INTRODUCTION: Thymic carcinoma is a rare and aggressive thymic neoplasm. The European Society of Thoracic Surgeons developed a retrospective database collecting patients undergoing resection for thymic tumors from 1990 to 2010. METHODS: Of 2265 patients with thymic tumors, there were 229 thymic carcinomas. Clinicopathological characteristics were analyzed including age, associated paraneoplastic diseases, stage (Masaoka-Koga), World Health Organization histologic subtypes, type of resection (total/subtotal/biopsy/no resection), tumor size, pre/postoperative treatments, and recurrence. Outcome measures included overall survival (OS), freedom from recurrence, and cumulative incidence of recurrence. RESULTS: A complete resection was achieved in 140 patients (69%). Recurrence occurred in 54 patients (28%). Five- and 10-year OS rates were 0.61 and 0.37. Five- and 10-year freedom from recurrence rates were 0.60 and 0.43. Cumulative incidence of recurrence was 0.21 (3 yr), 0.27 (5 yr), and 0.32 (10 yr). Survival was better after surgical resection versus biopsy/no resection (p < 0.001), after complete resection versus subtotal resection (p < 0.001), and when using Masaoka-Koga system (stages I-II versus III versus IV) (p < 0.001). The use of multidisciplinary treatments resulted in a survival advantage which was significant in the surgery + radiotherapy group (p = 0.02). Incomplete resection (p < 0.0001) and advanced stage (Masaoka-Koga III-IV) (p = 0.02) had a negative impact on OS at multivariable analysis. Administration of adjuvant radiotherapy was beneficial in increasing OS (p = 0.02). CONCLUSIONS: The results of our study indicate that patients with thymic carcinoma should undertake surgical resection whenever possible; a complete resection and early Masaoka-Koga stage are independent predictors of improved survival; our results also suggest that postoperative radiotherapy is beneficial in improving survival.

*Section of Thoracic Surgery Department of Surgery University of Torino Torino Italy; †Section of Thoracic Surgery Yale University New Haven Connecticut; ‡Department of Thoracic Surgery University Hospitals Leuven Leuven Belgium; §Department of Thoracic Surgery National Cancer Institute Pascale Foundation Naples Italy; ‖Department of Thoracic Surgery Aix Marseille University Marseille France; ¶Department of Thoracic Surgery University Hospital Zurich Switzerland; Division of Thoracic Surgery St Jame's University Hospital Leeds United Kingdom; **Department of Thoracic Surgery Toronto General Hospital University of Toronto Toronto Ontario Canada; ††Department of Thoracic Surgery New York Presbyterian Hospital Weill Cornell Medical Center New York New York; ‡‡3rd Department of Surgery 1st Faculty of Medicine Charles University Prague and University Hospital Motol Prague Czech Republic; §§Department of thoracic surgery Hopital Europeen Georges Pompidou and Hopital Laennec Paris France; ‖‖Department of Thoracic Surgery European Institute of Oncology Milan Italy; ¶¶Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Division Imperial College London United Kingdom; Department of Thoracic Surgery Istanbul University Istanbul Medical School Istanbul Turkey; ***Department of Thoracic Surgery University of Rome SAPIENZA Policlinico Umberto 1 Fondazione Eleonora Lorilard Spencer Cenci Rome Italy

References provided by Crossref.org