Clinical Patterns and Patient Outcomes in the Multimodal Treatment of Thymic Carcinoma: Results from a High-Volume Single-Center Cohort

Introduction Thymic carcinomas (TC) are rare thymic epithelial tumors (TET), whose management is complicated by the aggressiveness and lack of large-scale studies. Methods Patients diagnosed with TC between 1984-2025 in the Thoraxklinik Heidelberg were analyzed. The tumor stage was assessed using the TNM staging system, 8th edition. Results Overall 239 patients were identified with a median age of 58 years (range 16-90) and a predominance of male (66%) patients with stage IV (62%) squamous cell carcinomas (57%) presenting with local chest symptoms (109/189 patients with available data), while myasthenia gravis was rare (2/189). The rate of surgery (OP) was 97% (30/31) for stage I (one patient received radiotherapy [RT] due to comorbidities), 91% (10/11) for stage II (one patient received chemotherapy and radiotherapy due to a small-cell tumor component), 77% for stage III (37/48), 53% (18/34) for stage IVA, and 28,8% (32/111) for stage IVB. RT was administered to 58% (18/31) stage I, 72% (8/11) stage II, 79% (38/48) stage III, and 46% (69/149) stage IV patients (19/34 IVa, 48/111 IVb). Chemotherapy (CHT) was given to 44% (21/48) stage III, and 80% (119/149) stage IV patients (23/34 IVa, 93/111 IVb). 5 patients received pembrolizumab in combination with platinum-based chemotherapy. The median overall survival (OS) was 17,2 years for stages I-II (95% confidence interval [CI] 5,9-28,4), 8 years for stage III (95% CI 5,5-10,5), 5,5 years for stage IVa (95% CI 0,71-10,28) and 3 years for stage IVb (95% CI 1,7-4,3). OP, RT and CHT were independently associated with longer OS for stage IV tumors (RT HR=0,51 with p=0,006; CHT HR=0,58 with p=0,065; OP hazard ratio [HR]=0.64 with p=0.07). There was no statistically significant difference in survival between the platinum- and anthracycline-based regiments across the different histological subtypes (all p>0,25). Conclusion Life expectancy of patients with thymic carcinomas varies widely according to the tumor stage and exceeds 10 years for disease without infiltration into neighboring organs. For metastatic tumors, multidisciplinary management including a combination of chemotherapy, radiotherapy and surgery whenever possible, significantly prolongs survival. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany