{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:48Z","timestamp":1787027928287,"version":"build-2736575974"},"reference-count":19,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T00:00:00Z","timestamp":1700179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>According to the different classifications now in use, thymic tumours are staged by the extent of local invasiveness, and tumour size is not included as a major determinant for the T category. The aim of this double-site retrospective study is to analyse the correlation between tumour dimension and overall survival (OS) in patients who underwent surgical treatment. From January 2000 to December 2020, patients with thymic epithelial tumours who underwent surgical resection were included in this study. Data from a total of 332 patients were analysed. Five- and ten-year overall survival (5\u201310 YOS) was 89.26% and 87.08%, respectively, while five- and ten-year disease-free survival (DFS) was 88.12% and 84.2%, respectively. Univariate analysis showed a significant correlation between male sex (p-value 0.02), older age (p-value &lt; 0.01), absence of myasthenia gravis (p-value &lt; 0.01), increase in pTNM (pathological Tumor Node Metastasis) (p-value 0.03) and increase in the number of infiltrated organs (p-value 0.02) with an increase in tumour dimension. Tumour dimension alone was not effective in the prediction of DFS and OS, both when considered as a continuous variable and when considered with a cut-off of 3 and 5 cm. However, with multivariate analysis, it was effective in predicting OS in the aforementioned conditions (p-value &lt; 0.01). Moreover, multivariate analysis was also used in the thymoma and Masaoka I subgroups. In our experience, the role of tumour dimension as a descriptor of the T parameter of the TNM (Tumor Node Metastasis) staging system seemed to be useful in improving this system.<\/jats:p>","DOI":"10.3390\/diagnostics13223468","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T09:23:43Z","timestamp":1700213023000},"page":"3468","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Unsolved Issues in Thymic Epithelial Tumour Stage Classification: The Role of Tumour Dimension"],"prefix":"10.3390","volume":"13","author":[{"given":"Carolina","family":"Sassorossi","sequence":"first","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6267-0099","authenticated-orcid":false,"given":"Pietro","family":"Bertoglio","sequence":"additional","affiliation":[{"name":"Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy"},{"name":"Chirurgia Toracica, Alma Mater Studiorum, Universit\u00e0 di Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-5554","authenticated-orcid":false,"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Santoro","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7189-5903","authenticated-orcid":false,"given":"Elisa","family":"Meacci","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-9678","authenticated-orcid":false,"given":"Dania","family":"Nachira","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5563-0331","authenticated-orcid":false,"given":"Maria Teresa","family":"Congedo","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jury","family":"Brandolini","sequence":"additional","affiliation":[{"name":"Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Petroncini","sequence":"additional","affiliation":[{"name":"Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9396-373X","authenticated-orcid":false,"given":"Adriana","family":"Nocera","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diepriye","family":"Charles-Davies","sequence":"additional","affiliation":[{"name":"Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Agostino Gemelli, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Solli","sequence":"additional","affiliation":[{"name":"Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Margaritora","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-6911","authenticated-orcid":false,"given":"Marco","family":"Chiappetta","sequence":"additional","affiliation":[{"name":"UOC di Chirurgia Toracica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.jtho.2022.03.005","article-title":"The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Unresolved Issues to be Addressed for the Next Ninth Edition of the TNM Classification of Malignant Tumors","volume":"17","author":"Ruffini","year":"2022","journal-title":"J. Thorac. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1440-1827.1994.tb02936.x","article-title":"A review of 79 thymomas: Modification of staging system and reap-praisal of conventional division into invasive and non invasive thymoma","volume":"44","author":"Koga","year":"1994","journal-title":"Pathol. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S65","DOI":"10.1097\/JTO.0000000000000290","article-title":"The IASLC\/ITMIG Thymic Epithelial Tumors Staging Project: Proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors","volume":"9","author":"Detterbeck","year":"2014","journal-title":"J. Thorac. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1093\/ejcts\/ezz001","article-title":"Tumour size determines both recurrence-free survival and diseasespecific survival after surgical treatment for thymoma","volume":"56","author":"Okumura","year":"2019","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1097\/JTO.0000000000000303","article-title":"The IASLC\/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the T component for the forthcoming (8th) edition of the TNM classification of malignant tumors","volume":"9","author":"Nicholson","year":"2014","journal-title":"J. Thorac. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"12273","DOI":"10.18632\/oncotarget.24315","article-title":"Thymoma size significantly affects the survival, metastasis and effectiveness of adjuvant therapies: A population based study","volume":"9","author":"Bian","year":"2018","journal-title":"Oncotarget"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1093\/ejcts\/ezw178","article-title":"Prognostic impact of tumour size in completely resected thymic epithelial tumours","volume":"6","author":"Fukui","year":"2016","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1055\/s-0040-1715490","article-title":"Different view on tumor size dilemma in tumor-node-metastasis staging system for thymoma","volume":"69","author":"Cangir","year":"2021","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jtho.2019.11.013","article-title":"The International Association forthe Study of Lung Cancer Thymic tumors staging project: The impact of the eighth edition of the Union for International Cancer Control and American joint committee on cancer TNM stage classification of Thymic tumors","volume":"15","author":"Ruffini","year":"2020","journal-title":"J. Thorac. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"v40","DOI":"10.1093\/annonc\/mdv277","article-title":"Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"26","author":"Girard","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_11","unstructured":"(2023, July 21). NCCN Guide-lines. Available online: https:\/\/www.nccn.org\/guidelines\/category_1."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s00595-023-02705-w","article-title":"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","volume":"53","author":"Okumura","year":"2023","journal-title":"Surg. Today"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.jtcvs.2020.05.048","article-title":"Korean Association for Research on the Thymus (KART). Tumor size as a prognostic factor in limited-stage thymic epithelial tumors: A multicenter analysis","volume":"162","author":"Yun","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Chiappetta, M., Lococo, F., Pogliani, L., Sperduti, I., Tabacco, D., Bria, E., D\u2019Argento, E., Massaccesi, M., Boldrini, L., and Meacci, E. (2021). Masaoka-Koga and TNM Staging System in Thymic Epithelial Tumors: Prognostic Comparison and the Role of the Number of Involved Structures. Cancers, 13.","DOI":"10.3390\/cancers13215254"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.radonc.2015.03.001","article-title":"Patterns and predictors of recurrence after radical resection of thymoma","volume":"115","author":"Xu","year":"2015","journal-title":"Radiother. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/ejcts\/ezt649","article-title":"European Association of Thoracic Surgeons (ESTS) Thymic Working Group. Tumours of the thymus: A cohort study of prognostic factors from the European Society of Thoracic Surgeons database","volume":"46","author":"Ruffini","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1016\/j.jtcvs.2005.07.026","article-title":"Predictors of recurrence in thymic tumors: Importance of invasion, World Health Organization histology, and size","volume":"130","author":"Wright","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S1698","DOI":"10.1097\/JTO.0b013e31821e7b12","article-title":"A review of prognostic factors in thymic malignancies","volume":"6","author":"Detterbeck","year":"2011","journal-title":"J. Thorac. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s00595-022-02530-7","article-title":"Tumor size exceeding 5 cm as a valid prognostic factor in all stages of thymic epithelial tumors","volume":"53","author":"Sakai","year":"2023","journal-title":"Surg. Today"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/22\/3468\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:24:54Z","timestamp":1760131494000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/22\/3468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,17]]},"references-count":19,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["diagnostics13223468"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13223468","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,17]]}}}