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Liu J, Yin P, Wang S, Liu T, Sun C, Hong N. CT-Based Radiomics Signatures for Predicting the Risk Categorization of Thymic Epithelial Tumors. Front Oncol 2021; 11:628534. [PMID: 33718203 PMCID: PMC7953900 DOI: 10.3389/fonc.2021.628534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives This study aims to assess the performance of radiomics approaches based on 3D computed tomography (CT), clinical and semantic features in predicting the pathological classification of thymic epithelial tumors (TETs). Methods A total of 190 patients who underwent surgical resection and had pathologically confirmed TETs were enrolled in this retrospective study. All patients underwent non-contrast-enhanced CT (NECT) scans and contrast-enhanced CT (CECT) scans before treatment. A total of 396 hand-crafted radiomics features of each patient were extracted from the volume of interest in NECT and CECT images. We compared three clinical features and six semantic features (observed radiological traits) between patients with TETs. Two triple-classification radiomics models (RMs), two corresponding clinical RMs, and two corresponding clinical-semantic RMs were built to identify the types of the TETs. The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) were useful to evaluate the different models. Results Of the 190 patients, 83 had low-risk thymoma, 58 had high-risk thymoma, and 49 had thymic carcinoma. Clinical features (Age) and semantic features (mediastinal fat infiltration, mediastinal lymph node enlargement, and pleural effusion) were significantly different among the groups(P < 0.001). In the validation set, the NECT-based clinical RM (AUC = 0.770 for low-risk thymoma, 0.689 for high-risk thymoma, and 0.783 for thymic carcinoma; ACC = 0.569) performed better than the CECT-based clinical-semantic RM (AUC = 0.785 for low-risk thymoma, 0.576 for high-risk thymoma, and 0.774 for thymic carcinoma; ACC = 0.483). Conclusions NECT-based and CECT-based RMs may provide a non-invasive method to distinguish low-risk thymoma, high-risk thymoma, and thymic carcinoma, and NECT-based RMs performed better. Advances in Knowledge Radiomics models may be used for the preoperative prediction of the pathological classification of TETs.
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Affiliation(s)
- Jin Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Ping Yin
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Sicong Wang
- Pharmaceutical Diagnostic Team, GE Healthcare, Shanghai, China
| | - Tao Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Chao Sun
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital, Beijing, China
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Abstract
Thymic tumours are a heterogeneous group of malignancies with a range of clinical presentations. The most common types are thymoma and thymic carcinoma, but overall it remains a rare cancer, and one without a clear aetiology. In this review of the epidemiology of the disease, the relationship between sex, age, and ethnicity is reviewed, along with limited evidence on the genetics of the condition. In terms of risk factors and potential causative factors, environmental exposures such as tobacco, radiation, alcohol, or diet, seem to be irrelevant, but there is some evidence linking the development of thymoma and thymic carcinoma with viral conditions, including Epstein Barr Virus. But data is not conclusive, and in the absence of large patient numbers, it is difficult to prove causation. There has been good research looking at the link between thymoma and other malignancies, either before or after the diagnosis. There does not appear to be a significant increased likelihood of thymoma following other malignancies. But, there is a suggestion, in several papers, that there is an increased risk of other malignancies following the diagnosis of thymoma, although the magnitude of this risk is disputed. There does appear to be an increased risk of non-Hodgkins Lymphoma after a diagnosis of thymoma, and this could be related to a disruption in T-cell function caused by either the disease process or the treatment directed at the thymoma. In summary though, it is a rare malignant process with a variety of presentations, often limited to the anterior mediastinum, and without an aggressive disease profile.
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Affiliation(s)
- Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Campus, Nottingham, UK
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Zeng H, Yang W, Xu B, Zou J, Su C, Zhong B, Zhu H, Chen Z. Relationship of possible biomarkers with malignancy of thymic tumors: a meta-analysis. BMC Cancer 2020; 20:928. [PMID: 32993581 PMCID: PMC7523049 DOI: 10.1186/s12885-020-07332-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background Role of biomarkers for promotion of tumor proliferation (BPTPs) and for promotion of apoptosis (BPAs) in thymic malignant tumors is still unclear. The purpose of this study was to evaluate the relationship between BPTPs and/or BPAs and malignancy of thymic malignant tumors. Methods Studies on thymic malignant tumors and biomarkers were searched in PubMed, ISI Web of Knowledge, and Embase databases, and all statistical analyses were conducted using Review Manager. Results Twelve articles related to biomarkers and thymic malignant tumors were selected and analyzed. A relationship between BPAs and Masaoka stage was demonstrated for four markers, namely Bax, p73, Casp-9 and Bcl-2, included 138 stage I/II patients and 74 stage III/IV patients, and BPAs were significantly correlated with high Masaoka staging (P = 0.03). We further found a relationship between BPAs and degree of malignancy for four markers, namely Bax, p73, Casp-9 and Bcl-2, included 176 thymoma patients and 36 thymic carcinoma patients, and BPAs were significantly correlated with thymic carcinoma (P = 0.010). In addition, a relationship between BPTP and Masaoka staging was demonstrated for seven markers, namely Podoplanin, Glut-1, Muc-1, Egfr, Igf1r, c-Jun, and n-Ras, included 373 patients with stage I/II and 212 patients with stage III/IV, and BPTPs were significantly correlated with high Masaoka staging (P < 0.001). We also found a relationship between BPTPs and degree of malignancy for ten markers, namely Mesothelin, c-Kit (CD117), Egfr, Lat-1, Muc-1,Ema, Glut-1, Igf1r, c-Jun, and n-Ras, included 748 thymoma patients and 280 thymic carcinoma patients, and BPTPs were significantly correlated with thymic carcinoma (P < 0.001). Conclusion These findings show that high levels of BPTPs or BPAs are more closely related to thymic carcinoma and Masaoka stage III/IV, suggesting that BPTPs and BPAs may play an important role in the occurrence and development of thymic malignant tumors.
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Affiliation(s)
- Huilan Zeng
- Department of Thoracic Surgery and Department of Cardiothoracic Surgery of East Division, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, No. 58, Zhongshan Road II, Guangzhou, Guangdong, 510080, P. R. China
| | - Weilin Yang
- Department of Thoracic Surgery and Department of Cardiothoracic Surgery of East Division, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, No. 58, Zhongshan Road II, Guangzhou, Guangdong, 510080, P. R. China
| | - Bo Xu
- Department of Thoracic Surgery and Department of Cardiothoracic Surgery of East Division, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, No. 58, Zhongshan Road II, Guangzhou, Guangdong, 510080, P. R. China
| | - Jianyong Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, P. R. China
| | - Chunhua Su
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, P. R. China
| | - Beilong Zhong
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, P. R. China
| | - Haoshuai Zhu
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, P. R. China
| | - Zhenguang Chen
- Department of Thoracic Surgery and Department of Cardiothoracic Surgery of East Division, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, No. 58, Zhongshan Road II, Guangzhou, Guangdong, 510080, P. R. China. .,Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, P. R. China. .,Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, P. R. China.
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Yue J, Gu Z, Yu Z, Zhang H, Ma Z, Liu Y, Fang W. [Pretreatment Biopsy for Histological Diagnosis and Induction Therapy in Thymic Tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:437-44. [PMID: 27339720 PMCID: PMC6133982 DOI: 10.3779/j.issn.1009-3419.2016.07.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
背景与目的 探讨术前病理学诊断在胸腺肿瘤诊断和治疗中的价值及其对胸腺肿瘤治疗的影响。 方法 对中国胸腺肿瘤协作组(Chinese Alliance for Research in Thymomas, ChART)收集的1994年-2012年的多中心且具有明确活检状态的胸腺肿瘤患者的临床病理资料进行回顾性分析,探讨术前病理学诊断的应用趋势及其对胸腺肿瘤患者预后的影响。 结果 1, 902例胸腺肿瘤患者中,术前病理学诊断患者336例(17.1%)。近年来术前病理学诊断的比例较前明显增加(P=0.008),胸腔镜/纵隔镜/超声内镜下经支气管活检(endobronchial ultrasound, E-BUS)比例较前升高(P=0.029)。术前行病理学诊断患者的生存明显差于无病理学诊断患者(P < 0.001),术前病理学诊断后的目的与肿瘤的Masaoka分期(P < 0.001)、切除程度(P=0.025)、病理类型(P < 0.001)具有相关性。术前病理学诊断后直接手术患者的生存要明显优于诱导治疗后再手术患者(P < 0.001)。 结论 胸腺瘤诊断主要依靠临床及组织学判断,近年来术前病理学诊断在胸腺肿瘤的诊断和治疗中起重要作用;根治性手术切除是胸腺肿瘤的首先治疗手段;术前病理学诊断后直接手术患者的预后要明显优于诱导治疗后患者。
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Affiliation(s)
- Jie Yue
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Hongdian Zhang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Zhao Ma
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Yuan Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Modified Masaoka stage and size are independent prognostic predictors in thymoma and modified Masaoka stage is superior to histopathologic classifications. J Thorac Oncol 2015; 10:691-700. [PMID: 25629638 DOI: 10.1097/jto.0000000000000482] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The prognostic value of histopathologic classifications of thymoma is debated. Problematic reproducibility might cause this controversy. We studied the prognostic significance of three histopathologic classifications of thymomas after three thoracic pathologists agreed upon thymoma subtype and invasion. We also compared the outcome to established prognostic parameters. METHODS Patients, surgically treated for thymic epithelial neoplasm at Mayo Clinic (1942-2008), were staged according to the modified Masaoka staging and the recently proposed staging by Moran. Three thoracic pathologists independently classified all cases according to the World Health Organization, Bernatz, and proposed Suster and Moran classification. Only thymoma that all three pathologists diagnosed as the same histopathologic subtype and extent of invasion were included in outcome analysis. RESULTS In 214 (proposed Suster and Moran classification), 145 (World Health Organization classification), and 120 cases (Bernatz classification), reviewers agreed upon subtype of thymoma and invasion and follow-up was available. Median follow-up time was 7.5-7.7 years (range between classifications). All histopathologic classifications were associated with overall survival (OS) and disease-free survival (p ≤ 0.0001 to p = 0.048); only Bernatz classification was independent of modified Masaoka staging associated with OS (p = 0.04). Modified Masaoka stage predicted outcome independent of all histopathologic classifications and resection status and strongly correlated with the proposed Moran stage (correlation coefficient, 0.95). Thymoma size and age were prognostic parameters for OS independent of any histopathologic classification. CONCLUSIONS Histopathologic classifications of thymomas are associated with prognosis but are in general not independent predictors of outcome. Modified Masaoka stage and proposed Moran staging are independent prognostic parameters for thymoma and superior to histopathologic classifications.
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Roden AC, Yi ES, Jenkins SM, Donovan JL, Cassivi SD, Garces YI, Marks RS, Aubry MC. Diagnostic significance of cell kinetic parameters in World Health Organization type A and B3 thymomas and thymic carcinomas. Hum Pathol 2014; 46:17-25. [PMID: 25455993 DOI: 10.1016/j.humpath.2014.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 01/25/2023]
Abstract
The prognostic importance of histologic classifications of thymic epithelial neoplasms is controversial. Evidence suggests that difficulties in reproducibility affect prognostic studies. Two thoracic pathologists independently classified 80 cases of type A or B3 thymoma and thymic carcinoma according to World Health Organization (WHO) classification. Ki-67 labeling index (LI) was used to identify cutoff points between WHO types. Recursive partitioning (Rpart) and ad hoc methods separated the data points. The pathologists agreed on type A (n = 31), type B3 (n = 21), and thymic carcinoma (n = 14). Ki-67 LI differed between types A and B3 (P < .001) and between thymic carcinoma and type A (P < .001) or type B3 (P = .001). Mitotic activity differed between thymic carcinoma and type A (P < .001) or type B3 (P < .001). Rpart revealed Ki-67 LI greater than 14.0% only in thymic carcinoma; cases with Ki-67 LI less than 5.1% did not represent thymic carcinoma. Ad hoc analysis showed Ki-67 LI greater than or equal to 13.5% represents thymic carcinoma; only type A had Ki-67 LI less than 2%. The pathologists disagreed on histologic type in 14 cases. In 11 of 14 cases with available Ki-67, the Rpart method predicted the WHO type; in 7 of 14 cases, the ad hoc method predicted the WHO type. In conclusion, Ki-67 LI is helpful in differentiating thymic epithelial neoplasms, with Ki-67 LI less than 2% and greater than or equal to 13.5% distinguishing type A thymoma and thymic carcinoma, respectively.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA.
| | - Eunhee S Yi
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, MN, 55905, USA
| | - Janis L Donovan
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Mayo Clinic Rochester, MN, 55905, USA
| | - Yolanda I Garces
- Department of Radiation-Oncology, Mayo Clinic Rochester, MN, 55905, USA
| | - Randolph S Marks
- Division of Medical Oncology, Mayo Clinic Rochester, MN, 55905, USA
| | - Marie-Christine Aubry
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA
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Imai H, Kaira K, Yoshino R, Sato K, Shimizu K, Kawashima O, Tanaka S, Mori M. Clinical features of patients with invasive thymoma: A retrospective analysis of 61 cases. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kyoichi Kaira
- Department of Medicine and Molecular Science; Gunma University Graduate School of Medicine; Maebashi; Gunma
| | - Reiko Yoshino
- Department of Respiratory Medicine; National Hospital Organization Nishigunma Hospital; Shibukawa; Gunma
| | - Koji Sato
- Department of Respiratory Medicine; Gunma Cancer Center; Ohta; Gunma
| | - Kimihiro Shimizu
- Department of Thoracic and Visceral Organ Surgery; Gunma University Graduate School of Medicine; Maebashi; Gunma
| | - Osamu Kawashima
- Department of Respiratory Surgery; National Hospital Organization Nishigunma Hospital; Shibukawa; Gunma
| | - Shigebumi Tanaka
- Department of Surgery; Isesaki Municipal Hospital; Isesaki; Gunma
| | - Masatomo Mori
- Department of Medicine and Molecular Science; Gunma University Graduate School of Medicine; Maebashi; Gunma
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