Thymic Epithelial Tumors: Prognostic Determinants Among Clinical, Histopathologic, and Computed Tomography Findings Jung Won Moon, MD, Kyung Soo Lee,

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Thymic Epithelial Tumors: Prognostic Determinants Among Clinical, Histopathologic, and Computed Tomography Findings Jung Won Moon, MD, Kyung Soo Lee, MD, Myung-Hee Shin, MD, Seonwoo Kim, PhD, Sook Young Woo, MS, Geewon Lee, MD, Joungho Han, MD, Young Mog Shim, MD, Yong Soo Choi, MD The Annals of Thoracic Surgery Volume 99, Issue 2, Pages 462-470 (February 2015) DOI: 10.1016/j.athoracsur.2014.09.050 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Patient selection flow sheet. (CT = computed tomography.) The Annals of Thoracic Surgery 2015 99, 462-470DOI: (10.1016/j.athoracsur.2014.09.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Various computed tomography (CT) stages of thymic epithelial tumors. (A) Stage I, well encapsulated thymic epithelial tumor (arrow) of World Health Organization (WHO) classification A and Masaoka-Koga stage I in a 37-year-old woman. (B) Stage II, tumor invasion into surrounding mediastinal fat (arrow) of WHO classification AB and Masaoka-Koga stage II in a 66-year-old man. (C) Stage III, tumor invasion into superior vena cava (arrow) of WHO classification B3 and Masaoka-Koga stage III in a 60-year-old man. (D) Stage IV, tumor pleural seeding (arrow) of thymic carcinoma (star) and Masaoka-Koga stage IV in a 34-year-old woman. (E) Stage IV, bilateral hilar and subcarinal lymph node metastases (arrows) of thymic carcinoma (star) and Masaoka-Koga stage IV in a 30-year-old man. (F) Stage IV, pulmonary metastases (arrow) of thymic carcinoma (star) and Masaoka-Koga stage IV in a 49-year-old man. The Annals of Thoracic Surgery 2015 99, 462-470DOI: (10.1016/j.athoracsur.2014.09.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Overall survival (OS) and progression-free survival (PFS) curves. Regarding (A) OS curves and (B) PFS curves according to Masaoka-Koga staging, no significant difference is shown between stage I (black lines) and stage II (red lines), whereas significant drops in survival are noted between stage III (green lines) and stage IV (blue lines) in OS. Significant difference in PFS is also noted between stages III and IV. On (C) OS curves and (D) PFS curves according to simplified WHO classification, significant difference in survival among WHO classifications A, AB, and B1 (black lines), B2 and B3 (red lines), and carcinoma (green lines) is shown. Both (E) OS curves and (F) PFS curves according to completeness of resection (R0) show that R2 (green lines) renders significantly poorer OS and PFS as compared with R0 (black lines) and R1 (red lines). However, difference in prognosis between R0 and R1 is not significant. The (G) OS curves and (H) PFS curves according to computed tomography (CT) stages I (black lines), II (red lines), III (green lines), and IV (blue lines) demonstrate that significant drops in both OS and PFS are seen between various combinations of all CT stages. The Annals of Thoracic Surgery 2015 99, 462-470DOI: (10.1016/j.athoracsur.2014.09.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Overall survival (OS) and progression-free survival (PFS) curves. Regarding (A) OS curves and (B) PFS curves according to Masaoka-Koga staging, no significant difference is shown between stage I (black lines) and stage II (red lines), whereas significant drops in survival are noted between stage III (green lines) and stage IV (blue lines) in OS. Significant difference in PFS is also noted between stages III and IV. On (C) OS curves and (D) PFS curves according to simplified WHO classification, significant difference in survival among WHO classifications A, AB, and B1 (black lines), B2 and B3 (red lines), and carcinoma (green lines) is shown. Both (E) OS curves and (F) PFS curves according to completeness of resection (R0) show that R2 (green lines) renders significantly poorer OS and PFS as compared with R0 (black lines) and R1 (red lines). However, difference in prognosis between R0 and R1 is not significant. The (G) OS curves and (H) PFS curves according to computed tomography (CT) stages I (black lines), II (red lines), III (green lines), and IV (blue lines) demonstrate that significant drops in both OS and PFS are seen between various combinations of all CT stages. The Annals of Thoracic Surgery 2015 99, 462-470DOI: (10.1016/j.athoracsur.2014.09.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions