Characteristics of postthymectomy cancer mortality. To investigate the causes of death after thymectomy, a detailed medical record review was performed on all 112 patients who underwent a thymectomy procedure who died. Of these, 64 had adequate records available to adjudicate causes of death. Six patients had a genetic syndrome diagnosed (ie, multiple endocrine neoplasia, Lynch syndrome) and were excluded from the analysis, leaving a total of 58 patients who underwent a thymectomy procedure. Medical record review was also performed on 216 control patients who died, of whom 124 had adequate death records available for review. This analysis matched on postoperative rates of infection, malignancy, and autoimmune disease. (A) Among the patients who passed away, the causes of mortality were different between control (N = 124) and patients who underwent a thymectomy procedure (N = 58); 63.8% of mortality in patients who underwent a thymectomy procedure occurred because of cancer vs 29.8% in control patients (P < .001). Outside of cancer, autoimmunity (10.3%; P = .002) and infection (8.6%; P = .057) were the major drivers of mortality in patients who underwent a thymectomy procedure. (B) The types of cancers that directly caused death also differed between control and patients who underwent a thymectomy procedure, whereby patients who underwent a thymectomy procedure (N = 37 patients, 41 cancers) experienced a significant burden of thymoma, sarcoma, and rarer malignancies (eg, germ cell tumor) that were not observed in control patients (N = 37 patients, 37 cancers) who passed away. (C) Relapse after definitive therapy was significantly more frequent (P < .001) in patients who underwent a thymectomy procedure (among all 71 patients who underwent a thymectomy procedure who developed cancer of the total 112 surveyed that died) vs control patients (among all 69 control patients who developed cancer of the total 124 surveyed that died). The types of cancers that recurred in patients who underwent a thymectomy procedure who passed away were also different, featuring a burden of aggressive thymoma, sarcoma, leukemia, and lymphoma that was not observed in control patients.
Figure 2.

Characteristics of postthymectomy cancer mortality. To investigate the causes of death after thymectomy, a detailed medical record review was performed on all 112 patients who underwent a thymectomy procedure who died. Of these, 64 had adequate records available to adjudicate causes of death. Six patients had a genetic syndrome diagnosed (ie, multiple endocrine neoplasia, Lynch syndrome) and were excluded from the analysis, leaving a total of 58 patients who underwent a thymectomy procedure. Medical record review was also performed on 216 control patients who died, of whom 124 had adequate death records available for review. This analysis matched on postoperative rates of infection, malignancy, and autoimmune disease. (A) Among the patients who passed away, the causes of mortality were different between control (N = 124) and patients who underwent a thymectomy procedure (N = 58); 63.8% of mortality in patients who underwent a thymectomy procedure occurred because of cancer vs 29.8% in control patients (P < .001). Outside of cancer, autoimmunity (10.3%; P = .002) and infection (8.6%; P = .057) were the major drivers of mortality in patients who underwent a thymectomy procedure. (B) The types of cancers that directly caused death also differed between control and patients who underwent a thymectomy procedure, whereby patients who underwent a thymectomy procedure (N = 37 patients, 41 cancers) experienced a significant burden of thymoma, sarcoma, and rarer malignancies (eg, germ cell tumor) that were not observed in control patients (N = 37 patients, 37 cancers) who passed away. (C) Relapse after definitive therapy was significantly more frequent (P < .001) in patients who underwent a thymectomy procedure (among all 71 patients who underwent a thymectomy procedure who developed cancer of the total 112 surveyed that died) vs control patients (among all 69 control patients who developed cancer of the total 124 surveyed that died). The types of cancers that recurred in patients who underwent a thymectomy procedure who passed away were also different, featuring a burden of aggressive thymoma, sarcoma, leukemia, and lymphoma that was not observed in control patients.

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