Treatments and outcomes of spinal metastasis from thymic epithelial tumors: 10-year experience with 15 patients in a single center

WHO histological classification and tumor size are predictors of the locally aggressive behavior of thymic epithelial tumors

OBJECTIVE

The aim of this study was to explore the influencing factors that affect the local invasive behavior of thymic epithelial tumors (TETs).

METHOD

We retrospectively analyzed 524 patients with TETs who underwent surgical treatment at our center from January 2010 to January 2022. Cox regression analysis was applied to identify predictors associated with the prognosis of TET. Logistic regression analysis was used to analyze the factors associated with the locally invasive behavior of TETs. Receiver operating characteristic analysis and the Youden index were applied to determine the predictive efficiency and cutoff value.

RESULTS

There were 275 males and 249 females with a median age of 56 years. Seventy-seven patients had locally invasive behavior. The prognosis of local invasive TETs was significantly worse that of noninvasive TETs (P < 0.001). WHO classification and tumor size were two hazard factors for tumor invasive behavior. The risk of local invasion increased by 2.196 (OR (95 % CI): 1.813-2.659) times for each grade in WHO classification with a change from type A to thymic carcinoma. The tumor size cutoff of 6 cm represented a distinct boundary in predicting the hazard of local invasion (AUC: 0.784, specificity: 0.711, sensitivity: 0.726).

CONCLUSION

WHO classification and tumor size are important factors in predicting the locally aggressive behavior of TETs. The invasion capability of TETs is constantly increasing with an escalation in WHO classification. Tumors greater than 6 cm in size have a higher risk for local invasion.

Correlation Between Gait and Life Expectancy in Patients with Spinal Metastases

BACKGROUND

Metastatic epidural spinal cord compression (MESCC) may lead to walking disability. The effect of regaining gait ability on the life expectancy of cancer patients is still unknown. To explore this issue, we evaluated the effect of gait ability recovery in nonambulatory patients after treatment for a metastatic spinal tumor.

METHODS

In total, 105 patients who underwent surgery for MESCC between January 2006 and December 2016 and survived longer than 3 months were enrolled. All the patients were nonambulatory because of the MESCC and had undergone posterior decompression and fixation with intraoperative radiotherapy. At postoperative month 3, patients who had regained their gait ability were categorized as ambulatory and those who had not were categorized as nonambulatory. Age, sex, prognosis score (modified Bauer score), preoperative and postoperative Frankel grade scores, tumor origin site, Charlson comorbidity index, and survival time were compared between the groups.

RESULTS

Seventy-two patients regained gait ability at postoperative month 3, and 33 patients did not. The modified Bauer score did not differ between the groups (P = 0.08); therefore, the presumptive life expectancy of the groups before treatment was not biased. The median survival time was significantly longer in the ambulatory group (610 days) than that in the nonambulatory group (181 days, P < 0.05).

CONCLUSIONS

Patients who regained their gait ability after treatment for MESCC tended to live longer than those who did not, indicating that recovery of gait ability by patients with cancer is associated with improved life expectancy.

Treatment strategy and prognostic analysis of spinal metastases from thymomas: A retrospective study from a single center

OBJECTIVE

Thymomas are rare in clinical practice, and cases of metastatic spinal thymoma are extremely scarce, with only a few case reports or case series described in the literature. In this study, we characterized the clinical features, treatment options and prognostic analysis of patients with metastatic spinal thymomas.

PATIENTS AND METHODS

This study included seven patients with metastatic spinal thymoma who underwent open surgery or minimally invasive surgery, and adjuvant treatment in a single center of Peking Union Medical College Hospital from 2010 to 2019. The basic clinical data of the patients were analyzed retrospectively. The possible prognostic factors of progression-free survival (PFS) and overall survival (OS) were studied using the Kaplan-Meier method.

RESULTS

This retrospective study included six male patients and one female patient, with a median age of 58.4 (47-75) years. The time from initial diagnosis to detection of spinal metastasis was 54.2 (30-108) months. Kaplan-Meier survival analysis showed the number of spinal metastasis and adjuvant therapies were favorable factors for improving OS and PFS in patients with metastatic spinal thymomas.

CONCLUSION

Radiation therapy after the primary operation is an efficient adjuvant therapy, since patients who received postoperative radiation treatment have longer OS and PFS than those who receive chemoradiotherapy. The number of spinal metastases seems to be an effective prognostic factor for longer OS and PFS of patients with spinal metastasis of thymoma.

Pretreatment serum neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios: Two tumor-related systemic inflammatory markers in patients with thymic epithelial tumors

OBJECTIVES

To understand underlying changes in pretreatment serum inflammatory markers associated with thymic epithelial tumors (TETs) development.

METHODS

A retrospective analysis of 113 TETs patients who underwent 18-fluorine fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography combined computed tomography (PET/CT) one to two weeks before tumor resection or biopsy was performed. Pretreatment serum neutrophil, monocyte, platelet, and lymphocyte counts, and fibrinogen and C-reaction protein (CRP) concentrations were measured one day before surgery or biopsy. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were calculated by dividing corresponding cells counts by lymphocyte counts, respectively. The maximum standard uptake value (SUVmax) of ¹⁸F-FDG of primary TETs was applied to reflect tumor glycolytic activity. The student's t-test, one-way ANOVA analysis, Chi-square test, receiver operating characteristic curve analysis, and Logistic regression analysis were used for statistical analysis.

RESULTS

The serum NLR and MLR were significantly higher in TETs patients than in healthy volunteers (P both ≤ 0.001). High serum NLR and MLR were related to the thymic carcinomas (TCs) subtype, elevated Masaoka-Koga (M-K) tumor stage, and metastasis of TETs (P all < 0.005). High serum NLR and MLR were also associated with high SUVmax values of TETs (P all < 0.005), with increasingly differences between groups as the cut-off values defining low-SUVmax and high-SUVmax groups increased. With the medium cutoff of NLR, MLR, and SUVmax of 3.07, 0.25, and 8.00 respectively, the high NLR and MLR levels were significantly associated with high SUVmax level of TETs (P both < 0.005). Moreover, the incidences of co-high SUVmax/NLR and co-high SUVmax/MLR were higher in TETs patients older than 55 years, with TCs, in M-K stage IV, and with metastasis (P all < 0.05). Both the co-high SUVmax/NLR and co-high SUVmax/MLR increased the risk of TETs metastasis (P both < 0.001), while the co-high SUVmax/MLR was also an independent risk factor for TETs metastasis (odds ratio: 3.92, 95% confidence interval: 1.02-15.12, P = 0.047).

CONCLUSION

Pretreatment serum NLR and MLR of TETs patients are two tumor-progression- and tumor-glycolysis-related inflammatory markers. Enhanced tumor glycolytic activity and associated systemic inflammatory reaction may play a synergistic role in TETs metastasis.