{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T11:32:34Z","timestamp":1740137554473,"version":"3.37.3"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T00:00:00Z","timestamp":1597276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T00:00:00Z","timestamp":1597276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thymic epithelial tumors are rare neoplasias. There are no internationally accepted standards to treat this complex oncological disease. The studies on which our knowledge is based frequently have methodological weaknesses. If the tumor is resectable, complete surgical excision is currently the first-line therapy. Thymic epithelial tumors respond to radiation. The therapeutic benefit of adjuvant radiotherapy depends on tumor stage. To validate and improve treatment, we share our current experiences with clinical management and surgical intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single-center retrospective study included 40 patients with primarily resectable thymic epithelial tumors who underwent resection with curative intent. The survival data was collected and presented according to Kaplan-Meier. Single- and multiple predictor survival analyses were carried out using the log-rank test and Cox proportional hazards model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Single-predictor survival analysis showed survival to be dependent on the Masaoka-Koga classification, WHO histological classification, resection status, surgical technique, and Clavien-Dindo grade for postoperative complications. Multiple predictor analysis confirms that the Masaoka-Koga stage (HR = 4.876,<jats:italic>P<\/jats:italic>= 0.032) and Clavien-Dindo grade (HR = 4.904,<jats:italic>P<\/jats:italic>= 0.011) are independent prognostic factors for survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In addition to the Masaoka stage, the occurrence of severe postoperative complications represents an independent prognostic factor. Given the tumor\u2019s sensitivity to radiation, the use of neoadjuvant radiotherapy can be considered to downstage Masaoka-Koga stages III and higher, thus reducing surgical risks. Further prospective multicenter studies are urgently needed.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12957-020-01988-4","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T17:10:30Z","timestamp":1597338630000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A single-center experience: management of patients with thymic epithelial tumors"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4831-8782","authenticated-orcid":false,"given":"Marius","family":"Kemper","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Moradzadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugen","family":"Bellon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad S.","family":"Bahar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer","family":"Grotel\u00fcschen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Reeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob R.","family":"Izbicki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Bachmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,8,13]]},"reference":[{"key":"1988_CR1","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.critrevonc.2016.01.012","volume":"99","author":"M Scorsetti","year":"2016","unstructured":"Scorsetti M, Leo F, Trama A, D\u2019Angelillo R, Serpico D, Macerelli M, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol. 2016;99:332\u201350.","journal-title":"Crit Rev Oncol Hematol"},{"key":"1988_CR2","doi-asserted-by":"crossref","unstructured":"Benjamin DJ, Klapheke A, Lara PN, Cress RD, Riess JW. A population-based study of incidence and survival of 1588 thymic malignancies: results from the California Cancer Registry. Clin Lung Cancer. 2019;20(6):477\u201383.","DOI":"10.1016\/j.cllc.2019.06.005"},{"key":"1988_CR3","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.athoracsur.2012.09.006","volume":"95","author":"B Weksler","year":"2012","unstructured":"Weksler B, Dhupar R, Parikh V, Nason KS, Pennathur A, Ferson PF. Thymic carcinoma: a multivariate analysis of factors predictive of survival in 290 patients. Ann Thorac Surg. 2012;95:299\u2013303.","journal-title":"Ann Thorac Surg"},{"key":"1988_CR4","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1186\/s12957-015-0718-z","volume":"13","author":"J Lindenmann","year":"2015","unstructured":"Lindenmann J, Fink-Neuboeck N, Pichler M, Anegg U, Maier A, Smolle J, et al. Stage-based treatment for thymoma in due consideration of thymectomy: a single-center experience and comparison with the literature. World J Surg Oncol. 2015;13:303.","journal-title":"World J Surg Oncol"},{"key":"1988_CR5","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1016\/j.ejso.2014.05.011","volume":"40","author":"Z Song","year":"2014","unstructured":"Song Z, Zhang Y. Outcomes after surgical resection of thymic carcinoma: a study from a single tertiary referral centre. Eur J Surg Oncol. 2014;40:1523\u20137.","journal-title":"Eur J Surg Oncol"},{"key":"1988_CR6","doi-asserted-by":"publisher","first-page":"e0146609","DOI":"10.1371\/journal.pone.0146609","volume":"11","author":"Y-H Tseng","year":"2016","unstructured":"Tseng Y-H, Lin Y-H, Tseng Y-C, Lee Y-C, Wu Y-C, Hsu W-H, et al. Adjuvant therapy for thymic carcinoma \u2013 a decade of experience in a Taiwan National Teaching Hospital. Heymann D, editor PLoS One. 2016;11:e0146609\u201310.","journal-title":"Heymann D, editor PLoS One"},{"key":"1988_CR7","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jtcvs.2014.09.124","volume":"149","author":"U Ahmad","year":"2015","unstructured":"Ahmad U, Yao X, Detterbeck F, et al. Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg. 2015;149:95\u2013101.e2.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"1988_CR8","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1016\/j.ijrobp.2011.03.010","volume":"82","author":"S Patel","year":"2012","unstructured":"Patel S, Macdonald OK, Nagda S, Bittner N, Suntharalingam M. Evaluation of the role of radiation therapy in the management of malignant thymoma. Int J Radiat Oncol Biol Phys. 2012;82:1797\u2013801.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"1988_CR9","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1097\/JTO.0b013e3181e8f345","volume":"5","author":"AT Fernandes","year":"2010","unstructured":"Fernandes AT, Shinohara ET, Guo M, Mitra N, Wilson LD, Rengan R, et al. The role of radiation therapy in malignant thymoma: a Surveillance, Epidemiology, and End Results database analysis. J Thorac Oncol. 2010;5:1454\u201360.","journal-title":"J Thorac Oncol"},{"key":"1988_CR10","doi-asserted-by":"crossref","unstructured":"Sch\u00fcnke M, Schulte E, Schumacher U, Voll M, Wesker KH. PROMETHEUS Innere Organe. 2018;.","DOI":"10.1055\/b-0038-151670"},{"key":"1988_CR11","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1016\/j.athoracsur.2003.10.001","volume":"77","author":"FC Detterbeck","year":"2004","unstructured":"Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg. 2004;77:1860\u20139.","journal-title":"Ann Thorac Surg"},{"key":"1988_CR12","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.1002\/1097-0142(19811201)48:11<2485::AID-CNCR2820481123>3.0.CO;2-R","volume":"48","author":"A Masaoka","year":"1981","unstructured":"Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485\u201392.","journal-title":"Cancer."},{"key":"1988_CR13","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/j.1440-1827.1994.tb02936.x","volume":"44","author":"K Koga","year":"2008","unstructured":"Koga K, Matsuno Y, Noguchi M, Mukai K, Asamura H, Goya T, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int. 2008;44:359\u201367.","journal-title":"Pathol Int"},{"key":"1988_CR14","doi-asserted-by":"publisher","first-page":"S1710","DOI":"10.1097\/JTO.0b013e31821e8cff","volume":"6","author":"FC Detterbeck","year":"2011","unstructured":"Detterbeck FC, Nicholson AG, Kondo K, Schil PV, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011;6:S1710\u20136.","journal-title":"J Thorac Oncol"},{"key":"1988_CR15","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1016\/S0003-4975(03)00555-1","volume":"76","author":"K Kondo","year":"2003","unstructured":"Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76:878\u201384.","journal-title":"Ann Thorac Surg"},{"key":"1988_CR16","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1097\/JTO.0000000000000154","volume":"9","author":"A Marx","year":"2014","unstructured":"Marx A, Str\u00f6bel P, Badve SS, Chalabreysse L, Chan JKC, Chen G, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9:596\u2013611.","journal-title":"J Thorac Oncol"},{"key":"1988_CR17","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/RTI.0b013e31828609a0","volume":"28","author":"EM Marom","year":"2013","unstructured":"Marom EM. Advances in thymoma imaging. J Thorac Imaging. 2013;28:69\u201380 quiz 81\u20133.","journal-title":"J Thorac Imaging"},{"key":"1988_CR18","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1148\/radiol.14131643","volume":"273","author":"AAKA Razek","year":"2014","unstructured":"Razek AAKA, Khairy M, Nada N. Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology. 2014;273:268\u201375.","journal-title":"Radiology"},{"key":"1988_CR19","doi-asserted-by":"publisher","first-page":"S344","DOI":"10.1097\/JTO.0b013e3181f20eb3","volume":"5","author":"CD Wright","year":"2010","unstructured":"Wright CD. Extended resections for thymic malignancies. J Thorac Oncol. 2010;5:S344\u20137.","journal-title":"J Thorac Oncol"},{"key":"1988_CR20","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/01243894-200605000-00007","volume":"1","author":"M Lucchi","year":"2006","unstructured":"Lucchi M, Melfi F, Dini P, Basolo F, Viti A, Givigliano F, et al. Neoadjuvant chemotherapy for stage III and IVA thymomas: a single-institution experience with a long follow-up. J Thorac Oncol. 2006;1:308\u201313.","journal-title":"J Thorac Oncol"},{"key":"1988_CR21","doi-asserted-by":"publisher","first-page":"S1739","DOI":"10.1097\/JTO.0b013e31821ea553","volume":"6","author":"A Toker","year":"2011","unstructured":"Toker A, Sonett J, Zielinski M, Rea F, Tomulescu V, Detterbeck FC. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol. 2011;6:S1739\u201342.","journal-title":"J Thorac Oncol"},{"key":"1988_CR22","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1016\/j.jtcvs.2010.09.003","volume":"141","author":"A Pennathur","year":"2011","unstructured":"Pennathur A, Qureshi I, Schuchert MJ, Dhupar R, Ferson PF, Gooding WE, et al. Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg. 2011;141:694\u2013701.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"1988_CR23","doi-asserted-by":"crossref","first-page":"e214","DOI":"10.1093\/ejcts\/ezt305","volume":"44","author":"T Kimura","year":"2013","unstructured":"Kimura T, Inoue M, Kadota Y, Shiono H, Shintani Y, Nakagiri T, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiol. 2013;44:e214\u20138.","journal-title":"Eur J Cardiol"},{"key":"1988_CR24","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1097\/JTO.0b013e3181653c8c","volume":"3","author":"T Onuki","year":"2008","unstructured":"Onuki T, Ishikawa S, Yamamoto T, Ito H, Sakai M, Onizuka M, et al. Pathologic radioresponse of preoperatively irradiated invasive thymomas. J Thorac Oncol. 2008;3:270\u20136.","journal-title":"J Thorac Oncol"},{"key":"1988_CR25","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1097\/JTO.0000000000000128","volume":"9","author":"E Ruffini","year":"2014","unstructured":"Ruffini E, Detterbeck F, Van Raemdonck D, et al. Thymic carcinoma: a cohort study of patients from the European Society of Thoracic Surgeons Database. J Thorac Oncol. 2014;9:541\u20138.","journal-title":"J Thorac Oncol"},{"key":"1988_CR26","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1093\/icvts\/ivs133","volume":"15","author":"S Attaran","year":"2012","unstructured":"Attaran S, McCormack D, Pilling J, Harrison-Phipps K. Which stages of thymoma benefit from adjuvant chemotherapy post-thymectomy? Interact Cardiov Th. 2012;15:273\u20135.","journal-title":"Interact Cardiov Th"},{"key":"1988_CR27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.lungcan.2012.12.012","volume":"80","author":"Y Okuma","year":"2013","unstructured":"Okuma Y, Hosomi Y, Takagi Y, Sasaki E, Hishima T, Maeda Y, et al. Clinical outcomes with chemotherapy for advanced thymic carcinoma. Lung Cancer. 2013;80:75\u201380.","journal-title":"Lung Cancer"},{"key":"1988_CR28","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1053\/j.semtcvs.2004.11.003","volume":"17","author":"TL Evans","year":"2005","unstructured":"Evans TL, Lynch TJ. Role of chemotherapy in the management of advanced thymic tumors. Semin Thorac Cardiovasc Surg. 2005;17:41\u201350.","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"1988_CR29","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205\u201313.","journal-title":"Ann Surg"},{"key":"1988_CR30","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1016\/j.athoracsur.2009.11.057","volume":"89","author":"Y Hosaka","year":"2010","unstructured":"Hosaka Y, Tsuchida M, Toyabe S, Umezu H, Eimoto T, Hayashi J. Masaoka stage and histologic grade predict prognosis in patients with thymic carcinoma. Ann Thorac Surg. 2010;89:912\u20137.","journal-title":"Ann Thorac Surg"},{"key":"1988_CR31","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.ejcts.2009.02.019","volume":"36","author":"CY Lee","year":"2009","unstructured":"Lee CY, Bae MK, Park IK, Kim DJ, Lee JG, Chung KY. Early Masaoka stage and complete resection is important for prognosis of thymic carcinoma: a 20-year experience at a single institution. European J Cardio-thoracic Surg. 2009;36:159\u201362 discussion 163.","journal-title":"European J Cardio-thoracic Surg"},{"key":"1988_CR32","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1309\/AJCP88FZTWANLRCB","volume":"138","author":"A Weissferdt","year":"2012","unstructured":"Weissferdt A, Moran CA. Thymic Carcinoma, Part 1. Am J Clin Pathol. 2012;138:103\u201314.","journal-title":"Am J Clin Pathol"},{"key":"1988_CR33","first-page":"32","volume":"123","author":"SF Khuri","year":"2005","unstructured":"Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;123:32\u201348.","journal-title":"Ann Surg"},{"key":"1988_CR34","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jtcvs.2013.08.061","volume":"147","author":"RJ Korst","year":"2014","unstructured":"Korst RJ, Bezjak A, Blackmon S, Choi N, Fidias P, Liu G, et al. Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial. J Thorac Cardiovasc Surg. 2014;147:36\u201346.e1.","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-020-01988-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12957-020-01988-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-020-01988-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T18:47:22Z","timestamp":1696531642000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjso.biomedcentral.com\/articles\/10.1186\/s12957-020-01988-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,13]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1988"],"URL":"https:\/\/doi.org\/10.1186\/s12957-020-01988-4","relation":{},"ISSN":["1477-7819"],"issn-type":[{"type":"electronic","value":"1477-7819"}],"subject":[],"published":{"date-parts":[[2020,8,13]]},"assertion":[{"value":"21 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study protocol was approved by the Ethics Committee of the Medical Board in Hamburg, Germany. Informed written consent was obtained from all participants.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"202"}}