The specificity could have been compromised by two parameters, short followup and surgical and adjuvant therapies. Of the 16 patients classified as class 2 without metastases, only two patients had followup greater than 5 years. In addition, nine of these patients had no evidence of disease following treatment for the thymoma and nine had received adjuvant therapies. Postoperative therapeutic management has predominantly been subjective and loosely based upon Masaoka stage, presence of residual disease, and, to a limited extent, WHO type. Recent studies have shown that all types of thymic tumors, regardless of histologic type or completeness of resection, can be associated with invasion, thoracic metastases, and extrathoracic metastases. Without level one evidence, the National Comprehensive Cancer Network guidelines propose adjuvant radiation or chemoradiation therapy for all patients with resected stage II/III tumors, irrespective of other factors mentioned above. This leads to undertreatment of patients with aggressive tumors diagnosed at an early stage of disease as well as overtreatment of indolent tumors diagnosed at a later stage. A more accurate method to identify metastatic behavior could DprE1-IN-1 result in prescription of adjuvant therapies to these likely patients. Patients at low or no risk can be spared from the toxicities associated with chemo- and radiation therapies. In addition, the presence of biologically heterogeneous cases in clinical trials could result in biased conclusions regarding therapeutic efficacy of drugs. A number of groups have tried to develop prognostic/predictive markers for thymomas. Most of these studies have correlated histologic type and tumor stage with markers of proliferation, cell death, migration, or invasion. Molecular profiling technologies have identified differentially regulated genes between different histologic types. However, MCE Chemical Ser-Phe-Leu-Leu-Arg-Asn histology-based hierarchical clustering of gene expression data did not show an association with relapse or metastases in our prior study. In this study, we have developed and validated a nine-gene signature and compared its prognostic value with other clinicopathological parameters. In univariate analysis, apart from the gene sign