Okuma Y, Ko R, Shukuya T, et al. - Using one of the largest, representative, multi-institutional databases (the NEJ023 database), researchers explored the prognostic factors, especially metastatic sites, for thymic malignancies. They included 279 patients with metastases and a predominantly squamous histology (66.7%). Serosal dissemination was observed in most patients (53.0%), while pulmonary, lymph node, bone, and liver metastases were observed in 26.5%, 21.9%, 19.7%, and 15.8%, respectively. In a multivariate analysis, bone metastasis, liver metastasis, and hypoalbuminemia were noted to be prognostic factors. Findings suggest survival outcomes are influenced by the site of metastatic involvement in patients with thymic carcinoma. This finding may indicate the sensitivity of metastatic sites to pharmacotherapy. The prognosis of patients with thymic carcinoma may improve by controlling liver metastasis with pharmacotherapy.