Beruflich Dokumente
Kultur Dokumente
OF THE
THYMUS
S304
FIGURE 1. L/E ratio of thymomas. Reprinted with permission from Cancer 1977;40:1225.
FIGURE 2. L/E ratios of noninvasive and invasive thymomas. Reprinted with permission from Cancer 1977;40:1226.
Copyright 2010 by the International Association for the Study of Lung Cancer
S305
Masaoka
FIGURE 4. Process of invasion of thymoma. Left lane indicates course to pleural cavity. Right lane indicates course to
deep mediastinum.
TABLE 3. Masaokas Stages and Patients Distribution
(Osaka University, 1981)
Stages
Description
On the other hand, at that time, another problem concerning thymomectomy was pointed out. It was the occurrence of myasthenia gravis after thymomectomy for nonm-
S306
Stage I
Stage II
Stage III
Stage IVa
Stage IVb
Total
No. of Patients
37
13
32
8
3a
93
Copyright 2010 by the International Association for the Study of Lung Cancer
T3
T4
N factor
N0
N1
N2
N3
M factor
M0
M1
Exploratory Subtotal
Simple
Extended
Thoracotomy Resection Thymomectomy Thymectomy Total
1
1
1
2
0
0
0
2
7
0
0
2
3
3
8
8
6
30
1
5
8
6
1
0
3
9
33
0
2
6
9
19
22
43
30
131
19711975
19761980
19811985
19861990
19911995
19962000
20012005
20062008
Total
2
8
17
20
23
30
54
47
201
were found in the anterior mediastinal adipose tissues resected by this operation. This let us propose our tumor, node,
metastasis (TNM) classification system.
Copyright 2010 by the International Association for the Study of Lung Cancer
S307
Masaoka
City
Publish
No. of Case
Survival
Pescarmona et al.10
Regnard et al.11
Gripp et al.12
Wilkins et al.13
Rome
Le Plessis- Robinson
Dsseldorf
Baltimore
1990
1996
1998
1999
83
307
70
136
Lardinois et al.14
Lausanne
2000
71
Ogawa et al.15
Multi institutional
2002
103
Okumura et al.16
Nakagawa et al.17
Kondo et al.18
Park et al.19
Rea et al.20
Zhu et al.21
Osaka
Tokyo
Tokushima
Seoul
Padua
Shanghai
2002
2003
2004
2004
2004
2004
273
130
100
150
132
175
Kim et al.22
Rena et al.23
Seoul
Torino
2005
2005
108
178
Mineo et al.24
Rome
2005
88
Wright et al.25
Bedini et al.26
Boston
Milan
2005
2005
179
123
Overall
Disease free
Disease free
Overall
Thymoma related
Overall
Disease free
Overall
Disease free
Tumor specific
Overall
Disease free
Overall
Overall
Overall
Disease free
Tumor specific
Overall
Disease free
Overall
Disease free
Tumor specific
Progression free
0.001
0.00001
0.0001
0.123
0.290
0.05
0.0001
0.0001
0.0001
0.0001
0.000
0.002
0.001
0.003
0.0001
0.0001
0.000
0.036
0.012
0.001
0.0001
0.0001
0.0001
Remarks
Modified Masaoka
Thymic EP tumor
Thymic EP tumor
Thymic EP tumor
I/76
II/61
III/31
IVa/33
IVb/10
10
20
100/62
98.2/49
85.3/22
87.4/24
77.8/7
96.4/48
93.3/35
72.5/15
70.4/16
77.8/5
94.0/36
89.7/24
72.5/13
55.9/9
77.8/3
87.1/20
80.6/14
44.9/6
20.0/2
51.9/1
81.7/6
67.2/1
44.9/1
finding was due to the presence of persistent tumor in surviving patients with stage IVb.
Univariate analysis proved that the relationship between overall survival and stage is significant (p 0.0001).
However, we could not show a relation between progressionfree survival and stage, because the progression-free survival
in stage I remained 100% up to 20-year follow-up.
S308
Copyright 2010 by the International Association for the Study of Lung Cancer
I/76
II/61
III/31
IVa/33
IVb/10
10
20
100/62
100/49
91.7/22
85.1/20
100/7
100/48
100/35
68.8/12
75.9/11
83.3/4
100/36
100/24
59.6/8
53.7/4
41.7/2
100/20
94.1/15
49.7/5
0/0
0/0
100/6
94.1/1
41.4/1
Copyright 2010 by the International Association for the Study of Lung Cancer
S309
Masaoka
EPILOGUE
The Masaoka staging system still remains a valuable
and reproducible prognostic factor of thymoma. However,
some proposals of revision of the staging system have been
offered, to identify significant differences in survival between
each identified stage. In my opinion, the staging system
should obey the following principles:
1. It should be logically justified.
2. It should be simple to use.
3. Frequent revisions should be avoided.
Stage IV
S310
N0
N0
N1
N1
N0, 1
Any N
N2, 3
Any N
M0
M0
M0
M0
M0
M0
M0
M1
Copyright 2010 by the International Association for the Study of Lung Cancer
TABLE 10. The Istituto Nazionale Tumori TNM-Based Staging System (Bedini et al.26)
T1
T2
T3
T4
N0
N1
N2
N3
M0
M1a
M1b
Stage grouping
I
II
III
Classification of
residual disease
R0
R1
R2a
R2b
No capsular invasion
Microscopic invasion into the capsule, or extracapsular involvement limited to the surrounding fatty tissue or normal thymus
Direct invasion into the mediastinal pleura and/or anterior pericardium
Direct invasion into neighboring organs, such as sternum, great vessels, and lungs; implants to the mediastinal pleura or pericardium,
only if anterior to phrenic nerves
No lymph node metastasis
Metastasis to anterior mediastinal lymph nodes
Metastasis to intrathoracic lymph nodes other than anterior mediastinal
Metastasis to prescalene or supraclavicular nodes
No hematogenous metastasis
Implants to the pericardium or mediastinal pleura beyond the sites defined in the T4 category
Hematogenous metastasis to other sites, or involvement of lymph nodal stations other than those described in the N categories
Locally restricted disease
Locally advanced disease
Systemic disease
T12
T34
Any T
Any T
Any T
N0
N0
N12
N3
Any N
M0
M0
M0
M0
M1
No residual tumor
Microscopic residual tumor
Local macroscopic residual tumor after reductive resection (80% of the tumor)
Other features of residual tumor
Copyright 2010 by the International Association for the Study of Lung Cancer
S311
Masaoka
S312
Copyright 2010 by the International Association for the Study of Lung Cancer