Does the World Health Organization histological classification predict outcomes after thymomectomy? Results of a multicentre study on 750 patients

Eur J Cardiothorac Surg. 2015 Jul;48(1):48-54. doi: 10.1093/ejcts/ezu368. Epub 2014 Sep 21.


Objectives: The World Health Organization (WHO) thymoma histological classification clinical value remains a controversy. In this study, we evaluated its prognostic significance in patients with thymoma treated with radical intent.

Methods: Six high-volume Italian Thoracic Surgery Institutions collaborated with their own retrospective anonymized datasets. Demographic, clinical, pathological and treatment data were examined. A WHO histological classification (WHO-HC) collapsed scheme (A/AB and B1/B2 types merged) was proposed and compared with the traditional one. Predictors of survival were assessed using a Cox model with shared frailty. Competing-risk regression models were performed to identify the association between individual factors and freedom from recurrence.

Results: Between 1990 and 2011, 750 thymomas were operated on in participating centres. Myasthenia gravis was observed in 363 (48%) patients. A complete resection was achieved in 676 (91%) cases. One hundred and nine patients (15%) had a WHO-HC A type, 166 (22%) AB, 179 (24%) B1, 158 (21%) B2 and 135 (18%) B3. The rate of 5-year OS and cumulative incidence of recurrence for all cases was 91% and 0.11, respectively. Five-year survival rates by WHO-HC in the collapsed scheme were A/AB 93%, early-B 90% and advanced-B 85%. Masaoka stage only was demonstrated to be an independent predictor for survival and recurrence. The WHO-collapsed scheme showed a trend in influencing recurrence overall survival development (hazard ratio: 1.32; P = 0.16).

Conclusions: Our results show evidence of lack of significance by WHO-HC in influencing prognosis, even though the proposed collapsed scheme revealed a fair stratification of risk to relapses and better correlation with patients' clinical characteristics.

Keywords: Histology; Recurrence; Surgery; Survival; Thymoma; WHO classification.

Publication types

  • Multicenter Study

MeSH terms

  • Female
  • Humans
  • Male
  • Middle Aged
  • Myasthenia Gravis / pathology
  • Myasthenia Gravis / surgery
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Thymectomy* / mortality
  • Thymoma / classification*
  • Thymoma / diagnosis
  • Thymoma / mortality
  • Thymoma / pathology
  • Thymoma / surgery
  • Thymus Gland / pathology*
  • Thymus Neoplasms / classification*
  • Thymus Neoplasms / diagnosis
  • Thymus Neoplasms / mortality
  • Thymus Neoplasms / pathology
  • Thymus Neoplasms / surgery
  • Treatment Outcome
  • World Health Organization