The treatment and survival of patients with postoperative recurrent thymic carcinoma and neuroendocrine carcinoma: a multicenter retrospective study

Acute myeloid leukemia post‑cytotoxic therapy following chemotherapy for thymoma: A case report

The present study reports the case of a patient with acute myeloid leukemia post-cytotoxic therapy (AML-pCT) that developed following chemotherapy for thymoma. A 64-year-old female patient underwent surgical resection for a mediastinal tumor and was diagnosed with stage IVa thymoma. She received chemotherapy, including carboplatin/etoposide, carboplatin/paclitaxel and amrubicin monotherapy. At 56 months following surgery, she developed blastosis and was diagnosed with AML-pCT. As demonstrated herein, although treatment for thymoma is associated with a markedly lower frequency of myeloid neoplasms post-cytotoxic therapy (MN-pCT) than treatment for other malignancies, such as breast carcinoma, it is important to be aware that MN-pCT may occur as a late complication of thymoma treatment.

Failure patterns for thymic carcinoma with completed resection and postoperative radiotherapy

BACKGROUND AND PURPOSE

We aimed to evaluate the pattern and risk factors of disease failure in patients with thymic carcinoma after complete resection and postoperative radiotherapy (PORT).

MATERIALS AND METHODS

We retrospectively analyzed 127 patients with thymic carcinoma who underwent PORT after complete resection between 2003 and 2020 in our center. Data on clinical characteristics and radiation fields were collected. Failure patterns were recorded as locoregional (disease appearing in the tumor bed or regional lymph nodes), pleural, or distant failure (including hematogenous metastasis and nonregional lymph node metastasis).

RESULTS

All patients underwent tumor bed irradiation. During a median follow-up period of 64 months, disease failure was observed in 51 patients (40.2 %). The 5-year disease-free survival (DFS) and overall survival rates were 58.9 % and 85.0 %, respectively. The sequence of failure patterns was distant (n = 41, 32.3 %), pleural (n = 28, 22.0 %), and locoregional failure (n = 19, 15.0 %). Of the locoregional failure patients, failures occurred in-field in three patients (2.4 %), marginal failure in one patient (0.8 %), out-of-field failure in nine patients (7.1 %), synchronous in-field and out-of-field failures in two patients (1.6 %), synchronous marginal and out-of-field failures in two patients (1.6 %), and unknown failure fields in two patients (1.6 %). Multivariate analysis showed that Masaoka stage (hazard ratio [HR], 3.88; p = 0.000) and adjuvant chemotherapy (HR, 0.47; p = 0.015) were independent predictors of DFS.

CONCLUSION

The most common failure was distant, the Masaoka stage and adjuvant chemotherapy were independent predictors of DFS, and low locoregional failure-supported tumor bed irradiation was sufficient for patients with thymic carcinoma after complete resection.

Clinical Significance of Tumor Markers for Advanced Thymic Carcinoma: A Retrospective Analysis from the NEJ023 Study

Simple Summary

Advanced thymic carcinoma (ATC) is rare. Owing to its rarity, there is limited information on the prognostic factors, and the optimal serum tumor markers are also unknown. We conducted a multi-institutional retrospective study of patients with ATC. In this study, we collected data on patient characteristics, progression-free survival (PFS), overall survival (OS), and tumor marker values, and investigated the relationship between tumor marker values and PFS/OS. We found that the neuron-specific enolase (NSE) level may be a useful prognostic tumor marker for ATC, regardless of histology. The findings of the analysis limited to squamous cell carcinoma suggested that the NSE and squamous cell carcinoma antigen levels may be useful prognostic factors.

Abstract

The optimal tumor marker for predicting the prognosis of advanced thymic carcinoma (ATC) remains unclear. We conducted a multi-institutional retrospective study of patients with ATC. A total of 286 patients were treated with chemotherapy. Clinicopathological information, including serum tumor markers, was evaluated to determine the overall survival (OS) and progression-free survival (PFS). The carcinoembryonic antigen, cytokeratin-19 fragment, squamous cell carcinoma (SCC) antigen, progastrin-releasing peptide, neuron-specific enolase (NSE), and alpha-fetoprotein levels were evaluated. In the Kaplan–Meier analysis, the OS was significantly shorter in the patients with elevated NSE levels than in those with normal NSE levels (median, 20.3 vs. 36.8 months; log-rank test p = 0.029; hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.05–2.31 (Cox proportional hazard model)); a similar tendency regarding the PFS was observed (median, 6.4 vs. 11.0 months; log-rank test p = 0.001; HR, 2.04; 95% CI, 1.31–3.18). No significant differences in the OS and PFS were observed among the other tumor markers. In both univariate and multivariate analyses of the patients with SCC only, the NSE level was associated with the OS and PFS. Thus, the NSE level may be a prognostic tumor marker for thymic carcinoma, regardless of histology.