Background: Thymic carcinomas (TC) are rare cancers with limited data regarding outcomes, particularly for those patients (pts) with advanced disease. Methods: We identified pts with TC diagnosed between 1993-2012. Pt characteristics, recurrence free survival (RFS) from date of resection, and overall survival (OS) from date of diagnosis were analyzed. Pts were followed until death or last follow up. Time-to-event outcomes were determined using the Kaplan-Meier method. Results: 121 pts with TC were identified with 7 pts (6%) with Masaoka stage I, 13 (11%) with stage II, 25 (21%) with stage III, 13 (11%) with stage IVA, 61 (51%) with stage IVB, and 2 (2%) with unclear staging. Higher Masaoka stage was associated with worse OS and RFS (5-yr OS of 100%, 81%, 51%, 24%, and 17% for stage I, II, III, IV respectively, p<0.001 and 5-yr RFS of 80%, 28%, and 7% for stage I/II, III, and IV respectively, p<0.001). Stage IVB pts with lymph node involvement had a better 5-year OS as compared to stage IVB pts with distant metastasis (24% vs. 7%, p=0.025). Of the 61 pts with stage IVB disease, 22/29 pts (76%) with lymph node involvement underwent curative intent resection vs. 3/32 pts (9%) with visceral metastasis. Of the 29 stage IVB pts with lymph node involvement treated with surgery, chemotherapy, and radiation, 3 (10%) are currently free of disease with long-term follow-up (range: 3.4 years to 6.8 years). Conclusions: This is the largest review of the clinical features of pts with TC in North America. Stage IVB pts with lymph node positive disease have significantly better OS as compared to Stage IVB pts with distant metastasis. Stage IVB pts with lymph node positive disease treated with multi-modality therapies can have long term recurrence free survival. If validated, these data would support a revised Masaoka staging system with subclassification of stage IVB disease into two groups.