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I read with great interest the recent article by Ruffini et al. [1] regarding a cohort study of thymic epithelial tumours using the large database of the European Society of Thoracic Surgeons. I would like to thank the authors for publishing the invaluable data. They analysed the largest database of patients with thymic epithelial tumours and their findings indicate that adjuvant therapy provides significant benefit on overall survival. In their forest plot with propensity score, there was not an effect modification by specific subgroup, which may mean that adjuvant therapy will benefit both thymoma patients and thymic carcinoma patients. Notably included in the large database was information on adjuvant chemotherapy, whereas it is often lacking in other databases on thymic epithelial tumours. Compared with radiotherapy for thymic epithelial tumours, chemotherapy has been less investigated [2, 3]. They mentioned in the paper that the effect of adjuvant radiotherapy was nearly as identical as that of the whole adjuvant therapy. I am interested in the effect of adjuvant chemotherapy (alone or with radiotherapy) on overall survival of thymic epithelial tumours or any histological subtype. Previously, a significant benefit of adjuvant chemotherapy on overall survival was not shown for thymoma or thymic carcinoma patients [2, 4]. In their study, was adjuvant chemotherapy as effective as adjuvant radiotherapy and significantly effective on overall survival of thymic epithelial tumours or any histological subtype? Also was the effect of adjuvant chemotherapy different between histological subtypes? I would appreciate any input from the authors in these regards. Again I would like to thank the authors for the opportunity to read and comment on this paper.

Does adjuvant chemotherapy following complete resection also have a significant effect on overall survival of thymic epithelial tumours?