 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), absence of pericardial involvement (<jats:italic>p<\/jats:italic>\u2009=\u20090.001), number of involved structures (<jats:italic>p<\/jats:italic>\u2009=\u20090.018), R0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and adjuvant radiotherapy (<jats:italic>p<\/jats:italic>\u2009=\u20090.008) were favorable prognostic CSS factors. A significant better prognosis was present in \u22642 involved structures vs &gt;2 involved structures (5\u2010 and 10\u2010year CSS: 95% and 93% vs. 80% and 51%). Multivariable analysis confirmed as independent prognostic factor R0 (<jats:italic>p<\/jats:italic>\u2009=\u20090.033, hazard ratio [HR]: 0.093, 95% confidence interval [CI] 0.010\u20130.827) and number of involved structures (<jats:italic>p<\/jats:italic>\u2009=\u20090.046, HR: 0.187, 95% CI: 0.036\u20130.968). In Masaoka Stage 3, patients with \u22642 involved structures had a significant better CSS than patients with &gt;2 (10\u2010year CSS: 98% vs. 73%, <jats:italic>p<\/jats:italic>\u2009=\u20090.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The number of involved structures and the concomitant involvement of the pericardium seems to be associated with a poor prognosis in surgically treated advanced thymoma patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.26593","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T16:31:51Z","timestamp":1626107511000},"page":"858-866","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prognostic factors for survival in advanced thymomas: The role of the number of involved structures"],"prefix":"10.1002","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-6911","authenticated-orcid":false,"given":"Marco","family":"Chiappetta","sequence":"first","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Department of Thoracic Surgery Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8538-1719","authenticated-orcid":false,"given":"Vittorio","family":"Aprile","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery University of Pisa Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Department of Thoracic Surgery Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Zanfrini","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Department of Thoracic Surgery Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dania","family":"Nachira","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Department of Thoracic Surgery Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Meacci","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Department of Thoracic Surgery Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stylianos","family":"Korasidis","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery University of Pisa Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Ambrogi","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery University of Pisa Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Lucchi","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery University of Pisa Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Margaritora","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"},{"name":"Department of Thoracic Surgery Fondazione Policlinico Universitario A. 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