Masaoka-koga and tnm staging system in thymic epithelial tumors: Prognostic comparison and the role of the number of involved structures

Marco Chiappetta, Filippo Lococo, Luca Pogliani, Isabella Sperduti, Diomira Tabacco, Emilio Bria, Ettore D'Argento, Mariangela Massaccesi, Luca Boldrini, Elisa Meacci, Venanzio Porziella, Dania Nachira, Maria Teresa Congedo, Stefano Margaritora

Research output: Contribution to journalArticle


Background: The aim of this study was to evaluate the Masaoka–Koga and the tumor node metastases (TNM) staging system in thymic epithelial tumors (TET) considering possible improvements. Methods: We reviewed the data of 379 patients who underwent surgical resection for TET from 1 January 1985 to 1 January 2018, collecting and classifying the pathological report according to the Masaoka–Koga and the TMN system. The number of involved organs was also considered as a possible prognostic factor and integrated in the two staging systems to verify its impact. Results: Considering the Masaoka–Koga system, 5-and 10-year overall survival (5–10YOS) was 96.4% and 88.9% in stage I, 95% and 89.5% in stage II and 85.4% and 72.8% in stage III (p = 0.01), with overlapping in stage I and stage II curves. Considering the TNM system, 5–10YOS was 95.5% and 88.8% in T1, 84.8% and 70.7% in T2 and 88% and 76.3% in T3 (p = 0.02), with overlapping T2– T3 curves. Including the number of involved structures, in Masaoka–Koga stage III, patients with singular involved organs had a 100% and 76.6% vs. 87.7% 5–10YOS, which was 76.6% in patients with multiple organ infiltration. Considering the TNM, T3 patients with singular involved structures presented a 5–10YOS of 100% vs. 62.5% and 37.5% in patients with multiple organ involvement (p = 0.07). Conclusion: The two staging systems present limitations due to overlapping curves in early Masaoka–Koga stages and in advanced T stages for TNM. The addition of the number of involved organs seems to be a promising factor for the prognosis stratification in these patients.
Original languageEnglish
Pages (from-to)5254-N/A
Publication statusPublished - 2021


  • Masaoka–Koga
  • Surgery
  • TNM
  • Thymic carcinoma
  • Thymoma


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