Commentary: Thymic epithelial tumors—time to move beyond traditional staging?

Central MessageThymomas represent a group of heterogeneous tumors with different staging systems that exclude tumor size. Given their heterogeneity, predictive risk model may be more appropriate than traditional systems.See Article page 309. Thymomas systems. See comprise diverse spectrum rare diseases the singular common feature arising from residual thymic tissues in anterior mediastinum. Most progress slowly, and patients experience prolonged disease-free survival periods 70% to 90% at 15 years, depending on specific histologic type initial involvement. The nature contributed development numerous related degree local invasion or type. Historically, most frequently used were Masaoka–Koga, for invasion, World Health Organization system, based histology. More recently, American Joint Commission Cancer included tumor–node–metastasis system malignancies eighth edition manual. Interestingly, have not recognized size as prognostic factor. Tumor is well-established indicator many cancers such lung breast.1Zhang J. Gold K.A. Lin H.Y. Swisher S.G. Xing Y. Lee J.J. et al.Relationship between non-small-cell cancer (NSCLC): an analysis surveillance, epidemiology, end results (SEER) registry.J Thorac Oncol. 2015; 10: 682-690Abstract Full Text PDF PubMed Scopus (99) Google Scholar,2Foulkes W.D. Size surprise? Tumour size, nodal status, outcome after breast cancer.Curr 2012; 19: 241-243Crossref (14) Scholar Yun colleagues3Yun J.K. Kim H.R. D.K. Y.T. Chung K.Y. factor limited-stage epithelial tumors: multicenter analysis.J Cardiovasc Surg. 2021; 162: 309-317.e9Abstract (3) analyzed influence overall recurrence-free tumors. was independent completely resected, (confined within surrounding fatty without invasion) but advanced-stage Similarly, Surveillance, Epidemiology, End Results database review demonstrated stepwise decrements increasing size.4Bian D. Zhou F. Yang W. Zhang K. Chen L. Jiang G. al.Thymoma significantly affects survival, metastasis effectiveness adjuvant therapies: population study.Oncotarget. 2018; 9: 12273-12283Crossref In contrast, Nicholson colleagues5Nicholson A.G. Detterbeck F.C. Marino M. Stratton Giroux al.Staging Prognostic Factors CommitteeMembers Advisory BoardsParticipating Institutions Thymic DomainThe IASLC/ITMIG project: proposals T component forthcoming (8th) TNM classification malignant tumors.J 2014; S73-S80Abstract (101) multiple international databases only among Masaoka–Koga stage III-IV incomplete resections. Other characteristics outcomes, playing minor role, did correlate ability perform complete resection. As result, clinical value prognosis R1/2 resection, impact any decisions.5Nicholson current study other retrospective studies challenged this notion suggested could predict survival. There is, however, no agreement cutoffs convey greatest differences prognostication. Conflicting comparable patient numbers imply additional factors contribute long-term outcomes. With malignancies, we already histology, outlined by prominent contributing heterogeneity discrepant correlating prognosis, perhaps rather appropriate. A analysisThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 1PreviewThe significance (TETs) has been fully evaluated. We aimed clarify TETs. Full-Text