Sandbox Thymoma staging
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]
Overview
Staging of thymic epithelial tumors was initially proposed by Bergh and his colleagues in 1978,[1] modified by Wilkins and Castleman in 1979,[2] and advanced by Masaoka et al. in 1981 and became widely adopted.[3][4] In 1999, World Health Organization (WHO) proposed
- There is no universally accepted system; no AJCC staging exists.
- Historically, a classifiaction system used both histological features and clinical behavior.
- Masaoka staging is the clinically used staging system, although it may not be predictive for thymic carcinoma.
- GETT staging is the surgical staging system, and may have better correlation with outcome.
- A meta-analysis from UCLA suggests that evaluation of transcapsular extension (Stage I vs. Stage IIa) is of no clinical value, as they have same DFS and OS outcomes.
GETT Staging
- Stage IA - Encapsulated, completely resected.
- Stage IB - Macroscopically completely resected but suspicion of mediastinal adhesions or potential capsular invasion at surgery.
- Stage II - Invasive tumor, completely resected.
- Stage IIIA - Invasive tumor, subtotal resection.
- Stage IIIB - Invasive tumor, biopsy alone.
- Stage IVa - Supraclav or pleural met.
- Stage IVb - Distant metastases.[5]
Previously Reported Staging and Classification
1999 WHO Rosai [6]
| Stage | Description |
|---|---|
| I | Grossly and microscopically completely encapsulated |
| II1 | Microscopic transcapsular invasion |
| II2 | Macroscopic invasion into thymic or surrounding fatty tissue, or grossly adherent to but not breaking through mediastinal pleura or pericardium |
| III | Macroscopic invasion of neighboring organ (i.e., pericardium, great vessel, or lung) |
| IVa | Pleural or pericardial dissemination |
| IVb | Lymphatic or hematogenous metastasis |
| Masaoka Stage | T factor | N factor | M factor |
|---|---|---|---|
| Stage I | T1 | N0 | M0 |
| Stage II | T2 | N0 | M0 |
| Stage III | T3 | N0 | M0 |
| Stage IVa | T4 | N0 | M0 |
| Stage IVb | Any T | N1, N2, or N3 | M0 |
| Any T | Any N | M1 |
| T/N/M Stage | Description | |
|---|---|---|
| T factor | T1 | Macroscopically completely encapsulated and microscopically no capsular invasion |
| T2 | Macroscopically adhesion or invasion into surrounding fatty tissue or mediastinal pleura, or microscopic invasion into capsule | |
| T3 | Invasion into neighboring organs, such as pericardium, great vessels, and lung | |
| T4 | Pleural or pericardial dissemination | |
| N factor | N0 | No lymph node metastasis |
| N1 | Metastasis to anterior mediastinal lymph nodes | |
| N2 | Metastasis to intrathoracic lymphnodes except anterior mediastinal lymph nodes | |
| N3 | Metastasis to extrathoracic lymphnodes | |
| M factor | M0 | No hematogenous metastasis |
| M1 | Hematogenous metastasis | |
| Stage | Description |
|---|---|
| I | Macroscopically completely encapsulated and microscopically no capsular invasion |
| II | 1. Macroscopic invasion into surrounding fatty tissue or mediastinal pleura 2. Microscopic invasion into capsule |
| III | Macroscopic invasion into neighboring organ (ie, pericardium, great vessels, or lung) |
| IVa | Pleural or pericardial dissemination |
| IVb | Lymphogenous or hematogenous metastasis |
| Author | Stage | Description |
|---|---|---|
| Bergh et al. | I | Intact capsule or growth within the capsule |
| II | Pericapsular growth into the mediastinal fat tissue | |
| III | Invasive growth into the surrounding organs and/or intrathoracic metastases | |
| Wilkins et al. | I | Intact capsule or growth within the capsule |
| II | Pericapsular growth into the mediastinal fat tissue or adjacent pleura or pericardium | |
| III | Invasive growth into the surrounding organs and/or intrathoracic metastases |
References
- ↑ 1.0 1.1 Bergh, NP.; Gatzinsky, P.; Larsson, S.; Lundin, P.; Ridell, B. (1978). "Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas". Ann Thorac Surg. 25 (2): 91–8. PMID 626543. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Wilkins, EW.; Castleman, B. (1979). "Thymoma: a continuing survey at the Massachusetts General Hospital". Ann Thorac Surg. 28 (3): 252–6. PMID 485626. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Masaoka, A.; Monden, Y.; Nakahara, K.; Tanioka, T. (1981). "Follow-up study of thymomas with special reference to their clinical stages". Cancer. 48 (11): 2485–92. PMID 7296496. Unknown parameter
|month=ignored (help) - ↑ Kondo, K. (2005). "Invited commentary". Ann Thorac Surg. 80 (6): 2000–1. doi:10.1016/j.athoracsur.2005.08.053. PMID 16305832. Unknown parameter
|month=ignored (help) - ↑ "Seventeen years of surgical treatmen... [Eur J Cardiothorac Surg. 1991] - PubMed - NCBI".
- ↑ Rosai, Juan; Sobin, L. H. (1999). Histological typing of tumours of the thymu. Berlin ; New York: Springer. ISBN 3-540-65731-2.
- ↑ Tsuchiya, R.; Koga, K.; Matsuno, Y.; Mukai, K.; Shimosato, Y. (1994). "Thymic carcinoma: proposal for pathological TNM and staging". Pathol Int. 44 (7): 505–12. PMID 7921194. Unknown parameter
|month=ignored (help) - ↑ Yamakawa, Y.; Masaoka, A.; Hashimoto, T.; Niwa, H.; Mizuno, T.; Fujii, Y.; Nakahara, K. (1991). "A tentative tumor-node-metastasis classification of thymoma". Cancer. 68 (9): 1984–7. PMID 1913546. Unknown parameter
|month=ignored (help)