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Shao K, Zeng X, Hao Y, Wang Y, Xu C, Song Z. Rechallenge immunotherapy after immune resistance in patients with advanced thymic carcinoma. Clin Transl Oncol 2024:10.1007/s12094-024-03597-z. [PMID: 39048777 DOI: 10.1007/s12094-024-03597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUNDS Immunotherapy is effective for patients with advanced thymic carcinoma (TC). However, the effectiveness of rechallenge immunotherapy in patients who are resistant to immunotherapy has not been investigated. METHODS Thirty-five patients with advanced TC using immunotherapy between 2016 and 2023 at Zhejiang Cancer Hospital, The Second Affiliated Hospital of Nanchang University, and Fujian Cancer Hospital were evaluated in this study. Tumor response was evaluated according to the Response Evaluation Criteria in Solid Tumors version 1.1. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. RESULTS A total of 35 patients were included in this study. The median PFS (mPFS) for all patients was 5.43 months and the median OS (mOS) was 16 months. After rechallenge immunotherapy, only three patients achieved partial response, resulting in an overall response rate of 16.7%, and nine patients attained stable disease, resulting in a disease control rate of 66.7%. Patients who underwent rechallenge immunotherapy had shorter mPFS compared to chemotherapy (3.53 months vs. 6.00 months, P = 0.041). In addition, the incidence of Grade 3-4 treatment-related adverse events in these patients was 22.2%. CONCLUSION Rechallenge immunotherapy has poor efficacy in immunotolerant TC patients.
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Affiliation(s)
- Keda Shao
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China
- Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Xiaohong Zeng
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China
- Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yue Hao
- Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yanhua Wang
- Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Chunwei Xu
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, People's Republic of China.
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, 310022, China.
| | - Zhengbo Song
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
- Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
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Hu S, Wang J, Cui Z, Zhou Y, Gao D. Late coronary artery injury following chemoradiotherapy for thymic carcinoma: a case report. BMC Cardiovasc Disord 2024; 24:269. [PMID: 38778265 PMCID: PMC11110269 DOI: 10.1186/s12872-024-03948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Surgery remains the primary treatment modality for thymic carcinoma, with adjuvant radiotherapy being recommended to effectively mitigate local recurrence and metastasis rates subsequent to incomplete or complete resection. Chemoradiotherapy has the potential to induce coronary artery occlusion, thereby potentially impacting patients' long-term survival rates. The existing literature currently lacks comprehensive research on the lesion characteristics of coronary artery injury resulting from chemoradiotherapy. CASE PRESENTATION The male patient, aged 55, was admitted to the hospital due to recurrent chest tightness and pain persisting for one week. Notably, the patient had previously undergone curative resection surgery for thymic carcinoma seven years ago. After the surgical procedure, the patient underwent a course of adjuvant chemotherapy comprising docetaxel and platinum. 11 months later, imaging examination diagnosed tumor recurrence, and concurrent chemoradiotherapy was administered at a total dose of 62 Gy/31F for planning gross target volume (PGTV) and 54 Gy/31F for planning target volume (PTV) with 2 cycles of paclitaxel and cisplatin. Re-admission of the patient occurred after a 7-year interval subsequent to the completion of concurrent chemoradiotherapy, leading to a subsequent diagnosis of acute non-ST segment elevation myocardial infarction. Following administration of antiplatelet, anticoagulant, and anti-myocardial ischemia therapy, coronary angiography revealed the presence of a bifurcation lesion at the distal end of the left main trunk. Intravascular ultrasound (IVUS) examination demonstrated significant negative remodeling of both the main trunk and its branches at the bifurcation site, characterized by minimal atherosclerotic plaque components. CONCLUSIONS Chemoradiotherapy may induce damage to endothelial cells, resulting in an inflammatory response. Negative remodeling of blood vessels is likely to occur, primarily characterized by vasoconstriction but with less atherosclerotic plaque burden. Routine stent implantation in negatively remodeled areas may lead to vascular rupture, necessitating intravascular imaging examination.
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Affiliation(s)
- Sigan Hu
- Department of Cardiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Jun Wang
- Department of Cardiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Zhen Cui
- Department of Radiation Oncology, First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Yongchun Zhou
- Department of Radiation Oncology, First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China.
| | - Dasheng Gao
- Department of Cardiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China.
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Rajan A, Sivapiromrat AK, McAdams MJ. Immunotherapy for Thymomas and Thymic Carcinomas: Current Status and Future Directions. Cancers (Basel) 2024; 16:1369. [PMID: 38611047 PMCID: PMC11010813 DOI: 10.3390/cancers16071369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Thymic epithelial tumors are a histologically diverse group of cancers arising from the epithelial compartment of the thymus. These tumors are characterized by a low tumor mutation burden, a lack of actionable genomic changes, and, especially with thymomas, defects in immune tolerance. Surgery is the mainstay of the management of resectable disease, whereas advanced, unresectable tumors are treated with platinum-based chemotherapy. Disease recurrence can occur months to years after frontline treatment. Although several options are available for conventional treatment of recurrent thymic tumors, response rates are generally low, and treatment-related toxicity can affect quality of life. A subset of patients benefit from biologic therapies, but there remains an unmet need for the development of new treatments. Immune checkpoint inhibitors are safe, clinically active, and have contributed to an improvement in survival for patients with a wide variety of cancers. However, the application of these revolutionary treatments for thymic cancers is limited to their use for the management of recurrent thymic carcinoma because of the risk of immune toxicity. In this paper, we review the current uses of immunotherapy for the management of thymic epithelial tumors and highlight potential strategies to improve safety and broaden the application of these treatments for patients with thymic cancers.
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Affiliation(s)
- Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Zhang A, Meng X, Yao Y, Zhou X, Zhang Y, Li N. Head to head comparison of 68Ga-DOTA-FAPI-04 vs 18F-FDG PET/CT in the evaluation of primary extrapulmonary tumors in the chest. Eur Radiol 2024; 34:1960-1970. [PMID: 37668694 DOI: 10.1007/s00330-023-10130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE We conducted a prospective study using 18F-flurodeoxyglucose (18F-FDG) and 68Ga-DOTA-FAPI-04 (fibroblast-activation protein inhibitor, 68Ga-FAPI) PET/CT to diagnose, differentiate, and stage primary extrapulmonary tumors of the thorax. METHODS Fifty-four participants were undergoing 18F-FDG and 68Ga-FAPI PET/CT and divided into the benign, intermediate, and malignant based on pathology. The maximum standardized uptake value (SUVmax), the tumor-to-blood pool ratio, and tumor-to-liver ratio were compared for primary tumors, lymph nodes, and metastases between the two modalities by two independent samples t tests. One-way ANOVA was used to compare the uptake of 18F-FDG or 68Ga-FAPI among the three groups. RESULTS Fifty-four participants were confirmed to have 71 primary lesions, 56 metastatic lymph nodes, and 43 metastatic lesions. 18F-FDG PET/CT could both effectively distinguish malignant lesions from non-malignant lesions, accuracies of 87.32% (p < 0.001). 68Ga-FAPI PET/CT effectively differentiated benign lesions from the non-benign, accuracy being 91.55% (p < 0.001). The accuracies of 18F-FDG and 68Ga-FAPI for detecting lymph node metastasis were 77.22% (61/79) and 87.34% (69/79) (p = 0.096). The uptake of 68Ga-FAPI in metastatic lymph nodes was significantly higher than that of the nonmetastatic (p < 0.001). The detection rate of 68Ga-FAPI PET/CT for metastatic lesions was significantly higher than that of 18F-FDG, 100% (43/43) vs. 53.49% (23/43) (p < 0.001). Compared with 18F-FDG PET/CT, 68Ga-FAPI PET/CT changed the treatment strategy of 7.4% (4/54) participants. CONCLUSION 68Ga-FAPI PET/CT is valuable in the diagnosis and differentiation of primary extrapulmonary tumors and superior to 18F-FDG PET/CT for evaluating lymph node and distant metastasis. CLINICAL RELEVANCE STATEMENT The application of 68Ga-FAPI PET/CT in primary extrapulmonary chest tumors is valuable, which is reflected in diagnosis, differentiation and exploration of lymph node metastasis and distant metastasis. KEY POINTS • 68Ga-FAPI PET/CT is valuable in the diagnosis, differentiation, and staging of primary extrapulmonary tumors. • 68Ga-FAPI PET/CT is superior to 18 F-FDG PET/CT for evaluating lymph node and distant metastasis.
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Affiliation(s)
- Annan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing, 100142, China
| | - Xiangxi Meng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing, 100142, China
| | - Yuan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing, 100142, China
| | - Xin Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing, 100142, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing, 100142, China
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing, 100142, China.
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Ho IW, Pan YL, Lai JI, Liu CY. Characteristics and outcome of systemic treatment for metastatic or unresectable thymic carcinoma: A single institution experience. Thorac Cancer 2024; 15:339-346. [PMID: 38149471 PMCID: PMC10834203 DOI: 10.1111/1759-7714.15198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Thymic carcinoma is a rare disease with an incidence of around 0.5 cases per million with a poor prognosis. The aim of this study was to assess patient outcomes with advanced thymic carcinoma receiving first-line chemotherapy. METHODS In our retrospective cohort study, we included patients who underwent treatment for metastatic thymic carcinoma between January 2013 to December 2019 in our hospital. Overall survival, progression-free survival (PFS), objective response rates (ORR) and chemotherapy regimens were assessed and analyzed. RESULTS A total of 27 patients were retrospectively analyzed. All patients received a platinum (cisplatin or carboplatin) based regimen as first-line chemotherapy (29.6% received ADOC, 11.1% received PE, 40.7% received CP, 14.8% received CAP). The median PFS on first-line chemotherapy was 199 days. The response rate was 40.7%. Median overall survival (OS) was 585 days. Positive CD5 staining was associated with better PFS. CONCLUSION We highlight the critical role of platinum-based chemotherapy agents as a primary treatment modality in advanced thymic carcinoma, underscoring the efficacy of platinum as a first-line option for recurrent disease, even in cases previously treated with platinum. Additionally, our findings indicate that CD5 positivity could be associated with improved PFS, suggesting its potential as a prognostic marker.
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Affiliation(s)
- I-Wei Ho
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ling Pan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, En Chu Kong hospital, New Taipei city, Taiwan
| | - Jiun-I Lai
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Yang Y, Chen C, Zheng B, Fan L, Chen X, Hu M. Pure white cell aplasia before and after thymectomy in the rare conundrum of thymoma: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e36920. [PMID: 38241556 PMCID: PMC10798751 DOI: 10.1097/md.0000000000036920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
RATIONALE Pure white cell aplasia (PWCA) is a rare paraneoplastic syndrome that occurs in patients with thymomas. Currently, the pathogenesis and treatment of this disease remain in the exploratory stage. PATIENT CONCERNS We report a 68-year-old woman with thymoma experienced PWCA involvement as her first presentation. The patient had high fever and agranulocytosis at the onset of the disease. The white blood cell count in the complete blood count was 1.9 × 109/L with a neutrophil of 0.1 × 109/L. The bone marrow aspirates showed decreased granulocyte proliferation. Computed tomography showed a large mass in the anterior mediastinum. DIAGNOSES The final diagnosis of our patient was PWCA and thymoma. INTERVENTIONS She underwent a thymectomy and cyclosporine A administration during first remission. OUTCOMES Long-term remission was achieved following the readministration of cyclosporine A after the disease recurrence. LESSONS PWCA or agranulocytosis with thymoma has been confirmed to be an extremely rare disease. Thymomas with PWCA correlate with autoimmunity. From this case study and the literature review, we concluded that the pathogenesis of thymomas in PWCA is mainly related to the activation of autoreactive T cells. Thymectomy and the immunosuppressive drug, cyclosporine A, were chosen for treatment. The patient's granulocyte levels were unable to recover after surgery because of the inability to promptly clear activated T cells. After surgery, cyclosporine A continued to take for a long time. Thymectomy combined with prolonged cyclosporine A administration may be an effective method for treating this rare disease.
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Affiliation(s)
- Yang Yang
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chunmei Chen
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bingrong Zheng
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liping Fan
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiajun Chen
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Meiwei Hu
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Agrafiotis AC, Brandão M, Berghmans T, Durieux V, Jungels C. Immunotherapy and Targeted Therapies Efficacy in Thymic Epithelial Tumors: A Systematic Review. Biomedicines 2023; 11:2722. [PMID: 37893096 PMCID: PMC10604659 DOI: 10.3390/biomedicines11102722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TET) are rare neoplasms of the anterior mediastinum. Surgery is the mainstay treatment for resectable TET, whereas systemic treatments are reserved for unresectable and metastatic tumors. The development of new treatments, such as immune checkpoint inhibitors (ICI) and targeted therapies, with promising results in other types of solid tumors, has led to the investigation of their potential efficacy in TET. The study of tumor microenvironments (TME) is another field of investigation that has gained the interest of researchers. Taking into account the complex structure of the thymus and its function in the development of immunity, researchers have focused on TME elements that could predict ICI efficacy. MATERIALS AND METHODS The primary objective of this systematic review was to investigate the efficacy of ICI in TET. Secondary objectives included the toxicity of ICI, the efficacy of targeted therapies in TET, and the evaluation of the elements of TME that may be predictive factors of ICI efficacy. A literature search was conducted in February 2023 using the Ovid Medline and SciVerse Scopus databases. RESULTS 2944 abstracts were retrieved, of which 31 were retained for the systematic review. Five phase II and one retrospective study assessed ICI efficacy. The overall response rate (ORR) varied from 0% to 34%. Median progression-free survival (PFS) ranged from 3.8 to 8.6 months, being lower in thymic carcinoma (TC) (3.8-4.2 months). Median overall survival (OS) ranged from 14.1 to 35.4 months. Treatment-related adverse events occurred in 6.6% to 27.3% of patients. Sixteen studies assessed targeted therapies. The most active molecule was lenvatinib, with 38% ORR in patients with TC while no activity was detected for imatinib, erlotinib plus bevacizumab, and saracatinib. Ten studies assessed TME elements that could predict ICI efficacy. Four studies focused on the tumor-infiltrating immune cells suggesting improved outcomes in patients with TC and high tumor-infiltrating lymphocyte densities. Another study showed that CD8+, CD20+, and CD204+ tumor-infiltrating immune cells in cancer stroma might be prognostic biomarkers in TC. Another study identified the immune-related long non-coding RNAs as a predictor of response to ICI. Tumor mutational burden was identified as a predictive factor of ICI efficacy in one study. CONCLUSIONS Despite study heterogeneity, this review shows that ICI could be a therapeutic option for selected patients with TET that are not amenable to curative radical treatment after first-line chemotherapy.
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Affiliation(s)
- Apostolos C. Agrafiotis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, University of Antwerp, B-2650 Edegem, Belgium
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
| | - Mariana Brandão
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Thoracic Oncology Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Thierry Berghmans
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Thoracic Oncology Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Valérie Durieux
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles, 1070 Brussels, Belgium
| | - Christiane Jungels
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Department of Oncological Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
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Guan S, Long W, Liu Y, Cai B, Luo J. Prognosis of Concurrent Versus Sequential Chemo-Radiotherapy Induction Followed by Surgical Resection in Patients with Advanced Thymic Epithelial Tumors: A Retrospective Study. Ann Surg Oncol 2023; 30:6739-6747. [PMID: 37454019 DOI: 10.1245/s10434-023-13954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND This study aimed to evaluate the prognosis of concurrent chemo-radiotherapy (CCRT) versus sequential chemo-radiotherapy (SCRT) induction followed by surgical resection in patients with advanced thymic epithelial tumors (TETs). METHODS This retrospective study included patients with advanced TETs who underwent CCRT or SCRT induction followed by surgical resection at the Second General Hospital of Guangdong Province between January 2008 and December 2019. The primary outcomes were induction response rate and surgical complete resection rate. The secondary outcomes were surgery combined resection, post-induction T staging, postoperative TNM staging, postoperative pathological tumor regression grade, progression-free survival (PFS) and overall survival (OS), and adverse events (AEs). RESULTS A total of 31 patients were included, 15 of whom received CCRT and the other 16 SCRT. The induction response rates were 80.0 and 62.5%, respectively, the post-induction step-down rates were 46.7 and 31.3%, respectively, and the post-induction R0 resection rates were 80.0 and 68.8%, respectively, without significant differences between CCRT and SCRT groups (all P > 0.05). The 5-year OS rate was 64.2 and 51.6%, respectively, and PFS was 42.3 and 21.4%, respectively, without significant differences between CCRT and SCRT groups (both P > 0.05). AEs in the hematologic system were significantly higher with CCRT compared with SCRT (P = 0.009). CONCLUSIONS Patients with advanced TETs might have a good prognosis with both CCRT and SCRT induction therapy, while SCRT induction may result in a lower probability of AEs in the hematologic system.
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Affiliation(s)
- Shubin Guan
- Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Weiguang Long
- Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yang Liu
- Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bin Cai
- Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Juan Luo
- Department of Chest Wall Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
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Yeung V, Zaemes J, Yeh J, Giancarlo C, Ahn J, Reuss JE, Kallakury BV, Liu SV, Duttargi A, Khan G, Kim C. High levels of expression of Trop-2 in thymic epithelial tumors. Lung Cancer 2023; 184:107324. [PMID: 37573703 DOI: 10.1016/j.lungcan.2023.107324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Trophoblastic antigen 2 (Trop2) is a cell surface glycoprotein expressed in multiple types of cancers, including breast cancer, non-small cell lung cancer, and gastrointestinal cancers. Trop2 expression and the use of Trop2-directed therapy such as antibody-drug conjugate (ADC) have not yet been investigated in thymic epithelial tumors (TETs). METHODS Patients with TETs treated at MedStar Georgetown University Hospital were retrospectively identified. Of the patients for whom tumor samples and normal thymus tissue were available, immunohistochemistry (IHC) membranous staining for Trop2 and PD-L1 were performed. Positivity for Trop2 required at least 10% of the tumor cells to be stained, with an intensity scored of 1+ (weak), 2+ (moderate), and 3+ (strong). Cases with CPS ≥ 5% were considered positive for PD-L1. RESULTS 30 TET samples from 29 patients (17 patients with thymoma and 12 patients with thymic carcinoma) were identified. One patient with thymic carcinoma had two samples from different time points. From the same set of patients, 13 samples of normal thymus tissue were available. In normal thymus tissue, eight samples (62%) showed no positivity of Trop2, while five samples (38%) showed 1 + IHC staining. In the thymoma samples, four (24%) showed 0 or 1 + IHC staining, while 13 (76%) showed 2 + or 3 + staining. Of the 13 thymic carcinoma samples, three samples (23%) showed 1 + IHC staining while seven (54%) showed 2 + staining and three (23%) showed 3 + staining. There was no statistically significant correlation found between PD-L1 expression and Trop-2 expression in thymoma or thymic carcinoma. CONCLUSIONS Trop2 is readily expressed in TETS with a higher degree of expression in thymic carcinoma. The expression of Trop-2 was lower in normal thymic tissue compared with TETs. The increased expression of Trop-2 in TETs suggests that Trop2 is an attractive therapeutic target for Trop-2 directed therapy.
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Affiliation(s)
- Vincent Yeung
- Rutgers Cancer Institute of New Jersey - University Hospital, Newark, NJ, USA
| | - Jacob Zaemes
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Justin Yeh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Joshua E Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Stephen V Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Anju Duttargi
- Department of Pathology, Georgetown University, Washington, DC, USA
| | - Galam Khan
- Department of Pathology, Georgetown University, Washington, DC, USA
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
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10
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Alqaidy D. Thymoma: An Overview. Diagnostics (Basel) 2023; 13:2982. [PMID: 37761349 PMCID: PMC10527963 DOI: 10.3390/diagnostics13182982] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Thymomas are considered one of the most prevalent types of mediastinal epithelial tumors, which frequently develop in the anterior mediastinum. Due to their rarity, these tumors' nomenclature, classification, and staging are likely to be the subject of debate and argument for most expert pathologists. Furthermore, the significance of thymoma histologic classifications have been debated over the past twenty years. While certain advocates argue that staging at the time of diagnosis is more significant, others believe that histologic subtyping has a significant impact on how patients behave clinically. In this review, we will focus on some of the challenges that diagnostic surgical pathologists may experience while evaluating the histopathology of thymomas and staging these tumors. We will additionally glance over the clinical characteristics of these distinct tumors and the current management strategy.
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Affiliation(s)
- Doaa Alqaidy
- Department of Pathology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Doi S, Yanagawa M, Matsui T, Hata A, Kikuchi N, Yoshida Y, Yamagata K, Ninomiya K, Kido S, Tomiyama N. Usefulness of Three-Dimensional Iodine Mapping Quantified by Dual-Energy CT for Differentiating Thymic Epithelial Tumors. J Clin Med 2023; 12:5610. [PMID: 37685677 PMCID: PMC10488564 DOI: 10.3390/jcm12175610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Dual-energy CT has been reported to be useful for differentiating thymic epithelial tumors. The purpose is to evaluate thymic epithelial tumors by using three-dimensional (3D) iodine density histogram texture analysis on dual-energy CT and to investigate the association of extracellular volume fraction (ECV) with the fibrosis of thymic carcinoma. Methods: 42 patients with low-risk thymoma (n = 20), high-risk thymoma (n = 16), and thymic carcinoma (n = 6) were scanned by dual-energy CT. 3D iodine density histogram texture analysis was performed for each nodule on iodine density mapping: Seven texture features (max, min, median, average, standard deviation [SD], skewness, and kurtosis) were obtained. The iodine effect (average on DECT180s-average on unenhanced DECT) and ECV on DECT180s were measured. Tissue fibrosis was subjectively rated by one pathologist on a three-point grade. These quantitative data obtained by examining associations with thymic carcinoma and high-risk thymoma were analyzed with univariate and multivariate logistic regression models (LRMs). The area under the curve (AUC) was calculated by the receiver operating characteristic curves. p values < 0.05 were significant. Results: The multivariate LRM showed that ECV > 21.47% in DECT180s could predict thymic carcinoma (odds ratio [OR], 11.4; 95% confidence interval [CI], 1.18-109; p = 0.035). Diagnostic performance was as follows: Sensitivity, 83.3%; specificity, 69.4%; AUC, 0.76. In high-risk thymoma vs. low-risk thymoma, the multivariate LRM showed that the iodine effect ≤1.31 mg/cc could predict high-risk thymoma (OR, 7; 95% CI, 1.02-39.1; p = 0.027). Diagnostic performance was as follows: Sensitivity, 87.5%; specificity, 50%; AUC, 0.69. Tissue fibrosis significantly correlated with thymic carcinoma (p = 0.026). Conclusions: ECV on DECT180s related to fibrosis may predict thymic carcinoma from thymic epithelial tumors, and the iodine effect on DECT180s may predict high-risk thymoma from thymoma.
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Affiliation(s)
- Shuhei Doi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Akinori Hata
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Noriko Kikuchi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Yuriko Yoshida
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Kazuki Yamagata
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Keisuke Ninomiya
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Shoji Kido
- Department of Artificial Intelligence Diagnostic Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
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12
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Zhang X, Zang X, Yang H, Jiao P, Zhang J, Song N, Lv Z. Ultrahigh-performance liquid chromatography-high-resolution mass spectrometry-based plasma metabolomics study of thymoma and thymic hyperplasia. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2023; 37:e9529. [PMID: 37125446 DOI: 10.1002/rcm.9529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023]
Abstract
RATIONALE Thymoma is a rare malignant tumor but it is the most common primary tumor of the anterior mediastinum. The current imaging methods for thymoma screening suffer from false positive rate problems, and thymoma pathogenesis remains elusive. Study of thymoma metabolic characteristics could provide clues for improving the diagnosis and understanding the pathogenesis of thymoma. METHODS Metabolic profiling of plasma from thymoma and thymic hyperplasia patients was performed using ultrahigh-performance liquid chromatography combined with high-resolution mass spectrometry in both positive and negative ionization modes. After pre- and post-processing, the dataset was divided into three age groups and statistical analysis was performed to select differential metabolites of thymoma. For feature identification, experimental tandem mass spectra were matched to those of databases and available chemical standards, and also manually annotated with plausible chemical structures to ensure high identification confidence. RESULTS A total of 47 differential metabolites were identified in thymoma. Significantly higher levels of histidine, sphinganine 1-phosphate, lactic acid dimer, phenylacetylglutamine, LPC (18:3) and LPC (16:1), and significantly lower levels of phenylalanine, indole-3-propionic acid (IPA), hippuric acid and mesobilirubinogen were associated with thymoma. Tryptophan level in thymoma-associated myasthenia gravis (TAMG) was significantly lower than that of the MG(-) group. IPA and hippuric acid abundances exhibited increasing trends from indolent to aggressive thymoma. CONCLUSIONS Our study revealed aberrant aromatic amino acid metabolism and fatty acid oxidation might be associated with thymoma. The identified unique metabolic characteristics of thymoma may provide valuable information for study of the molecular mechanism of thymoma pathogenesis, and improvement of diagnosis and discovery of new therapeutic strategies for thymoma.
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Affiliation(s)
- Xin Zhang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Xiaoling Zang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
- Laboratory of Marine Drugs and Biological Products, Pilot National Laboratory for Marine Science and Technology, Qingdao, China
| | - Huanhuan Yang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Zhang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Ni Song
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Zhihua Lv
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
- Laboratory of Marine Drugs and Biological Products, Pilot National Laboratory for Marine Science and Technology, Qingdao, China
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13
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Moura de Azevedo S, Baptista P, Pichel RC, Dias RR, Bertão M. A Rare Case of Mediastinal Mass: Thymoma and Thymic Tumor. Cureus 2023; 15:e40956. [PMID: 37503485 PMCID: PMC10369011 DOI: 10.7759/cureus.40956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Thymomas and thymic carcinomas are rare mediastinal neoplasms arising from thymic epithelial cells, and the presence of synchronous or metachronous primary thymic neoplasms in a single patient is an extremely rare event. Thymoma patients appear to have an inherent predisposition toward developing additional neoplasms. This additionally presents a diagnostic challenge, revealing the importance of multidisciplinary expertise to the management of these patients. This is a case report of a patient with a thymoma and thymic carcinoma, submitted to surgical resection and postoperative radiotherapy.
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Affiliation(s)
| | - Patrícia Baptista
- Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Rita C Pichel
- Oncology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Rita R Dias
- Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Manuela Bertão
- Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
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14
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Ao YQ, Gao J, Wang S, Jiang JH, Deng J, Wang HK, Xu B, Ding JY. Immunotherapy of thymic epithelial tumors: molecular understandings and clinical perspectives. Mol Cancer 2023; 22:70. [PMID: 37055838 PMCID: PMC10099901 DOI: 10.1186/s12943-023-01772-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
Immunotherapy has emerged to play a rapidly expanding role in the treatment of cancers. Currently, many clinical trials of therapeutic agents are on ongoing with majority of immune checkpoint inhibitors (ICIs) especially programmed death receptor 1 (PD-1) and its ligand 1 (PD-L1) inhibitors. PD-1 and PD-L1, two main immune checkpoints, are expressed at high levels in thymic epithelial tumors (TETs) and could be predictors of the progression and immunotherapeutic efficacy of TETs. However, despite inspiring efficacy reported in clinical trials and clinical practice, significantly higher incidence of immune-related adverse events (irAEs) than other tumors bring challenges to the administration of ICIs in TETs. To develop safe and effective immunotherapeutic patterns in TETs, understanding the clinical properties of patients, the cellular and molecular mechanisms of immunotherapy and irAEs occurrence are crucial. In this review, the progress of both basic and clinical research on immune checkpoints in TETs, the evidence of therapeutic efficacy and irAEs based on PD-1 /PD-L1 inhibitors in TETs treatment are discussed. Additionally, we highlighted the possible mechanisms underlying irAEs, prevention and management strategies, the insufficiency of current research and some worthy research insights. High PD-1/PD-L1 expression in TETs provides a rationale for ICI use. Completed clinical trials have shown an encouraging efficacy of ICIs, despite the high rate of irAEs. A deeper mechanism understanding at molecular level how ICIs function in TETs and why irAEs occur will help maximize the immunotherapeutic efficacy while minimizing irAEs risks in TET treatment to improve patient prognosis.
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Affiliation(s)
- Yong-Qiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia-Hao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Deng
- Institute of Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Hai-Kun Wang
- CAS Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Bei Xu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jian-Yong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China.
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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15
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Zhao K, Chen Y, Liu L, Wang G, Zhang J, Zhou M, Gao X, Rao K, Yang L, Guo C, Zhang Y, Huang C, Liu H, Li S. Real-world study of treatment and outcome of type B2 + B3 thymoma: The neglected part of thymoma. Thorac Cancer 2023; 14:1339-1347. [PMID: 37037477 DOI: 10.1111/1759-7714.14875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study aimed to examine the treatment and prognosis of patients with type B2 + B3 thymoma and compare it with those patients with type B2 and B3 thymoma. METHODS We conducted a retrospective analysis of the results of 39 patients with type B2 + B3 thymoma, 133 patients with type B2 thymoma, and 64 patients with type B3 thymoma. The Kaplan-Meier technique was used to generate survival curves. For multivariate analysis, the Cox proportional hazard model was applied. RESULTS With a median follow-up of 60 months (range: 1-128 months), the percentage of patients with tumor, node, metastasis (TNM) stage III and IV disease gradually increased from 19.5% to 25.6% to 35.9% among those with histological subtypes B2, B2 + B3, and B3, respectively, p = 0.045. Twenty-three patients experienced recurrence or metastasis. The total 10-year progression-free survival (PFS) rates were 86.0% overall (85.0% in type B2, 87.2% in type B2 + B3, and 87.5% in type B3). Age, R0 resection, and Masaoka-Koga stage were found to have a significant on PFS in all patients. There was no statistically significant difference in PFS between different histotypes of thymoma, p = 0.650. PFS was predicted by R0 resection in all histotypes and by the Masaoka-Koga stage in the type B2 subgroup. CONCLUSION Combining the two staging methods to guide the diagnosis and treatment of patients with B2 + B3 thymoma is recommended. R0 resection is recommended to reduce recurrence. Patients with B2 + B3 thymoma have a prognosis similar to those with a B2 thymoma or a B3 thymoma alone.
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Affiliation(s)
- Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Mengxin Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xuehan Gao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ke Rao
- Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Libing Yang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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16
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Sunaga N, Miura Y, Sakurai R, Ohshima S, Uno S, Muto S, Sato M, Tsurumaki H, Yatomi M, Koga Y, Ohtaki Y, Nagashima T, Okano N, Kubo N, Maeno T, Hisada T. Sustained antitumor response to lenvatinib with weekend-off and alternate-day administration in chemotherapy-refractory thymic carcinoma: a case report. Anticancer Drugs 2023; 34:605-608. [PMID: 36729850 DOI: 10.1097/cad.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lenvatinib is a multitargeted kinase inhibitor and maintaining its dose intensity has been shown to be beneficial in patients with thyroid and hepatocellular carcinomas. However, most patients require lenvatinib interruption and dose reduction due to the high incidence of adverse events (AEs). Lenvatinib was recently approved in Japan for patients with unresectable thymic carcinoma; however, real-world evidence of its clinical benefit is limited. Here, we report the case of chemotherapy-refractory thymic carcinoma in a patient who was administered a starting dose of lenvatinib using a 5-day on/2-day off (weekend-off) protocol, followed by alternate-day administration after fatigue onset derived from overt or subclinical hypothyroidism. Consequently, the patient exhibited a durable response to lenvatinib, with a 17-month progression-free survival without any severe or intolerable AEs. The present case suggests that maintaining lenvatinib dose intensity using such alternative administration regimens contributes to favorable clinical outcomes in thymic carcinoma.
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Affiliation(s)
- Noriaki Sunaga
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Yosuke Miura
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | | | | | - Shogo Uno
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Sohei Muto
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Mari Sato
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Hiroaki Tsurumaki
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Masakiyo Yatomi
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Yasuhiko Koga
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | | | | | - Naoko Okano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine
| | - Toshitaka Maeno
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine
| | - Takeshi Hisada
- Gunma University Graduate School of Health Sciences, Maebashi, Japan
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17
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Radi ZA, Khan N. Pathophysiology and human cancer risk assessment of pharmaceutical-induced thymoma in carcinogenicity studies. Toxicol Appl Pharmacol 2023; 466:116471. [PMID: 36934859 DOI: 10.1016/j.taap.2023.116471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Thymoma, a tumor of thymic lymphocytes or thymic epithelial cells (TECs), is a common spontaneous tumor in Wistar Han rats, especially in females with up to 18% incidence in controls. In addition to sex, there are rat strain differences in background incidence of thymomas such as Sprague Dawley versus Wistar Han rats. Human thymomas are very rare and without clear differences in incidence between males and females. Immunomodulatory and anti-inflammatory pharmaceutical drug classes, including Janus kinase inhibitors, increase the incidence of benign thymoma in two-year rat carcinogenicity studies. Potential non-genotoxic mechanisms that might contribute to the pathogenesis of thymoma development in one sex (female) Wistar Han rats include: (1) hormonal differences, (2) high proliferation rate of TECs, (3) delayed physiologic thymic involution, and/or (4) significant level of immunosuppression at high doses of a pharmaceutical drug. Factors to consider in the human cancer risk assessment of pharmaceutical-induced thymoma are: the genotoxicity of the test article, sex and strain of rats, exposure safety margins, and pathophysiologic differences and similarities of thymoma between rats and humans. Totality of weight of evidence approach and available data suggest thymomas observed in carcinogenicity studies of pharmaceutical drugs are not relevant for human risk at clinically relevant therapeutic doses.
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Affiliation(s)
- Zaher A Radi
- Pfizer Worldwide Research, Development and Medical, Drug Safety R&D, 1 Portland Street, Cambridge, MA 02140, USA.
| | - Nasir Khan
- Pfizer Worldwide Research, Development and Medical, Drug Safety R&D, Eastern Point Road, Groton, CT 06340, USA
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18
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Fan Y, Cui T, Wei S, Gao X. Prognostic value of preoperative chemotherapy for thymic epithelial tumors: A propensity-matched analysis based on the SEER database. Front Surg 2023; 10:1108699. [PMID: 37009618 PMCID: PMC10063892 DOI: 10.3389/fsurg.2023.1108699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundThe aim of this study was to assess the impact of preoperative chemotherapy on long-term survival (≥1 month) in patients with thymic epithelial tumors (TETs) and conditions suitable for chemotherapy using data from surveillance, epidemiology, and end-result databases.MethodsThis retrospective study controlled for confounding factors by propensity score matching (PSM), analyzed overall survival (OS) and cancer-specific survival (CSS) by Kaplan-Meier methods, and analyzed factors affecting the prognosis of patients undergoing surgery for thymic epithelial tumors by univariate and multifactorial Cox regression.ResultsA total of 2,451 patients who underwent surgery for TETs were identified from the Surveillance, Epidemiology, and End Results database. Preoperative chemotherapy significantly improved OS and CSS in patients with stage III/IV TETs compared to patients without preoperative chemotherapy. Subgroup analysis showed that patients younger than 60 years of age with TETs, patients with thymic carcinoma, and patients with TETs with multiple cancers were more likely to benefit from preoperative chemotherapy.ConclusionThis study found that preoperative chemotherapy is a viable option for advanced thymoma with favorable overall and cancer-specific survival rates, but patient history and physical condition should be fully considered in conjunction with diagnostic imaging findings to assess patient tolerance to chemotherapy.
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Affiliation(s)
- Yan Fan
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tianjiao Cui
- Department of Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Wei
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xingcai Gao
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Correspondence: Xingcai Gao
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19
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Kanamori K, Suina K, Shukuya T, Takahashi F, Hayashi T, Hara K, Saito T, Mitsuishi Y, Shimamura SS, Winardi W, Tajima K, Ko R, Mimori T, Asao T, Itoh M, Kawaji H, Suehara Y, Takamochi K, Suzuki K, Takahashi K. CALML5 is a novel diagnostic marker for differentiating thymic squamous cell carcinoma from type B3 thymoma. Thorac Cancer 2023; 14:1089-1097. [PMID: 36924358 PMCID: PMC10125782 DOI: 10.1111/1759-7714.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Thymic squamous cell carcinoma and type B3 thymoma are primary neoplasms of the anterior mediastinum that are sometimes difficult to differentiate from one another histologically. However, only a few immunohistochemical markers are available for the differential diagnosis. The purpose of this study was to discover a novel marker for differentiating between thymic squamous cell carcinoma and type B3 thymoma. METHODS We used histological samples of thymic carcinomas (n = 26) and type B3 thymomas (n = 38) which were resected between 1986 and 2017. To search for candidates of differential markers, gene expression levels were evaluated in samples using promoter analysis by cap analysis of gene expression (CAGE) sequencing. RESULTS Promoter level expression of CALML5 genes was significantly higher in thymic carcinomas than in type B3 thymomas. We further validated the results of the CAGE analysis in all 26 thymic carcinomas and 38 type B3 thymomas by immunohistochemistry (IHC). CALML5 was strongly expressed in the cytoplasm in 19 of 26 cases with thymic carcinoma, whereas positivity at the protein level was shown in two of 38 type B3 thymomas. Thus, the sensitivity (73.1%) and specificity (94.7%) of CALML5 as markers for immunohistochemical diagnosis of thymic carcinoma were extremely high. CONCLUSION We identified CALML5 as a potential marker for differentiating thymic squamous cell carcinoma from type B3 thymoma. It is assumed that future clinical use of CALML5 may improve the diagnostic accuracy of differentiating between these two diseases.
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Affiliation(s)
- Koichiro Kanamori
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Suina
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Fumiyuki Takahashi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kieko Hara
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yoichiro Mitsuishi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shoko Sonobe Shimamura
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Wira Winardi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Ken Tajima
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Tomoyasu Mimori
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masayoshi Itoh
- RIKEN Preventive Medicine and Diagnosis Innovation Program, Saitama, Japan.,RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hideya Kawaji
- RIKEN Preventive Medicine and Diagnosis Innovation Program, Saitama, Japan.,Preventive Medicine and Applied Genomics Unit, RIKEN Advanced Center for Computing and Communication, Yokohama, Japan.,Research Center for Genome & Medical Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yoshiyuki Suehara
- Department of Orthopedic Surgery, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Research Institute for Diseases of Old Ages, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Falkson CB, Vella ET, Ellis PM, Maziak DE, Ung YC, Yu E. Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review. J Thorac Oncol 2023; 18:299-312. [PMID: 36343922 DOI: 10.1016/j.jtho.2022.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Thymic epithelial tumors are rare and are classified as thymoma, thymic carcinoma, and thymic neuroendocrine tumors. The objective of this systematic review was to evaluate the treatment options for patients with thymic epithelial tumors. METHODS This systematic review was developed by Ontario Health (Cancer Care Ontario)'s Program in Evidence-Based Care and by the Lung Cancer Disease Site Group. MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing surgical, radiotherapy, or systemic treatments against any combination of these treatments in patients with thymic epithelial tumors. Meta-analyses were conducted with clinically homogenous studies. RESULTS A total of 106 studies were included, mainly from observational studies. There was an overall survival benefit with postoperative radiotherapy for patients with thymic carcinoma (hazard ratio = 0.65, 95% confidence interval: 0.47-0.89) and for patients with thymoma (hazard ratio = 0.70, 95% confidence interval: 0.59-0.82), especially for those with a high risk for mortality. Patients with thymic carcinoma or thymoma had a response to chemotherapy. Selection bias affected the results for studies that evaluated neoadjuvant chemotherapy or minimally invasive surgical techniques. Furthermore, the overall survival benefit found for adjuvant chemotherapy may have been confounded by the administration of postoperative radiotherapy. CONCLUSIONS For patients with thymoma or thymic carcinoma, the literature is of low quality and subject to bias. There were overall survival benefits with postoperative radiotherapy. The results of this systematic review were used to inform treatment recommendations in a clinical practice guideline. Future large-scale prospective studies that control for confounders are needed.
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Affiliation(s)
- Conrad B Falkson
- Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada
| | - Emily T Vella
- Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | - Peter M Ellis
- Medical Oncology, Juravinski Cancer Centre and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Donna E Maziak
- Thoracic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Yee C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Edward Yu
- Radiation Oncology, London Regional Cancer Centre and Western University, London, Ontario, Canada
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Efficacy and safety of treatments for advanced thymic carcinoma after failure of first-line platinum-based chemotherapy: A systematic literature review and meta-analysis. Lung Cancer 2023; 176:132-139. [PMID: 36638588 DOI: 10.1016/j.lungcan.2023.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
Thymic carcinoma (TC) is a rare cancer and patients failing initial chemotherapy (relapse/refractory) face limited therapeutic options given no approved options or consensus standard of care. This study aimed to identify and summarize clinical outcomes of all regimens evaluated in clinical trials of relapsed or refractory patients. Interventional trials enrolling advanced TC patients who failed first-line chemotherapy and reported outcomes in this group were eligible for inclusion in our systemic literature review (SLR). Between-study heterogeneity was assessed to determine the feasibility of pooling specific studies and treatments. Objective response rate (ORR), overall survival (OS), progression-free survival (PFS), and duration of response (DOR) endpoints were of interest for meta-analysis. Nineteen trials were identified in the SLR. Three trials with one or two TC patients were removed from our assessment to reduce publication bias. Response rates among studies with at least ten TC patients varied from 9 % to 38 %. Pooled ORRs in patients receiving S-1 (46 patients), sunitinib (46 patients), or pembrolizumab (66 patients) were 28 %, 24 %, and 21 %, respectively. Prolonged duration of response with pembrolizumab was observed with a pooled median of 23.8 months (95 % confidence interval [CI]: 12, not reached). Median PFS of five months or greater was reported in patients treated with sunitinib, lenvatinib, pembrolizumab, capecitabine + gemcitabine, everolimus, or S-1. Median OS of 20 months or greater was reported in trials evaluating S-1 or pembrolizumab; this endpoint was not reached in trials evaluating lenvatinib, regorafenib, or sunitinib. Generalizability of treatment effects is challenging in the research of rare diseases and meta-analysis of clinical outcomes may help to increase precision and relevance of results to the larger TC population. Our study found limited treatment options upon relapse, demonstrating a need for further investigations into novel therapeutics and well-powered clinical trials to better inform on optimal treatments.
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Li W, Wu Y, Huang L, Chai Y. Neoadjuvant radiotherapy plus single-incision thoracoscopic surgery in the treatment of type B3 thymomas. Front Oncol 2023; 13:1094974. [PMID: 37035177 PMCID: PMC10076567 DOI: 10.3389/fonc.2023.1094974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Although minimally invasive surgery is the standard treatment for thymomas, minimally invasive thymectomy is difficult for patients with type B3 thymomas, especially for giant or aggressive lesions. These tumors are frequently treated with radical radiation therapy or surgery plus adjuvant radiotherapy. Few studies, however, have tested the efficacy of neoadjuvant radiotherapy prior to thoracoscopic surgery. Methods Patients with type B3 thymomas >5 cm or with infiltrates into vital organs on CT-guided puncture biopsy who underwent neoadjuvant radiotherapy followed by single-incision minimally invasive thymectomy from March 2016 to July 2020 were retrospectively evaluated. Reduction ratios, TNM stage changes according to WHO stage criteria, resectability, long-term survival, and the response in terms of RECIST v1.1 criteria achieved by preoperative RT were analyzed. Results The 11 patients who underwent neoadjuvant radiotherapy plus minimally invasive thymectomy included five men and six women, of mean age 49.5 years. Four patients had myasthenia gravis. Neoadjuvant radiotherapy consisted of 50 Gy in 25 fractions, with all patients showing varying degrees of lesion reduction after radiotherapy. Surgery was performed about 1 month after neoadjuvant radiotherapy, with none of these patients having severe radiation pneumonitis. All patients underwent radical resection of the tumor and adjacent tissue, with none experiencing tumor seeding or rupture during surgery. The median postoperative hospital stay was 3 days (range: 2-6 days) and the frequency of additional regular analgesics (including those for wound pain and neuralgia) was 2.5 times per person. On follow-up, one patient experienced pleural metastasis and one experienced pulmonary metastasis, with the other nine patients showing no evidence of tumor recurrence. Conclusion Neoadjuvant radiotherapy followed by minimally invasive surgery was a safe and efficacious procedure for the treatment of type B3 thymomas, with less postoperative pain and faster recovery. This strategy, of tumor shrinkage prior to surgery, may make possible the easier removal of type B3 thymomas by single-incision thoracoscopy.
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Affiliation(s)
- Wenshan Li
- Department of Thoracic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yimin Wu
- Department of Thoracic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lijian Huang
- Department of Thoracic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Chai
- Department of Thoracic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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23
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Wang C, Erick Elkowitz D, Esposito MJ, Shah RD, Tannous H, Barilla-Labarca ML, Seetharamu N. A multidisciplinary approach to treating a unique case of recurrent metastatic thymic carcinoma: case report. THERAPEUTIC ADVANCES IN RARE DISEASE 2023; 4:26330040231190661. [PMID: 37576433 PMCID: PMC10422886 DOI: 10.1177/26330040231190661] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023]
Abstract
Thymic carcinoma (TC) is a rare and aggressive malignancy of the thymus associated with less than 25% 5 years survivability. Our case report showcases the successful treatment of advanced metastatic TC using a multidisciplinary approach and the utility of checkpoint inhibitors in treatment of recurrent TC. A 50-year-old man presented with Raynaud's phenomenon and was found to have a stage IVb TC (T3N2M0). Eight months after management with neoadjuvant chemotherapy, surgical resection and adjuvant chemoradiotherapy, patient was diagnosed with metastasis of TC to the liver and a concurrent stage III (T2N1M0) primary sigmoid colon adenocarcinoma. Following complete resection of the colon adenocarcinoma, the patient started palliative-intent treatment for TC with pembrolizumab given PD-L1 tumor proportionate score of 100%. This resulted in a sustained complete response for 38 months. Our patient did have immune-related adverse events involving multiple organs but was able to continue pembrolizumab for a standard treatment duration of 2 years with multidisciplinary care. When recurrent disease was noted in a portocaval lymph node, pembrolizumab was reinitiated and a second complete response was achieved. The patient has maintained that complete response while maintaining an acceptable quality of life, showing that treatment with pembrolizumab is effective in patients after discontinuation with prior immunotherapy.
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Affiliation(s)
- Carol Wang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd., Hempstead, NY 11549, USA
| | - David Erick Elkowitz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael John Esposito
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Rakesh Dinesh Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | | | - Nagashree Seetharamu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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24
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Li Y, Tang Z, Zhu X, Tian H. Nomogram based on TNM stage to predict the prognosis of thymic epithelial tumors (TETs) patients undergoing extended thymectomy. Front Surg 2023; 10:1136166. [PMID: 36936648 PMCID: PMC10020510 DOI: 10.3389/fsurg.2023.1136166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Background Thymomas and thymic carcinoma are thymic epithelial tumors (TETs) of the anterior mediastinum. On the basis of The AJCC 8th Edition of TNM classification, no prognostic prediction model has been established for TETs patients undergoing surgical resection. In this study, based on data from Qilu Hospital of Shandong University, we identified prognostic factors and developed a nomogram to predict the prognosis for TETs patients undergoing extended thymectomy. Methods Patients with TETs who underwent thymectomy between 2010 and 2020 were consecutively enrolled. An analysis of multivariate Cox regression and stepwise regression using the Akaike information criterion (AIC) was conducted to identify prognostic factors, and a nomogram for TETs was derived from the results of these analyses. The model was validated internally with the Kaplan-Meier curves, ROC curves and calibration curves. Results There were 350 patients with TETs enrolled in the study, and they were divided into a training group (245,0.7) and a validation group (105,0.3). Age, histological type, tumor size, myasthenia gravis, and TNM stage were independent prognostic factors for CSS. The Kaplan-Meier curves showed a significant difference between high nomorisk group and low nomorisk group. A nomogram for CSS was formulated based on the independent prognostic factors and exhibited good discriminative ability as a means of predicting cause-specific mortality, as evidenced by the area under the ROC curves (AUCs) of 3-year, 5-year, and 10-year being 0.946, 0.949, and 0.937, respectively. The calibration curves further revealed excellent consistency between the predicted and actual mortality when using this nomogram. Conclusion There are several prognostic factors for TETs. Based on TNM stage and other prognostic factors, the nomogram accurately predicted the 3-, 5-, and 10-year mortality rates of patients with TETs in this study. The nomogram could be used to stratify risk and optimize therapy for individual patients.
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25
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Hao Y, Si J, Jin J, Wei J, Xiang J, Xu C, Song Z. Comparison of Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy between B3 Thymoma and Thymic Carcinoma. Curr Oncol 2022; 29:9452-9460. [PMID: 36547157 PMCID: PMC9776500 DOI: 10.3390/curroncol29120743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND B3 type thymoma is defined as a well-differentiated thymic carcinoma and is similar to a thymic carcinoma. However, the differences between them are not well defined. In addition, the data to compare the efficacy and safety of platinum-based chemotherapy as first-line therapy between B3 thymoma and thymic carcinoma are lacking. METHODS The efficacy and safety of platinum-based chemotherapy as first-line therapy was retrospectively compared between a group of 36 patients with type B3 thymoma and a group of 127 patients with thymic carcinoma treated between January 2009 and March 2022 at the Zhejiang Cancer Hospital. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events were analyzed. RESULTS The ORRs for B3 thymoma and thymic carcinoma were 36.1% and 28.3%, respectively (p = 0.370). Among all patients, the difference in PFS between B3 thymoma and thymic carcinoma was not significant (11.3 vs. 10.1 months, p = 0.118). The squamous carcinoma subgroup did not exhibit any differences in PFS compared to B3 thymoma (11.7 vs. 11.3 months, p = 0.161). The result for the non-squamous carcinoma subgroup was similar (6.5 vs. 11.3 months, p = 0.128). Furthermore, the OS values for B3 thymoma and thymic carcinoma were not significantly different (58.3 vs. 35.1 months, p = 0.067). However, there were differences in OS between B3 thymoma and non-squamous carcinoma (58.3 vs. 30.6 months, p = 0.031). CONCLUSIONS B3 thymoma and especially squamous carcinoma patients may be treated using a similar therapy scheme as that utilized for thymic carcinoma.
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Affiliation(s)
- Yue Hao
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, China
- Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jinfei Si
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, China
- Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jianan Jin
- Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jingwen Wei
- Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jing Xiang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310000, China
- Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Chunwei Xu
- Department of Respiratory Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210093, China
| | - Zhengbo Song
- Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, China
- Correspondence:
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26
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Gao W, Wu L, Jin S, Li J, Liu X, Xu J, Zhang W, Gong Q, Sun C, Wang W, Wang Z, Shao YW, Yin JC, Shen L, Chen L, Wang Q, Guo R. Rechallenge of immune checkpoint inhibitors in a case with adverse events inducing myasthenia gravis. J Immunother Cancer 2022; 10:jitc-2022-005970. [PMID: 36450378 PMCID: PMC9716945 DOI: 10.1136/jitc-2022-005970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
The mechanism(s) of immune checkpoint inhibitor (ICI)-induced myasthenia gravis (MG), an immune-related adverse event (irAE) that is fatal and limits subsequent ICI use, remain unexplored. Here, through comparative genomic analysis, we identified a pathogenic p.S467C germline variant in SLC22A5 in a thymoma case with ICI-induced MG, which was found to be associated with fatty acid oxidation through its regulation on L-carnitine levels. Remarkably, ICI rechallenge with L-carnitine pretreatment led to durable response without MG-related symptoms. Thus, we provide the first clinical evidence of genetic test-directed irAE management, which integrates individualized ICI treatment into the evolving paradigm of cancer management.
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Affiliation(s)
- Wen Gao
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lingxiang Wu
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Jiangsu, China,Department of Bioinformatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shidai Jin
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Li
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyin Liu
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiali Xu
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Zhang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qixing Gong
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunxiao Sun
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Wang
- Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zidun Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yang W Shao
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, China,School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiani C Yin
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, China
| | - Lu Shen
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, China
| | - Liang Chen
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qianghu Wang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, Jiangsu, China,Department of Bioinformatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Renhua Guo
- Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Abu Zaid MI, Radovich M, Althouse S, Liu H, Spittler AJ, Solzak J, Badve S, Loehrer PJ. A phase II study of buparlisib in relapsed or refractory thymomas. Front Oncol 2022; 12:891383. [PMID: 36330484 PMCID: PMC9623263 DOI: 10.3389/fonc.2022.891383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/05/2022] [Indexed: 10/19/2023] Open
Abstract
PURPOSE To investigate the efficacy and safety of buparlisib, an oral pan-PI3K inhibitor, in relapsed or refractory thymomas. METHODS This was a single center, single arm, open label phase II trial of buparlisib in patients with recurrent thymoma who have progressed after at least one prior line of treatment. The primary endpoint was objective response rate (complete response [CR] + partial response [PR]). Secondary endpoints included toxicity; progression free survival (PFS); overall survival (OS); disease control rate (DCR), i.e., the percentage of patients who achieve either PR or CR or stable disease [SD] for at least 4 months. RESULTS Between 10/13/2014 and 1/18/2017, 14 patients with stage IV disease were enrolled. Median age was 58y (23-74). 71% were females and 71% white. All patients had WHO B2 (29%) or B3 (71%) thymoma. Patients received buparlisib for a median of 4.5m (2-33). At a median follow up of 16.6m (2.4-31.3), onr patients (7%) achieved a PR. DCR was 50%. Median PFS was 11.1m (95% CI 2.9 - 18.8). Median OS, updated as of March, 2021 was 22.5m (10.7-31.3). Most common grade 3-4 adverse events related to buparlisib were dyspnea (21%), rash (14%), elevated transaminases (14%), cough (7%), pneumonitis (7%), anxiety (7%), fatigue (7%) and hyperglycemia (7%). Reasons for treatment discontinuation included progression of disease (n= 5), rash (n=4), pulmonary toxicity (n=3), sinusitis (n=1), and disseminated toxoplasmosis plus autoimmune cholangitis (n=1). As of 3/2021, 8 patients have died, 7 due to disease progression and 1 due to central nervous system toxoplasmosis and autoimmune cholangitis. CONCLUSION Buparlisib showed modest activity in patients with relapsed or refractory thymomas. Further investigation of PI3K pathway targeted therapy in thymoma is warranted. (clinicaltrials.gov ID: NCT02220855). CLINICAL TRIAL REGISTRATION clinicaltrials.gov, identifier (NCT02220855).
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Affiliation(s)
- Mohammad I. Abu Zaid
- Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | | | - Sandra Althouse
- Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Hao Liu
- Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Aaron J. Spittler
- Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | | | - Sunil Badve
- Department of Biostatistics, Emory University, Atlanta, GA, United States
| | - Patrick J. Loehrer
- Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, United States
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Wilde SA, Carroway WP, Hsu DS, Banks KC, Velotta JB. Invasive type B2 thymoma associated with myasthenia gravis, resection with superior vena cava reconstruction. J Surg Case Rep 2022; 2022:rjac368. [PMID: 36071728 PMCID: PMC9444289 DOI: 10.1093/jscr/rjac368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
After being diagnosed with myasthenia gravis, a 55-year-old male was referred for treatment of an invasive thymoma. Preoperative imaging revealed a thymoma adjacent to the superior vena cava (SVC) with possible invasion of the left innominate vein. After multidisciplinary discussion, he underwent upfront en bloc resection of the tumor with SVC resection and reconstruction. He was discharged after an uncomplicated postoperative course with improvement of his symptoms.
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Affiliation(s)
- Sawley A Wilde
- Department of Surgery, UCSF East Bay , Oakland, CA , USA
| | | | - Diana S Hsu
- Department of Surgery, UCSF East Bay , Oakland, CA , USA
| | - Kian C Banks
- Department of Surgery, UCSF East Bay , Oakland, CA , USA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Oakland Medical Center , Oakland, CA , USA
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29
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Chu C, Liang Y, Lin X, Liu Y, Liu S, Guo J, Wang D, Wang J, Liu H, Qiu B. Hypofractionated Radiation Therapy Combined With Weekly Chemotherapy in Patients With Unresectable or Recurrent Thymic Epithelial Tumor: A Prospective, Single-Arm Phase 2 Study (GASTO-1042). Int J Radiat Oncol Biol Phys 2022; 114:89-98. [PMID: 35598797 DOI: 10.1016/j.ijrobp.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/16/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This prospective phase 2 study aimed to evaluate the efficacy and safety of hypofractionated radiation therapy (HRT) combined with concurrent weekly chemotherapy in patients with unresectable or recurrent thymic epithelial tumors (TETs). METHODS AND MATERIALS Patients with unresectable or recurrent intrathoracic TETs that could be encompassed within the radiation fields were enrolled. HRT using intensity modulated radiation therapy (IMRT) technique was administered with 3 different levels of radiation doses (51 Gy/17 fractions (fx), 48 Gy/12 fx, and 45 Gy/9 fx; biologically effective dose of 66.3-67.5Gy), combined with weekly docetaxel (25 mg/m2) and nedaplatin (25 mg/m2). Weekly thymosin α1 (1.6 mg) was administered from the start to 2 months after radiation therapy. The objective response rate (ORR), progression-free survival (PFS), overall survival (OS), health-related quality of life (QOL), and toxicity were recorded. RESULTS Fifty eligible patients enrolled from August 1, 2018, to July 1, 2020, were analyzed. Most patients (82.0%) had stage IVB tumors. Patients had IMRT-HRT (36-51 Gy in 9-17 fx, median biologically effective dose of 67.2 Gy) and concurrent weekly docetaxel/nedaplatin (2-4 cycles). During a median follow-up of 25.0 months (14.0-40.0), the ORR was 83.7%, the 2-year PFS was 59.1%, and the 2-year OS was 90.0%. There was 1 (2.0%) in-field recurrence while 19 (38.0%) patients developed out-of-field recurrence. Grade 3 pneumonitis was observed in 1 patient (2.0%). The ORR, 2-year PFS, 2-year OS, and toxicity were similar among 3 dose levels. Fourteen (28.0%) patients had 2 to 4 courses of radiation therapy because of recurrent diseases. Only 1 suffered from grade 1 pulmonary fibrosis during follow-up. Most patients (88%) maintained a stable QOL within 1 year after radiation therapy. CONCLUSIONS IMRT-HRT and concurrent weekly docetaxel/nedaplatin was effective and well tolerated in unresectable or recurrent TETs. Considering the common out-of-field recurrence, this combined regimen could be an option for repeated radiation therapy. Thymosin α1 might help lower the incidence of pneumonitis and maintain the QOL.
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Affiliation(s)
- Chu Chu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Ying Liang
- State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China; Departments of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaosheng Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Yimei Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Songran Liu
- State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China; Departments of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinyu Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Daquan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Junye Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China; Departments of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China.
| | - Bo Qiu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine; Lung Cancer Institute, Sun Yat-sen University, Guangzhou, China; Guangdong Association Study of Thoracic Oncology, Guangzhou, China.
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Histological Classification and Invasion Prediction of Thymoma by Machine Learning-Based Computed Tomography Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4594757. [PMID: 36051922 PMCID: PMC9410846 DOI: 10.1155/2022/4594757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022]
Abstract
Purpose The values of machine learning-based computed tomography (CT) imaging in histological classification and invasion prediction of thymoma were investigated. Methods 181 patients diagnosed with thymoma by surgery or biopsy in Shantou Central Hospital between February 2017 and March 2022 were selected. According to the concept of simplified histological classification and the latest histological classification by the WHO, thymoma was divided into two groups, including low-risk (types A, AB, B1, and metaplastic type) and high-risk groups (types B2 and B3). CT images were reconstructed by filtering back projection (FBP) algorithm. CT image features were collected for statistical analysis. Results The main symptoms of patients diagnosed with thymoma included respiratory tract infection, chest distress and shortness of breath, and chest pain. 35.91% of them suffered from complicated myasthenia gravis. Tumor size and position in low-risk and high-risk groups showed no statistical significance (P > 0.05). Tumor morphology and boundary between the two groups suggested statistical difference (P < 0.05). Whether tumor invaded adjacent tissues was apparently correlated with simplified histological classification (P < 0.01). The sensitivity and specificity of CT images for the invasion of mediastinal pleura or pericardium were around 90% and negative predictive values both reached above 95%. Those of the CT images for lung invasion were over 80%. The negative and positive predictive values were 93.54% and 63.82%, respectively. Those of the CT images for blood vessel invasion were 67.32% and 97.93%. The negative and positive predictive values were 98.21% and 83%, respectively. Conclusion The machine learning-based CT image had significant values in the prediction of different histological classification and even invasion level.
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Wang Y, Zhang X, Tian D, Han S, Zhang J, Nie J, Dai L, Hu W, Chen X, Ma X, Tian G, Wu D, Zhang Z, Long J, Fang J. Second-line treatment options in advanced thymic carcinoma after failure of platinum-based chemotherapy: A multicenter retrospective study. Cancer Med 2022; 12:2303-2311. [PMID: 35924403 PMCID: PMC9939196 DOI: 10.1002/cam4.5053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Currently there is no standard therapy recommended for second-line treatment for thymic carcinoma. Our study compared multidrug chemotherapy, single-agent chemotherapy, and PD-1 inhibitors in patients diagnosed with advanced thymic carcinoma who had previous platinum-based chemotherapy at the clinic. METHODS The study included patients with thymic carcinoma who failed first-line platinum-based chemotherapy. Kaplan-Meier methods were applied in the study for estimating the progression-free survival (PFS) and overall survival (OS) curves. Pearson chi-square or Fisher's exact chi-square test was adopted to make comparisons of the objective response rate (ORR) between treatment groups. Cox regression was used for the multivariate analyses in PFS and OS. RESULTS Among the 92 patients enrolled, multidrug chemotherapy was used in 51 (55.4%) patients for second-line therapy. Thirty-six patients (35.9%) received single-agent chemotherapy, and eight patients (8.7%) underwent PD-1 inhibitors. The multidrug chemotherapy group showed better efficacy than the other two groups, with an ORR of 35.3% (p = 0.006). The median PFS of multidrug chemotherapy, single-agent chemotherapy and PD-1 inhibitors were 5.0 months, 3.0 months, and 4.0 months, respectively (p = 0.008). Patients in the multidrug chemotherapy group also showed an advantage in OS in comparison with the other two treatment groups (p = 0.045), with a median OS of 30.4 months. Multivariate analysis showed that second-line treatment was independent factor for both PFS (p = 0.035) and OS (p = 0.037). Grade 3-4 AEs were mostly detected in patients receiving multidrug chemotherapy and were primarily hematologic. Treatment-related mortality was not found in any of the groups. CONCLUSIONS Multidrug chemotherapy had a trend toward a more positive response rate and outcomes in longer survival time than single-agent chemotherapy and PD-1 inhibitors. Multidrug chemotherapy is a choice worth considering for second-line therapy in patients with thymic carcinoma if tolerable.
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Affiliation(s)
- Yang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xuanye Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Sen Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jie Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jun Nie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Ling Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Weiheng Hu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xiaoling Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xiangjuan Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Guangming Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Di Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Ziran Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jieran Long
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jian Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
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Tumour immune microenvironment in resected thymic carcinomas as a predictor of clinical outcome. Br J Cancer 2022; 127:1162-1171. [PMID: 35750748 DOI: 10.1038/s41416-022-01875-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 05/05/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The spatial distribution of tumour-infiltrating lymphocytes (TILs) is a novel descriptor characterising the tumour immune microenvironment (TIME). The aim of our study was to assess whether a specific TIME of surgically resected thymic carcinoma (TC) can predict tumour invasiveness, recurrence or survival. METHODS Digital microscopy was performed on 39 TCs immunohistochemically stained to investigate the activation of the immune checkpoint pathway (PD-L1/PD-1), along with density and spatial distribution of TILs phenotypes (CD3+, CD4+, CD8+, FOXP3+, CD56+). The impact of PD-L1 and TIL density considering the intratumoural (iTILs) and stromal (sTILs) distribution on pathological characteristics and clinical outcomes were analysed. RESULTS In early TC stages, we observed a higher total density of CD3+ (p = 0.05) and CD8+ (p = 0.02) TILs. PD-L1 was expressed in 71.8% of TCs. In advanced TC stages, we observed a lower density of CD3+ (p = 0.04) and CD8+ (p = 0.01) iTILs compared to early stages. Serum concentrations of PD-L1 were significantly higher in TCs compared to healthy controls: 134.43 ± 18.51 vs. 82.01 ± 6.34 pg/ml (p = 0.001), respectively. High densities of stromal CD4+ TILs (54 vs. 32%, p = 0.043) and CD8+ TILs (65 vs. 17%, p = 0.048) were associated with improved freedom from recurrence (FFR) and cause-specific survival (CSS). High density of FoxP3+ TILs were associated with improved FFR (p = 0.03) and CSS (p = 0.003). DISCUSSION Mapping TIL subpopulations complement the armamentarium for prognostication of TC outcomes. The improved outcome in patients with high density of TILs supports the use of immune checkpoint inhibitors in TC patients.
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Wang S, Ao Y, Jiang J, Lin M, Chen G, Liu J, Zhao S, Gao J, Zhang Y, Ding J, Tan L. How can the rate of nontherapeutic thymectomy be reduced? Interact Cardiovasc Thorac Surg 2022; 35:6586802. [PMID: 35579357 PMCID: PMC9419679 DOI: 10.1093/icvts/ivac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongqiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jiahao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Gang Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Roden AC, Ahmad U, Cardillo G, Girard N, Jain D, Marom EM, Marx A, Moreira AL, Nicholson AG, Rajan A, Shepherd AF, Simone CB, Strange CD, Szolkowska M, Truong MT, Rimner A. Thymic Carcinomas-A Concise Multidisciplinary Update on Recent Developments From the Thymic Carcinoma Working Group of the International Thymic Malignancy Interest Group. J Thorac Oncol 2022; 17:637-650. [PMID: 35227908 PMCID: PMC11080660 DOI: 10.1016/j.jtho.2022.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Thymic carcinomas are rare malignancies that in general arise in the prevascular (anterior) mediastinum. These tumors are usually invasive, often present at advanced stages, and typically behave aggressively. Studies are hampered by the paucity of these tumors, the large variety of carcinoma subtypes, and the lack of unique morphologic and immunophenotypic features. Despite these challenges, advances in diagnostic imaging, surgical approaches, systemic therapies, and radiation therapy techniques have been made. The WHO classification of thymic epithelial tumors has been updated in 2021, and the eighth tumor nodal metastasis staging by the American Joint Committee on Cancer/Union for International Cancer Control included thymic carcinomas in 2017. Molecular alterations that provide more insight into the pathogenesis of these tumors and that potentially permit use of novel targeted therapies are increasingly being identified. New approaches to radiation therapy, chemotherapy, and immunotherapy are under evaluation. International societies, including the International Thymic Malignancy Interest Group, European Society of Thoracic Surgeons, and Japanese, Chinese, and Korean thymic associations, have been critical in organizing and conducting multi-institutional clinical studies. Herein, we review contemporary multidisciplinary perspectives in diagnosis and management of thymic carcinoma.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Usman Ahmad
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Nicolas Girard
- Institut Curie, Institut du thorax Curie Montsouris, Paris, France; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Paris Saclay Campus, Versailles, France
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Edith M Marom
- Radiology Department, The Chaim Sheba Medical Center Affiliated With Tel Aviv University, Tel Aviv, Israel
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Annemarie F Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center and New York Proton Center, New York, New York
| | - Chad D Strange
- Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Texas
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Mylene T Truong
- Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Texas
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Remon J, Bernabé R, Diz P, Felip E, González-Larriba JL, Lázaro M, Mielgo-Rubio X, Sánchez A, Sullivan I, Massutti B. SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021). Clin Transl Oncol 2022; 24:635-645. [PMID: 35122634 PMCID: PMC8817662 DOI: 10.1007/s12094-022-02788-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
Thymic epithelial tumours (TET) represent a heterogeneous group of rare malignancies that include thymomas and thymic carcinoma. Treatment of TET is based on the resectability of the tumour. If this is considered achievable upfront, surgical resection is the cornerstone of treatment. Platinum-based chemotherapy is the standard regimen for advanced TET. Due to the rarity of this disease, treatment decisions should be discussed in specific multidisciplinary tumour boards, and there are few prospective clinical studies with new strategies. However, several pathways involved in TET have been explored as potential targets for new therapies in previously treated patients, such as multi-tyrosine kinase inhibitors with antiangiogenic properties and immune checkpoint inhibitors (ICI). One third of patient with thymoma present an autoimmune disorders, increasing the risk of immune-related adverse events and autoimmune flares under ICIs. In these guidelines, we summarize the current evidence for the therapeutic approach in patients with TET and define levels of evidence for these decisions.
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Affiliation(s)
- J Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Nou Delfos, HM Hospitales, Avinguda de Vallcarca, 151, 08023, Barcelona, Spain.
| | - R Bernabé
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - P Diz
- Department of Medical Oncology, Hospital Universitario de León, León, Spain
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J L González-Larriba
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - M Lázaro
- Department of Medical Oncology, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - X Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Sánchez
- Department of Medical Oncology, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - I Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - B Massutti
- Department of Medical Oncology, Hospital General Universitario de Alicante, Alicante, Spain
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Li Y, Jiang A, Zhao Y, Shi C, Ma Y, Fu X, Liang X, Tian T, Ruan Z, Yao Y. A novel risk classifier for predicting the overall survival of patients with thymic epithelial tumors based on the eighth edition of the TNM staging system: A population-based study. Front Endocrinol (Lausanne) 2022; 13:1050364. [PMID: 36561557 PMCID: PMC9763871 DOI: 10.3389/fendo.2022.1050364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Thymic epithelial tumors (TETs) are rare tumors that originated from thymic epithelial cells, with limited studies investigating their prognostic factors. This study aimed to investigate the prognostic factors of TETs and develop a new risk classifier to predict their overall survival (OS). METHODS This retrospective study consisted of 1224 TETs patients registered in the Surveillance, Epidemiology, and End Results (SEER) database, and 75 patients from the First Affiliated Hospital of Xi'an Jiaotong University. The univariate and multivariate Cox regression analyses were adopted to select the best prognostic variables. A nomogram was developed to predict the OS of these patients. The discriminative and calibrated abilities of the nomogram were assessed using the receiver operating characteristics curve (ROC) and calibration curve. Decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI) were adopted to assess its net clinical benefit and reclassification ability. RESULTS The multivariate analysis revealed that age, sex, histologic type, TNM staging, tumor grade, surgery, radiation, and tumor size were independent prognostic factors of TETs, and a nomogram was developed to predict the OS of these patients based on these variables. The time-dependent ROC curves displayed that the nomogram yielded excellent performance in predicting the 12-, 36- and 60-month OS of these patients. Calibration curves presented satisfying consistencies between the actual and predicted OS. DCA illustrated that the nomogram will bring significant net clinical benefits to these patients compared to the classic TNM staging system. The estimated NRI and IDI showed that the nomogram could significantly increase the predictive ability of 12-, 36- and 60-month OS compared to the classic TNM staging system. Consistent findings were discovered in the internal and external validation cohorts. CONCLUSION The constructed nomogram is a reliable risk classifier to achieve personalized survival probability prediction of TETs, and could bring significant net clinical benefits to these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yu Yao
- *Correspondence: Yu Yao, ; Zhiping Ruan,
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Canine Epithelial Thymic Tumors: Outcome in 28 Dogs Treated by Surgery. Animals (Basel) 2021; 11:ani11123444. [PMID: 34944221 PMCID: PMC8698125 DOI: 10.3390/ani11123444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Thymoma is a tumor of the cranial mediastinum rarely reported in dogs and should be differentiated from mediastinal lymphoma. CT and fine-needle aspirates or core biopsies are helpful in differential diagnosis, but flow cytometry may improve the pre-operative diagnostic ability. In thymomas, paraneoplastic syndromes such as myasthenia gravis and hypercalcemia may develop concurrently with the tumor. Their role as prognostic factors is not well determined. Surgical excision is the treatment of choice, but adjuvant radiotherapy and/or chemotherapy may prolong survival in cases of incomplete excision or if a thymic carcinoma is diagnosed. Local recurrence and metastasis are infrequently reported; therefore, a long survival is expected if the tumor is completely excised or if adjuvant therapy is undertaken. This article reports the authors’ experience with 28 dogs affected by 18 thymomas and 10 thymic carcinomas surgically treated from January 2000 to August 2021. The median overall survival time of the entire population was 1137 days; the median disease-free time was 903 days. Dogs with thymic carcinomas had significantly shorter disease-free intervals and shorter, although not statistically significant, survival times. Dogs with Masaoka Stage III tumors had worse outcomes. Abstract Thymoma is a tumor rarely reported in dogs and should be differentiated from mediastinal lymphoma. Clinical signs may have a late onset, and thymoma is often diagnosed when symptoms related to the space-occupying effect or paraneoplastic syndromes occur. CT and fine-needle aspirates or core biopsies are helpful in differential diagnosis, but flow cytometry may improve the pre-operative diagnostic ability. Concurrent paraneoplastic syndromes such as myasthenia gravis and hypercalcemia have been reported; however, their role as prognostic factors is not well determined. Surgical excision is the treatment of choice; adjuvant radiotherapy and/or chemotherapy may prolong survival in cases of incomplete excision or when a thymic carcinoma is diagnosed. Local recurrence and metastasis are infrequently reported; therefore, a long survival time is expected if the tumor is completely excised or if adjuvant therapy is undertaken. This article reports the authors’ experience with 28 dogs affected by 18 thymomas and 10 thymic carcinomas. The median overall survival in this series was 1173 days, and the median disease-free interval was 903 days. Dogs with thymic carcinoma had significantly shorter disease-free intervals and shorter, although not statistically significant, survival times. Dogs with Masaoka Stage III tumors had worse outcomes.
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Kaira K, Imai H, Yamaguchi O, Mouri A, Kagamu H. Salvage Chemotherapy in Patients with Previously Treated Thymic Carcinoma. Cancers (Basel) 2021; 13:5441. [PMID: 34771601 PMCID: PMC8582353 DOI: 10.3390/cancers13215441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Thymic carcinoma is a rare neoplasm, and it is difficult to achieve complete remission with systemic chemotherapy. In advanced or recurrent thymic carcinoma, platinum-based chemotherapy is chosen as the first-line setting; however, it remains unclear which regimen is better to improve its outcome. It remains unknown whether salvage chemotherapy should be administered to patients with platinum-based chemotherapy-refractory thymic carcinoma. Currently, several clinical studies have investigated the efficacy of second-line settings for advanced thymic carcinoma. As cytotoxic agents, S-1, amrubicin, pemetrexed, docetaxel, paclitaxel, and gemcitabine have been reported as prospective phase II studies or retrospective studies. The overall response rates (ORRs) of S-1, amrubicin, and pemetrexed were 25-50%, 11-44.4%, and 9-10%, respectively. Molecular targeting drugs, such as sunitinib, everolimus, and lenvatinib, also provide clinical effectiveness with tolerability after the failure of platinum-based regimens. Based on the results of the prospective phase II study, the ORR, median progression-free survival, and median overall survival were 16.6% and 5.6 months, respectively, in everolimus, 26% and 7.2 months, respectively, in sunitinib, and 38% and 9.3 months, respectively, in lenvatinib. Although it is difficult to compare each study, lenvatinib appears to be better in increasing efficacy as a second-line setting. However, each study had a small sample size, which may have biased the results of their studies. Further investigation is warranted to elucidate the therapeutic significance of salvage chemotherapy in advanced thymic carcinoma in a large-scale study.
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Affiliation(s)
- Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka 350-1298, Saitama, Japan; (H.I.); (O.Y.); (A.M.); (H.K.)
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Kitano H, Yamaguchi F, Atarashi K, Hiraiwa M, Shiratori Y, Onozaki S, Shikama Y. Correlation Between Thymoma and Soluble Interleukin-2 Receptor Expression in a Patient with Good Syndrome. Onco Targets Ther 2021; 14:5045-5049. [PMID: 34675549 PMCID: PMC8520479 DOI: 10.2147/ott.s326193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
Good syndrome is a rare condition characterized by the presence of thymoma in combination with adult-onset hypogammaglobulinemia. Immunological features of Good syndrome include various immunodeficiencies accompanied with hypogammaglobulinemia. In patients with thymoma, paraneoplastic syndromes including hypogammaglobulinemia worsen the prognosis. We herein describe a patient with advanced-stage type A thymoma who was effectively treated with chemotherapy and exhibited a parallel decrease in the serum level of soluble interleukin-2 receptor (sIL-2R), which depends on cellular immunity. The present case suggests the efficacy of sIL-2R as a potential prognostic biomarker in a subset of patients with Good syndrome.
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Affiliation(s)
- Haruka Kitano
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
| | - Kenji Atarashi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
| | - Mina Hiraiwa
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
| | - Yo Shiratori
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
| | - Shota Onozaki
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
| | - Yusuke Shikama
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
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Tegshee B, Kondo K, Soejima S, Muguruma K, Tsuboi M, Kajiura K, Kawakami Y, Kawakita N, Toba H, Yoshida M, Takizawa H, Tangoku A. GHSR methylation-dependent expression of a variant ligand and receptor of the ghrelin system induces thymoma tumorigenesis. Oncol Lett 2021; 22:793. [PMID: 34630704 PMCID: PMC8477069 DOI: 10.3892/ol.2021.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022] Open
Abstract
Our previous study reported that the DNA methylation of growth hormone secretagogue receptor (GHSR) was significantly higher in thymoma or thymic carcinoma (TC) than in normal thymic tissue samples. Thymic epithelial tumors (TETs) with higher GHSR DNA methylation were associated with significantly worse prognosis than those with lower levels of DNA methylation. Diversified components of the ghrelin-GHSR axis may exert opposing effects in cancer progression, depending on the cancer type in question. However, the precise function of the axis remains unclear. In the present study, the mRNA expression of five key components of the ghrelin system [native ligand ghrelin, variant ligand In-1 ghrelin, native receptor GHSR1a, variant receptor GHSR1b and acylation enzyme ghrelin O-acyltransferase (GOAT)] were examined in 58 TET samples by reverse transcription-quantitative PCR, and protein expression of GHSR1a and GHSR1b was assessed in 20 TETs using immunohistochemistry. The results revealed that In-1 ghrelin, GHSR1b (variant forms) and GOAT were more strongly expressed in thymoma compared with thymic-adjacent tissue. By contrast, no significant differences were observed in the expression of ghrelin and GHSR1a (native forms) between thymoma and thymic tissue. The mRNA expression of In-1 ghrelin and GHSR1b (variant forms) was positively associated with GHSR methylation in thymoma tissue samples. However, a relationship was not found between ghrelin, GHSR1a or GOAT expression (native forms) and GHSR methylation in thymoma. Immunohistochemical analysis revealed that mRNA expression of GHSR1a and GHSR1b generally correlated with expression of the corresponding protein, and that the expression of GHSR1b was increased in advanced-stage TETs. These results indicate that the DNA methylation of GHSR is associated with a shift from native expression (ghrelin and GHSR1a) to variant expression (In-1 ghrelin and GHSR1b), which induces the tumorigenesis of thymoma, but not TC.
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Affiliation(s)
- Bilguun Tegshee
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8509, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8509, Japan
| | - Shiho Soejima
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8509, Japan
| | - Kyoka Muguruma
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8509, Japan
| | - Mitsuhiro Tsuboi
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Koichiro Kajiura
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yukikiyo Kawakami
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima 770-8503, Japan
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Calabrese F, Fortarezza F, Pezzuto F, Lunardi F, Comacchio G, Sbaraglia M, Pasello G, Marulli G, Dei Tos AP, Rea F. The Rarest of Rare Thymic Lesions: A 10-Year Surgical Pathology Experience. Cancers (Basel) 2021; 13:4056. [PMID: 34439210 PMCID: PMC8392427 DOI: 10.3390/cancers13164056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
The thymus is a specialized primary lymphoid organ located in the midline pre-vascular mediastinum. The organ is the site of various pathological processes, neoplastic and not, whose rarity has not allowed in-depth studies on clinical or histological features of rarest and unusual variants. Herein, we report a 10-year Padova experience in the surgical pathology of the thymus, focusing on the pathological description of nonneoplastic lesions and rare epithelial and mesenchymal tumors recorded in our database, which comprises over 600 thymectomies. The extrapolated rare cases have been categorized into four groups that included 15 cysts, 18 carcinomas, 5 neuroendocrine tumors, and 2 soft tissue tumors. The cases are described from a clinical and pathological point of view and discussed in dedicated sections with a review of the most important literature. In this case, review series, we aim to update the epidemiology of these rare entities, improve diagnostic awareness, and finally, promote a collaborative network between referral centers.
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Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Giovanni Comacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Marta Sbaraglia
- Department of Medicine, University of Padova, 35121 Padova, Italy; (M.S.); (A.P.D.T.)
| | - Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, 35121 Padova, Italy;
| | - Giuseppe Marulli
- Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Angelo Paolo Dei Tos
- Department of Medicine, University of Padova, 35121 Padova, Italy; (M.S.); (A.P.D.T.)
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
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Zhang Y, Li Z, Chen Y, Tan L, Zeng Z, Ding J, Du S. Induction Strategy for Locally Advanced Thymoma. Front Oncol 2021; 11:704220. [PMID: 34367988 PMCID: PMC8339962 DOI: 10.3389/fonc.2021.704220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022] Open
Abstract
Surgery remains cornerstone for the management of thymoma. Complete surgical resection (R0), is recognized as the constant and significant factor for prognosis. However, in locally advanced (Masaoka-Koga stages III-IVa) thymomas, achieving R0 resection remains challenging due to local-regional invasion of the disease. Induction treatment, with the aim of reducing bulky tumor mass, offers new strategy to facilitate totally surgical resection. Herein, we reviewed recent progress and provided a comprehensive overview of induction strategy in locally advance thymoma.
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Affiliation(s)
- Yang Zhang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongjuan Li
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yixing Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shisuo Du
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Hayashi K, Nakazato Y, Ouchi M, Fujita T, Endou H, Chida M. Antitumor effect of dimethyl itaconate on thymic carcinoma by targeting LDHA-mTOR axis. Life Sci 2021; 282:119847. [PMID: 34293399 DOI: 10.1016/j.lfs.2021.119847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/02/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
AIMS Thymic carcinoma is a rare type of cancer without an established standard pharmaceutical treatment. This study investigated the antitumor effect of dimethyl itaconate (DI), a cell-permeable derivative of itaconate, on human thymic carcinoma cell line. MAIN METHODS Human thymic carcinoma cell line Ty82 was used to evaluate the effect of DI on cell viability. Western blotting and immunohistochemistry were performed to determine the molecular mechanism of antitumor effects of DI on Ty82. KEY FINDINGS DI suppressed cell growth and promoted apoptosis of Ty82. The suppressive effect of DI on Ty82 was mediated by the downregulation of lactate dehydrogenase A (LDHA), and the subsequent decrease in the activity of mechanistic target of rapamycin (mTOR). DI exhibited synergistic antitumor effects with a specific inhibitor of large neutral amino acid transporter 1 (LAT1), an amino acid transporter currently being investigated as a novel target for cancer therapy. SIGNIFICANCE Our findings demonstrate that DI is a novel potential strategy for thymic carcinoma treatment.
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Affiliation(s)
- Keitaro Hayashi
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Shimotsuga, Japan.
| | - Yoshimasa Nakazato
- Department of Diagnostic Pathology, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Motoshi Ouchi
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Tomoe Fujita
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | | | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
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Hamaji M, Omasa M, Nakanishi T, Nakakura A, Morita S, Miyamoto E, Nakagawa T, Miyahara S, Sonobe M, Takahashi M, Terada Y, Hijiya K, Sumitomo R, Huang CL, Kojima F, Shoji T, Date N, Miyata R, Suga M, Nakanobo R, Kawakami K, Aoyama A, Date H. Lymph node dissection in thymic carcinomas and neuroendocrine carcinomas. Interact Cardiovasc Thorac Surg 2021; 33:242-249. [PMID: 34151358 DOI: 10.1093/icvts/ivab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Although lymph node (LN) metastases are not uncommon in thymic carcinomas, preoperative LN evaluation, intraoperative lymph node dissection (LND) and postoperative outcomes remain unknown. The aim of this study was to elucidate the characteristics of and outcomes in patients with thymic carcinomas and thymic neuroendocrine carcinomas undergoing LND. METHODS A retrospective chart review was performed using our multi-institutional database to identify patients who underwent resection and LND for thymic carcinoma or thymic neuroendocrine carcinoma between 1991 and 2018. An enlarged mediastinal LN was defined as having a short-axis diameter >1 cm. We assessed survival outcomes using the Kaplan-Meier analysis. RESULTS N1-level LND was performed in 41 patients (54.6%), N2-level LND in 14 patients (18.7%) and both-level LND in 16 patients (21.3%). Pathological LN metastasis was detected in 20 patients (26.7%) among the 75 patients undergoing LND. There was a significant difference in the number of LN stations (P = 0.015) and metastasis factor (P = 0.0042) between pathologically LN-positive and pathologically LN-negative patients. The sensitivity of enlarged LNs on preoperative computed tomography was 18.2%. There was a tendency towards worse overall survival of pathologically N2-positive patients, although the difference was not statistically significant (P = 0.15). CONCLUSIONS Preoperative CT appears to play a limited role in detecting pathological LN metastases. Our findings suggest that the significance of N1- and N2-level LND should be evaluated in prospective studies to optimize the postoperative management of patients with thymic carcinomas and neuroendocrine carcinomas.
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Affiliation(s)
- Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Mitsugu Omasa
- Department of Thoracic Surgery, Nishi Kobe Medical Center, Kobe, Japan
| | - Takao Nakanishi
- Department of Thoracic Surgery, Nishi Kobe Medical Center, Kobe, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ei Miyamoto
- Department of Thoracic Surgery, Tenri Hospital, Nara, Japan
| | | | - So Miyahara
- Department of Thoracic Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Mamoru Takahashi
- Department of Thoracic Surgery, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yasuji Terada
- Department of Thoracic Surgery, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Kyoko Hijiya
- Department of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Ryota Sumitomo
- Department of Thoracic Surgery, Kitano Hospital, The Tazuke Kofukai Medical Institute, Osaka, Japan
| | - Cheng-Long Huang
- Department of Thoracic Surgery, Kitano Hospital, The Tazuke Kofukai Medical Institute, Osaka, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tsuyoshi Shoji
- Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan
| | - Naoki Date
- Department of Thoracic Surgery, Otsu Red Cross Hospital, Osaka, Japan
| | - Ryo Miyata
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Michiharu Suga
- Department of Thoracic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Ryo Nakanobo
- Department of Thoracic Surgery, Shiga General Hospital, Shiga, Japan
| | - Kenzo Kawakami
- Department of Thoracic Surgery, Shiga General Hospital, Shiga, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
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Soejima S, Kondo K, Tsuboi M, Muguruma K, Tegshee B, Kawakami Y, Kajiura K, Kawakita N, Toba H, Yoshida M, Takizawa H, Tangoku A. GAD1 expression and its methylation as indicators of malignant behavior in thymic epithelial tumors. Oncol Lett 2021; 21:483. [PMID: 33968199 PMCID: PMC8100960 DOI: 10.3892/ol.2021.12744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Thymic epithelial tumors (TETs) comprise thymomas and thymic carcinoma (TC). TC has more aggressive features and a poorer prognosis than thymomas. Genetic and epigenetic alterations in thymomas and TC have been investigated in an attempt to identify novel target molecules for TC. In the present study, genome-wide screening was performed on aberrantly methylated CpG islands in thymomas and TC, and the glutamate decarboxylase 1 gene (GAD1) was identified as the 4th significantly hypermethylated CpG island in TC compared with thymomas. GAD1 catalyzes the production of γ-aminobutyric acid from L-glutamic acid. GAD1 expression is abundant in the brain but rare in other tissues, including the thymus. A total of 73 thymomas and 17 TC tissues were obtained from 90 patients who underwent surgery or biopsy at Tokushima University Hospital between 1990 and 2017. DNA methylation was examined by bisulfite pyrosequencing, and the mRNA and protein expression levels of GAD1 were analyzed using reverse transcription-quantitative PCR and immunohistochemistry, respectively. The DNA methylation levels of GAD1 were significantly higher in TC tissues than in the normal thymus and thymoma tissues, and GAD1 methylation exhibited high sensitivity and specificity for discriminating between TC and thymoma. The mRNA and protein expression levels of GAD1 were significantly higher in TC tissues than in thymomas. Patients with TET with high GAD1 DNA hypermethylation and high mRNA and protein expression levels had significantly shorter relapse-free survival rates than those with low levels. In conclusion, significantly more epigenetic alterations were observed in TC tissues compared with in thymomas, which may contribute to the clinical features and prognosis of patients.
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Affiliation(s)
- Shiho Soejima
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan
| | - Mitsuhiro Tsuboi
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Kyoka Muguruma
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan
| | - Bilguun Tegshee
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan
| | - Yukikiyo Kawakami
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Koichiro Kajiura
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
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Lesire B, Durieux V, Grigoriu B, Girard N, Berghmans T. Management of thymoma associated autoimmune pure red cell aplasia: Case report and systematic review of the literature. Lung Cancer 2021; 157:131-146. [PMID: 34049719 DOI: 10.1016/j.lungcan.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare paraneoplastic syndrome observed in 2-5 % of thymomas. Literature reports great variability in its management. Based on an illustrative clinical case, we present a systematic literature review whose main objective is to evaluate the therapeutic management of PRCA. The literature search was performed based on the PICO method in the Medline and Scopus databases. The reference clinical case concerns a 51-year-old woman with stage IVa thymoma. After initial response to chemotherapy, a locoregional progression occurred with PRCA development that responded favorably under second line chemotherapy. The patient finally died in a context of bicytopenia with febrile neutropenia. The systematic review covers 135 articles published between 1950 and 2019. Thymectomy alone or in combination with other therapies showed a 31 % complete remission (CR) rate for PRCA of, whereas none was reported with anti-tumor treatments without thymectomy. Among immunomodulatory therapies, cyclosporin gave the highest percentage of CR (74 %). Finally, the combination of thymectomy and immunomodulatory treatments showed a CR rate of 45 %. Thymectomy appeared to be the most effective anti-tumor treatment for PRCA. Immunomodulatory therapies, particularly cyclosporine, are shown effective, but the risk of infectious complications must be considered. The optimal place of anti-tumor and immunomodulatory therapies against PRCA has yet to be determined.
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Affiliation(s)
- Bastien Lesire
- Department of Internal Medecine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles, Belgium.
| | - Bogdan Grigoriu
- Department of Intensive Care and Oncological Emergencies & Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France.
| | - Thierry Berghmans
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Laboratoire Facultaire de Médecine Factuelle de l'Université Libre de Bruxelles, Belgium.
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Shen L, Chen H, Wei Q. Immune-Therapy-Related Toxicity Events and Dramatic Remission After a Single Dose of Pembrolizumab Treatment in Metastatic Thymoma: A Case Report. Front Immunol 2021; 12:621858. [PMID: 33936037 PMCID: PMC8082155 DOI: 10.3389/fimmu.2021.621858] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitor therapy has become a promising option for the treatment of late-stage thymic epithelial tumors. In this manuscript, we presented a patient with metastatic thymoma administrated of anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab. Although the patient underwent a rapid and dramatic response to one dose of pembrolizumab, she suffered a storm of immune-therapy related toxicity events (irAEs), including liver and kidney dysfunction, hypothyroidism and myocarditis. We didn’t observe >grade 3 irAEs, and proceed with pembrolizumab therapy after the function recovered. Although no guidelines recommend dose reduction of immunotherapy re-treating following initial irAEs, we optimize dose of pembrolizumab to minimize the irAEs induced by PD-1 antibody while maintaining clinical effectiveness. Excitingly, we observe remarkable tumor remission and mild toxicities of half dose of pembrolizumab in this case. In conclusion, the clinical utilization of immunotherapy is an encouraging therapeutic alternative for advanced thymomas. At the same time, patients have to be monitored very carefully, because of the risk to develop irAEs.
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Affiliation(s)
- Li Shen
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Haiyan Chen
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qichun Wei
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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48
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Theermann R, Ohlmeier M, Hartwig CH, Wolff T, Gehrke T, Citak M. [Case report of an osseous (and lymphogenic) thymic carcinoma in an adult]. DER ORTHOPADE 2021; 50:326-332. [PMID: 32350550 DOI: 10.1007/s00132-020-03911-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A Thymic carcinoma in adults is rare. We present the case of a 47-year-old man, who was treated conservatively for spondylolisthesis L5/S1 in our institution for several years. In the further course, the patient complained about pain exacerbation with acute lower back pain. Cross-sectional scanning showed a tumor of the lumbar vertebral body three. A biopsy of this mass revealed a metastatic thymic carcinoma of the squamous cells. After palliative therapy, the patient died 9 months after initial diagnosis.
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Affiliation(s)
- R Theermann
- Abteilung für Gelenkchirurgie, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Deutschland. .,MVZ Orthopädie Mühlenkamp, Mühlenkamp 33a, 22303, Hamburg, Deutschland.
| | - M Ohlmeier
- Abteilung für Gelenkchirurgie, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Deutschland
| | - C H Hartwig
- Abteilung für Gelenkchirurgie, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Deutschland.,MVZ Orthopädie Mühlenkamp, Mühlenkamp 33a, 22303, Hamburg, Deutschland
| | - T Wolff
- Onkologische Schwerpunktpraxis, Lerchenfeld 14, 22303, Hamburg, Deutschland
| | - T Gehrke
- Abteilung für Gelenkchirurgie, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Deutschland
| | - M Citak
- Abteilung für Gelenkchirurgie, Helios ENDO-Klinik, Holstenstraße 2, 22767, Hamburg, Deutschland
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49
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Gao HJ, Shi GD, Pan MJ, Liu XT, Wei YC. Autogenous pericardial angioplasty for thymic malignancies: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2021; 5:6. [PMID: 35118312 PMCID: PMC8794382 DOI: 10.21037/med-20-57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/27/2020] [Indexed: 06/14/2023]
Abstract
Locally advanced thymic tumor usually invades adjacent great vessels, while the optimal treatment strategy for vessels resection and prosthetic replacement is still in controversial. We hereby present our series of patients undergoing autologous pericardial angioplasty for thymic malignancies. For invasive thymic tumors involving the superior vena cava (SVC), the replacement vessel was prepared by autologous pericardium and placed between the right atrium and distal left innominate vein stump to establish a SVC bypass. Then, the distal right innominate vein and proximal SVC were blocked, and the thymic tumor and involved vessel were completely resected, followed by SVC reconstruction using pericardium. We retrospectively analyzed the clinical characteristics and short-term outcomes of six related patients with autologous pericardial angioplasty. Due to the homologous advantages of autologous pericardial transplantation, those patients didn't need to receive anticoagulant therapy during the perioperative period, so as to avoid the occurrence of hemorrhage, embolism and other graft-related complications. There were no postoperative long-term thoracic drainage (>7 days), anastomotic bleeding, reconstructed vascular stenosis, embolism or even secondary thoracotomy and other related complications occurred in this case series. The application of autologous pericardium for the replacement of mediastinal great vessels in the surgery of locally advanced thymoma is a safe and effective technique. Compared with former artificial materials, such as polytetrafluoroethylene synthetic prosthesis, autologous pericardial transplantation avoids the occurrence of high risk graft-related complications such as postoperative hemorrhage and vascular stenosis, and its clinical application prospect is worth expecting.
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Affiliation(s)
- Hui-Jiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guo-Dong Shi
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mao-Jie Pan
- Department of Thoracic Surgery, Linyi People’s Hospital, Linyi, China
| | - Xiao-Tong Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Wong-Chong J, Bernadach M, Ginzac A, Veyssière H, Durando X. Pembrolizumab as a novel therapeutic option for patients with refractory thymic epithelial tumor: A case report. World J Clin Cases 2021; 9:1139-1147. [PMID: 33644178 PMCID: PMC7896660 DOI: 10.12998/wjcc.v9.i5.1139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thymic epithelial carcinomas are rare and have a poor prognosis. Treatment of thymic epithelial carcinoma is multimodal and includes surgery, post-operative radiation therapy, adjuvant and neoadjuvant chemotherapy, or exclusive chemotherapy based on disease resectability. However, there is currently no standard treatment regimen for metastatic and recurrent thymic carcinoma.
CASE SUMMARY A 45-year-old Caucasian male, with no past medical history, presented with hepatalgia and a cervical mass. A computed tomography (CT) scan showed multiple suspect lesions in the lungs, liver, and anterior mediastinum associated with mediastinal and cervical adenopathy. CT-guided percutaneous biopsies of the liver lesions and anterior mediastinal mass were performed, confirming the histopathology of thymic epithelial carcinoma. Management consisted of several chemotherapy regimens and radiation therapy, administered between April 2016 and December 2018. The patient achieved complete metabolic response. Fluorodeoxyglucose positron emission tomography/CT performed in June 2019 showed disease relapse, with reappearance of a large hypermetabolic hepatic mass and involvement of mediastinal and axillary lymph nodes. Intravenous pembrolizumab (200 mg, every 3 wk) was administered after two prior systemic therapies. The patient’s response to treatment was last documented on March 5, 2020.
CONCLUSION Pembrolizumab was successful in treatment of a patient with programmed death-ligand 1-negative metastatic thymic carcinoma, pretreated with chemotherapy.
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Affiliation(s)
- Jonathan Wong-Chong
- Département d’Oncologie Médicale, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- UFR Médecine, Université Clermont Auvergne, Clermont-Ferrand 63011, France
| | - Maureen Bernadach
- Département d’Oncologie Médicale, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
- Centre d’Investigation Clinique, UMR501, Clermont-Ferrand 63011, France
| | - Angeline Ginzac
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
| | - Hugo Veyssière
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
| | - Xavier Durando
- Département d’Oncologie Médicale, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- UFR Médecine, Université Clermont Auvergne, Clermont-Ferrand 63011, France
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
- Centre d’Investigation Clinique, UMR501, Clermont-Ferrand 63011, France
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