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Chiappetta M, Lococo F, Sassorossi C, Aigner C, Ploenes T, Van Raemdonck D, Vanluyten C, Van Schil P, Agrafiotis AC, Guerrera F, Lyberis P, Casiraghi M, Spaggiari L, Zisis C, Magou C, Moser B, Bauer J, Thomas PA, Brioude G, Passani S, Zsanto Z, Sperduti I, Margaritora S. The Prognostic Role of the Number of Involved Structures in Thymic Epithelial Tumors: Results from the ESTS Database. Ann Surg Oncol 2024; 31:4298-4307. [PMID: 38530530 DOI: 10.1245/s10434-024-15194-z] [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: 11/06/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The role of the number of involved structures (NIS) in thymic epithelial tumors (TETs) has been investigated for inclusion in future staging systems, but large cohort results still are missing. This study aimed to analyze the prognostic role of NIS for patients included in the European Society of Thoracic Surgeons (ESTS) thymic database who underwent surgical resection. METHODS Clinical and pathologic data of patients from the ESTS thymic database who underwent surgery for TET from January 2000 to July 2019 with infiltration of surrounding structures were reviewed and analyzed. Patients' clinical data, tumor characteristics, and NIS were collected and correlated with CSS using Kaplan-Meier curves. The log-rank test was used to assess differences between subgroups. A multivariable model was built using logistic regression analysis. RESULTS The final analysis was performed on 303 patients. Histology showed thymoma for 216 patients (71.3%) and NET/thymic carcinoma [TC]) for 87 patients (28.7%). The most frequently infiltrated structures were the pleura (198 cases, 65.3%) and the pericardium in (185 cases, 61.1%), whereas lung was involved in 96 cases (31.7%), great vessels in 74 cases (24.4%), and the phrenic nerve in 31 cases (10.2%). Multiple structures (range, 2-7) were involved in 183 cases (60.4%). Recurrence resulted in the death of 46 patients. The CSS mortality rate was 89% at 5 years and 82% at 10 years. In the univariable analysis, the favorable prognostic factors were neoadjuvant therapy, Masaoka stage 3, absence of metastases, absence of myasthenia gravis, complete resection, thymoma histology, and no more than two NIS. Patients with more than two NIS presented with a significantly worse CSS than patients with no more than two NIS (CSS 5- and 10-year rates: 9.5% and 83.5% vs 93.2% and 91.2%, respectively; p = 0.04). The negative independent prognostic factors confirmed by the multivariable analysis were incomplete resection (hazard ratio [HR] 2.543; 95% confidence interval [CI] 1.010-6.407; p = 0.048) and more than two NIS (HR 1.395; 95% CI 1.021-1.905; p = 0.036). CONCLUSIONS The study showed that more than two involved structures are a negative independent prognostic factor in infiltrative thymic epithelial tumors that could be used for prognostic stratification.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carolina Sassorossi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Till Ploenes
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), TU Dresden, Dresden, Sachsen, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Department of Thoracic Surgery, Fachkrankenhaus Coswig GmbH, Coswig, Saxony, Germany
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cedric Vanluyten
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Apostolos C Agrafiotis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Francesco Guerrera
- Thoracic Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paraskevas Lyberis
- Thoracic Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Monica Casiraghi
- Division of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Charalambos Zisis
- Department of Thoracic Surgery, Chest Disease Hospital "Sotiria", Athens, Greece
| | - Christina Magou
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - Bernhard Moser
- Head ESTS Thymic Working Group, Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jonas Bauer
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, North Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, North Hospital, APHM, Aix-Marseille University, Marseille, France
| | | | - Zalan Zsanto
- Department of Surgery Medical School, University of Pécs, Pecs, Hungary
| | - Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute - IRCCS, Rome, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Li J, Deng Z, Liu Y, Jin J, Xie C, Gan J. Prognostic and immunological significance of metastasis-associated protein 3 in patients with thymic epithelial tumors. Discov Oncol 2024; 15:216. [PMID: 38852126 PMCID: PMC11162987 DOI: 10.1007/s12672-024-01066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have shown promising anticancer activity and have recently been proposed as a therapy for thymic epithelial tumors (TETs); however, this treatment is only effective for a subgroup of TET patients. Thus, this study aims to identify the potential genes implicated in the regulation of cancer immunity in TETs. METHODS The TETs RNA-seq and clinical data were obtained from The Cancer Genome Atlas (TCGA) database. The clinical significance of the tumor microenvironment (TME) in TETs was evaluated. Weighted gene coexpression network analysis (WGCNA) was used to identify the immune response-related hub genes. The expression of metastasis-associated protein 3 (MTA3) in TETs was investigated in public datasets and a patient cohort. Kaplan‒Meier curves were generated to analyze the prognostic value of various factors. The Tumor Immune Estimation Resource (TIMER2.0) was used to estimate the relevance of MTA3 to immune cell infiltration. Gene set enrichment analysis (GSEA) and pathway enrichment analysis were applied to explore the MTA3-related pathways. RESULTS The TME was found to be clinically significant in TETs. Moreover, MTA3 was identified as a key gene associated with the immune score, and lower MTA3 expression was linked to poor TME and reduced cytotoxic activity in TETs. Furthermore, MTA3 was found to be deregulated in TETs, predictive of poor prognosis. MTA3 was also significantly associated with the infiltration levels of various immune cell types and highly correlated with their corresponding markers. Notably, MTA3 was positively associated with various immune response pathways. CONCLUSION MTA3 is clinically significant in TETs and correlated with immune cell infiltration. Thus, MTA3 might be a biomarker for predicting the prognosis and immune status of TET patients.
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Affiliation(s)
- Jinping Li
- Department of Histology and Embryology, School of Preclinical Medicine, Guilin Medical University, Guilin, China
| | - Zhenyan Deng
- Department of Clinical Laboratory, Guilin Hospital of the Second Xiangya Hospital CSU, Guilin, China
| | - Yu Liu
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
- Guangxi Health Commission Key Laboratory of Tumor Immunology and Receptor-Targeted Drug Basic Research, Guilin Medical University, Guilin, China
- Clinical Research Center, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Jiamin Jin
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
- Guangxi Health Commission Key Laboratory of Tumor Immunology and Receptor-Targeted Drug Basic Research, Guilin Medical University, Guilin, China
| | - Chichu Xie
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
- Guangxi Health Commission Key Laboratory of Tumor Immunology and Receptor-Targeted Drug Basic Research, Guilin Medical University, Guilin, China
| | - Jinfeng Gan
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China.
- Guangxi Health Commission Key Laboratory of Tumor Immunology and Receptor-Targeted Drug Basic Research, Guilin Medical University, Guilin, China.
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Liou DZ, Berry MF, Brown LM, Demmy TL, Huang J, Khullar OV, Padda SK, Shah RD, Taylor MD, Toker SA, Weiss E, Wightman SC, Worrell SG, Hayanga JWA. The Society of Thoracic Surgeons Expert Consensus Document on the Surgical Management of Thymomas. Ann Thorac Surg 2024:S0003-4975(24)00338-2. [PMID: 38718878 DOI: 10.1016/j.athoracsur.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, California
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sukhmani K Padda
- Department Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rachit D Shah
- Section of Thoracic and Foregut Surgery, VCU Health System, Richmond, Virginia
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Seyfi Alper Toker
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, VCU Health, Richmond, Virginia
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie G Worrell
- Thoracic Surgery Section, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - J W Awori Hayanga
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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Huang X, Wang X, Liu Y, Wang Z, Li S, Kuang P. Contrast-enhanced CT-based radiomics differentiate anterior mediastinum lymphoma from thymoma without myasthenia gravis and calcification. Clin Radiol 2024; 79:e500-e510. [PMID: 38242804 DOI: 10.1016/j.crad.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Abstract
AIM To explore the value of a radiomics model based on enhanced computed tomography (CT) in differentiating anterior mediastinal lymphoma (AML) and thymoma without myasthenia gravis (MG) and calcification. MATERIALS AND METHODS The present study analysed patients who were diagnosed histologically with AML and thymoma in three independent institutions. All pre-treatment patients underwent enhanced CT. In the training group of patients from institutions 1 (the First Affiliated Hospital of Kunming Medical University) and 3 (the Yunnan Cancer Hospital), two radiologists independently analysed the enhanced CT images and performed manual segmentation of each tumour. Radiomics features were screened using interobserver interclass coefficient (ICC) analysis, feature correlation analysis, and L1 regularisation. The discriminative efficacy of the logistic regression model was evaluated using receiver operating characteristic (ROC) analysis. Validation group of patients from institution 2 (the Second Affiliated Hospital of Zhejiang University School of Medicine) was used to validate the proposed models. RESULTS A total of 114 patients were enrolled in this study and 1,743 radiomics features were extracted from the enhanced CT images. After feature screening, the remaining 37 robust radiomics features were used to construct the model. In the training group, the AUC of the model was 0.987 (95% confidence interval [CI]: 0.976-0.999), the sensitivity, specificity, and accuracy were 0.912, 0.946, and 0.924, respectively. In the validation group, the AUC of the model was 0.798 (95% CI: 0.683-0.913), the sensitivity, specificity, and accuracy were 0.760, 0.700, and 0.743, respectively. CONCLUSION The radiomics model created provided effective information to assist in the selection of clinical strategies, thus reducing unnecessary procedures in patients with AML and guiding direct surgery in patients with thymoma to avoid biopsy.
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Affiliation(s)
- X Huang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - X Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Y Liu
- Department of Radiology, Yunnan Cancer Hospital, Kunming, China
| | - Z Wang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - S Li
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - P Kuang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Pardini E, Cucchiara F, Palumbo S, Tarrini G, Di Vita A, Coppedè F, Nicolì V, Guida M, Maestri M, Ricciardi R, Aprile V, Ambrogi MC, Barachini S, Lucchi M, Petrini I. Somatic mutations of thymic epithelial tumors with myasthenia gravis. Front Oncol 2023; 13:1224491. [PMID: 37671056 PMCID: PMC10475716 DOI: 10.3389/fonc.2023.1224491] [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: 05/17/2023] [Accepted: 07/14/2023] [Indexed: 09/07/2023] Open
Abstract
Background Thymic epithelial tumors are rare malignant neoplasms that are frequently associated with paraneoplastic syndromes, especially myasthenia gravis. GTF2I is an oncogene mutated in a subgroup of thymomas that is reputed to drive their growth. However, for GTF2I wild-type tumors, the relevant mutations remain to be identified. Methods We performed a meta-analysis and identified 4,208 mutations in 339 patients. We defined a panel of 63 genes frequently mutated in thymic epithelial tumors, which we used to design a custom assay for next-generation sequencing. We sequenced tumor DNA from 67 thymomas of patients with myasthenia gravis who underwent resection in our institution. Results Among the 67 thymomas, there were 238 mutations, 83 of which were in coding sequences. There were 14 GTF2I mutations in 6 A, 5 AB, 2 B2 thymomas, and one in a thymoma with unspecified histology. No other oncogenes showed recurrent mutations, while sixteen tumor suppressor genes were predicted to be inactivated. Even with a dedicated assay for the identification of specific somatic mutations in thymic epithelial tumors, only GTF2I mutations were found to be significantly recurrent. Conclusion Our evaluation provides insights into the mutational landscape of thymic epithelial tumors, identifies recurrent mutations in different histotypes, and describes the design and implementation of a custom panel for targeted resequencing. These findings contribute to a better understanding of the genetic basis of thymic epithelial tumors and may have implications for future research and treatment strategies.
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Affiliation(s)
- Eleonora Pardini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Federico Cucchiara
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Sara Palumbo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Tarrini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Alessia Di Vita
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Fabio Coppedè
- Medical Genetics, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Vanessa Nicolì
- Medical Genetics, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Melania Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Ricciardi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Aprile
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Marcello C. Ambrogi
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Serena Barachini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Iacopo Petrini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
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Byrd CT, Trope WL, Bhandari P, Konsker HB, Moradi F, Lui NS, Liou DZ, Backhus LM, Berry MF, Shrager JB. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma. J Thorac Cardiovasc Surg 2023; 165:371-381.e1. [PMID: 35568521 DOI: 10.1016/j.jtcvs.2022.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is nonsurgical and requires biopsy. Noninvasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria or positron emission tomography/computed tomography could accurately differentiate the 2, guiding a direct surgery versus biopsy decision. METHODS A total of 48 subjects with resectable thymoma and 29 subjects with anterior mediastinal lymphoma treated from 2006 to 2019 were retrospectively examined. All had pretreatment positron emission tomography/computed tomography and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and positron emission tomography/computed tomography maximum standardized uptake value were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. Receiver operating characteristic analysis identified the maximum standardized uptake value threshold most associated with thymoma. RESULTS There was no association between tumor type and age group (P = .183) between those with thymoma versus anterior mediastinal lymphoma. Patients with thymoma were less likely to report B symptoms (P < .001). The median maximum standardized uptake value of thymoma and lymphoma differed dramatically: 4.35 versus 18.00 (P < .001). Maximum standardized uptake value was independently associated with tumor type on multivariable regression. On receiver operating characteristic analysis, lower maximum standardized uptake value was associated with thymoma. Maximum standardized uptake value less than 12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. Maximum standardized uptake value less than 7.50 demonstrated 100.00% positive predictive value for thymoma. CONCLUSIONS Positron emission tomography/computed tomography maximum standardized uptake value of resectable anterior mediastinal masses may help guide a direct surgery versus biopsy decision. Tumors with maximum standardized uptake value less than 7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with maximum standardized uptake value greater than 7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with maximum standardized uptake value greater than 12.85.
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Affiliation(s)
- Catherine T Byrd
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Winston L Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Harrison B Konsker
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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7
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Yu CH, Zhang RP, Yang XT, Yang Z, Xin L, Zhao ZZ, Wang J, Wang LX. Dual-energy CT perfusion imaging for differentiating invasive thymomas, thymic carcinomas, and lymphomas in adults. Clin Radiol 2022; 77:e417-e424. [PMID: 35365296 DOI: 10.1016/j.crad.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the role of dual-energy computed tomography perfusion (DECTP) imaging in differentiating invasive thymomas (ITs), thymic cancers (TCs), and lymphomas in adults. MATERIALS AND METHODS Ninety-five patients with solid masses in the prevascular mediastinum who underwent DECTP examinations were enrolled in this study. The perfusion parameters (blood flow, BF; blood volume, BV; mean transit time, MTT; permeability surface, PS) and spectral parameters (water concentration, WC; iodine concentration, IC; normalised iodine concentration, NIC; the slope of spectral radiodensity [Hounsfield units] curve, λHU) of the lesions were analysed. RESULTS There were no differences in the MTT or WC values among ITs, TCs, and lymphomas (all p>0.05). The IC, NIC, and λHU values in the optimal arterial and venous phases and PS values of TCs were higher than those of ITs and lymphomas (all p<0.05), and there were no differences between ITs and lymphomas (all p>0.05). The BF and BV values of lymphomas were lower than those of ITs and TCs (all p<0.05), and there were no differences between ITs and TCs (all p>0.05). The cut-off values for BF and BV used to differentiate lymphomas from ITs and TCs were 42.83 ml/min/100 g and 4.66 ml/100 g, respectively (area under the receiver operating characteristic curve: 0.847 and 0.839; sensitivity, 80.6% and 82.1%; specificity, 75% and 71.4%; accuracy, 78.9% and 81.1%). CONCLUSIONS The perfusion and spectral parameters of DECTP imaging help to identify ITs, TCs, and lymphomas, and BF and BV values help to differentiate lymphomas from ITs and TCs.
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Affiliation(s)
- C H Yu
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China
| | - R P Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, PR China.
| | - X T Yang
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China.
| | - Z Yang
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China
| | - L Xin
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China
| | - Z Z Zhao
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China
| | - J Wang
- Department of Pathology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China
| | - L X Wang
- Department of Pathology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, PR China
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8
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Pasquini G, Menichelli C, Pastore G, Casamassima F, Fabrini MG, Cappelli S, Valleggi S, Lucchesi M, Lucchi M, Ricciardi R, Maestri M, Guida M, Chella A, Petrini I. Stereotactic body radiation therapy for the treatment of pleural metastases in patients with thymoma: a retrospective review of 22 patients. J Thorac Dis 2022; 13:6373-6380. [PMID: 34992817 PMCID: PMC8662497 DOI: 10.21037/jtd-19-3799] [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: 11/22/2019] [Accepted: 03/18/2020] [Indexed: 11/06/2022]
Abstract
Background Thymomas can benefit of cytoreductive surgery even if a complete resection is not feasible. The pleural cavity is the most common site of progression and the resection of pleural metastases can be performed in selected patients. We evaluated the results of stereotactic body radiation therapy for the treatment of pleural metastases in patients not eligible for surgery. Methods We retrospectively selected 22 patients treated with stereotactic body radiation therapy for pleural metastases between 2013 and 2019. According to RECIST criteria 1.1 modified for thymic epithelial tumors, time to local failure and progression free survival were calculated using Kaplan-Meier method. Results The median age was 40 years (range, 29-73 years). There were 1 A, 3 AB, 3 B1, 3 B2, 3 B2/B3 and 9 B3 thymomas. Pleural metastases and primary tumor were synchronous in 8 patients. Five patients had a single pleural metastatic site and 17 presented multiple localizations. Sixteen patients received stereotactic body radiation therapy on multiple sites of pleural metastases. The median dose of radiation was 30 Gy (range, 24-40 Gy). With a median follow-up of 33.2 months (95% CI: 13.1-53.3 months), ten patients experienced disease progression with a median progression free survival was 20.4 months (95% CI: 10.7-30.0 months). The disease control rate was 79% and 41% after 1 and 2 years, respectively. Local disease control rate was 92% and 78% after 1 and 2 years, respectively. There were not significant differences in progression free survival between patients diagnosed with synchronous and metachronous metastases (P=0.477), across those treated or not with chemotherapy (P=0.189) and between those who received or not a previous surgical resection of the pleural metastases (P=0.871). There were not grade 3-4 toxicities related to the treatment. Conclusions Stereotactic body radiation therapy of pleural metastases is feasible and offers a promising local control of diseases. The impact of this treatment on patients' survival is hardly predictable because of the heterogeneous clinical behavior of thymomas.
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Affiliation(s)
- Giulia Pasquini
- Medical Oncology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Claudia Menichelli
- Department of Radiotherapy, Institute of Clinical Research Ecomedica, Empoli, Italy
| | - Gabriella Pastore
- Department of Medical Physics, Institute of Clinical Research Ecomedica, Empoli, Italy
| | - Franco Casamassima
- Department of Radiotherapy, Institute of Clinical Research Ecomedica, Empoli, Italy
| | | | | | | | | | - Marco Lucchi
- Thoracic Surgery, Department of Surgical Pathology, Molecular Medicine and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Roberta Ricciardi
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Melania Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Pneumology Unit, University Hospital of Pisa, Pisa, Italy
| | - Iacopo Petrini
- General Pathology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
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9
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Markowiak T, Ansari MKA, Neu R, Schalke B, Marx A, Hofmann HS, Ried M. Evaluation of Surgical Therapy in Advanced Thymic Tumors. Cancers (Basel) 2021; 13:cancers13184516. [PMID: 34572742 PMCID: PMC8471625 DOI: 10.3390/cancers13184516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022] Open
Abstract
A complete resection of thymic tumors is known to be the most important prognostic factor, but it is often difficult to perform, especially in advanced stages. In this study, 73 patients with advanced thymic tumors of UICC stages III and IV who underwent radical resection were examined retrospectively. The primary endpoint was defined as the postoperative resection status. Secondary endpoints included postoperative morbidity, mortality, recurrence/progression-free, and overall survival. In total, 31.5% of patients were assigned to stage IIIa, 9.6% to stage IIIb, 47.9% to stage IVa, and 11% to stage IVb. In stages III a R0 resection was achieved in 53.3% of patients. In stages IV a R0/R1 resection was documented in 76.7% of patients. Surgical revision was necessary in 17.8% of patients. In-hospital mortality was 2.7%. Median recurrence/progression-free interval was 43 months (p = 0.19) with an overall survival of 79 months. The 5-year survival rate was 61.3%, respectively. Median survival after R2 resection was 25 months, significantly shorter than after R0 or R1 resection (115 months; p = 0.004). Advanced thymic tumors can be resected with an acceptable risk of complications and low mortality. In stage III as well as in stage IV the promising survival rates are dependent on the resection-status.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (T.M.); (M.K.A.A.); (R.N.); (H.-S.H.)
| | - Mohammed Khalid Afeen Ansari
- Department of Thoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (T.M.); (M.K.A.A.); (R.N.); (H.-S.H.)
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (T.M.); (M.K.A.A.); (R.N.); (H.-S.H.)
| | - Berthold Schalke
- Department of Neurology, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Alexander Marx
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (T.M.); (M.K.A.A.); (R.N.); (H.-S.H.)
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, 93049 Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (T.M.); (M.K.A.A.); (R.N.); (H.-S.H.)
- Correspondence: ; Tel.: +49-941-944-9801
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10
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Zhou Y, Bing Z, Qin Y, Ma D, Liu H. Type B thymoma in a patient with HIV infection: A case report with a review of HIV and thymoma coexistence. Thorac Cancer 2021; 12:2618-2621. [PMID: 34486210 PMCID: PMC8487817 DOI: 10.1111/1759-7714.14135] [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: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 12/01/2022] Open
Abstract
HIV infection predisposes people to cancer, including AIDS‐defining cancers, such as Kaposi sarcoma, and a broad range of non‐AIDS‐defining cancers. Here we report a case with rare coexistence of HIV and thymoma, and summarize all the comorbid cases that currently exist. We found that in all the cases reported, thymoma occurred when CD4+ counts were within a normal range, but the immune response in peripheral T‐cell repertoire remains unknown. In our case, an overview of the immune system under this complicated situation is given for the first time by showing the lymphocyte subpopulations in the blood and the immune cell distribution of the thymoma. This case expands the scope of non‐AIDS‐defining cancers, and provides insight into the influence of the immune system under two immunocompromising conditions, HIV infection and thymoma.
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Affiliation(s)
- Yaxuan Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Peking Union Medical College MD Program, Beijing, China
| | - Zhongxing Bing
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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11
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Chiappetta M, Aprile V, Lococo F, Zanfrini E, Nachira D, Meacci E, Korasidis S, Ambrogi M, Lucchi M, Margaritora S. Prognostic factors for survival in advanced thymomas: The role of the number of involved structures. J Surg Oncol 2021; 124:858-866. [PMID: 34252198 DOI: 10.1002/jso.26593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/14/2021] [Accepted: 06/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The Masoka-Koga and tumor node metastases staging systems for thymoma are based on structures involved, but the prognostic role of the number of infiltrated/involved structures is still debated. We analyzed the prognostic role of involved structures and their combinations in locally advanced thymomas patients. METHODS Data on 174 surgically treated locally advanced thymoma patients from 1/01/1990 to 31/12/2015 were reviewed. Clinical and pathological characteristic, involved structures, number of involved structures and different combinations were correlated to cancer specific survival (CSS) using Kaplan-Meier product-limit method. RESULTS Five and 10-year CSS was 92% and 87%. Masaoka Stage 3 (p < 0.001), absence of pericardial involvement (p = 0.001), number of involved structures (p = 0.018), R0 (p < 0.001) and adjuvant radiotherapy (p = 0.008) were favorable prognostic CSS factors. A significant better prognosis was present in ≤2 involved structures vs >2 involved structures (5- and 10-year CSS: 95% and 93% vs. 80% and 51%). Multivariable analysis confirmed as independent prognostic factor R0 (p = 0.033, hazard ratio [HR]: 0.093, 95% confidence interval [CI] 0.010-0.827) and number of involved structures (p = 0.046, HR: 0.187, 95% CI: 0.036-0.968). In Masaoka Stage 3, patients with ≤2 involved structures had a significant better CSS than patients with >2 (10-year CSS: 98% vs. 73%, p = 0.008). CONCLUSIONS The number of involved structures and the concomitant involvement of the pericardium seems to be associated with a poor prognosis in surgically treated advanced thymoma patients.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vittorio Aprile
- Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Edoardo Zanfrini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Dania Nachira
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Meacci
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stylianos Korasidis
- Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Marcello Ambrogi
- Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Department of Cardiac, Thoracic, and Vascular, Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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12
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Kakamad FH, Abdullah AM, Salih AM, Baba HO, Mohammed SH, Salih RQ, Abdulla BA, Hassan MN, Muhialdeen AS. Thymoma with osseous metaplasia; a case report with a brief literature review. Int J Surg Case Rep 2021; 85:106149. [PMID: 34280875 PMCID: PMC8318848 DOI: 10.1016/j.ijscr.2021.106149] [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: 05/07/2021] [Revised: 06/11/2021] [Accepted: 06/26/2021] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The thymus is a primary lymphatic organ within the mediastinum that plays an essential role in developing and maintaining cell-mediated immunity. The current study aims to report a case of intra-tumoral osseous metaplasia of the thymus gland, which is an infrequent phenomenon. CASE PRESENTATION A 43-year-old male presented with weakness and easy fatigability for 2 months. The patient had an elevated anti-acetylcholinesterase antibody (19.5 nmole/L). Magnetic resonance imaging showed a round, capsulated, enhanced mass in the anterior mediastinum measuring 5.5 × 3.5 cm, suspecting thymoma. The patient underwent plasmapheresis three times in one week, under general anesthesia, in a supine position, sternotomy was performed, and the thymoma was totally resected. DISCUSSION Thymomas are known to occur in all age groups with the peak of nearly between 35 and 70 years with the median age of 54 years. The sex distribution of thymoma is approximately equal with slight predilection of women in old age groups. However, among all reported cases of thymomas with osseous metaplasia, the majorities are female. The significance of this ossification is still to be clarified. CONCLUSION Although it is rare, secondary changes in thymoma may occur including calcification and ossification.
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Affiliation(s)
- Fahmi H Kakamad
- Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq.
| | - Ari M Abdullah
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Faculty of Medical Sciences, School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Baba
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | | | - Rawezh Q Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Marwan N Hassan
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Aso S Muhialdeen
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
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13
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Rappaport JMP, Huang J, Ahmad U. Thymic Malignancy-Updates in Staging and Management. Surg Oncol Clin N Am 2020; 29:581-601. [PMID: 32883460 DOI: 10.1016/j.soc.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thymomas are relatively indolent tumors that present with locally advanced disease in 30% of the patients. Thymic carcinoma is a more aggressive histology with shorter disease-free and overall survival. Early-stage tumors are managed best with complete resection. Multimodal therapy is the standard of care for locally advanced tumors and neoadjuvant therapy may help improve respectability. Stage and complete resection are the strongest prognostic factors for long-term survival. Based on early experience, targeted and immunotherapies have shown limited promise in advanced disease.
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Affiliation(s)
- Jesse M P Rappaport
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Usman Ahmad
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA; Transplant Institute, Cleveland Clinic, Cleveland, OH, USA.
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14
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Umana GE, Passanisi M, Tranchina MG, Fricia M, Nicoletti GF, Cicero S, Scalia G. Letter to the Editor Regarding "Rare Thymoma Metastases to the Spine: Case Reports and Review of the Literature". World Neurosurg 2020; 138:567-569. [PMID: 32544997 DOI: 10.1016/j.wneu.2020.01.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy.
| | - Maurizio Passanisi
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | | | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | | | - Salvatore Cicero
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Gianluca Scalia
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
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15
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Chen K, Che J, Zhang X, Jin R, Xiang J, Han D, Sun Y, Gong Z, Zhang D, Li H. Next-generation sequencing in thymic epithelial tumors uncovered novel genomic aberration sites and strong correlation between TMB and MSH6 single nucleotide variations. Cancer Lett 2020; 476:75-86. [PMID: 32061754 DOI: 10.1016/j.canlet.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/04/2020] [Accepted: 02/01/2020] [Indexed: 12/21/2022]
Abstract
Thymic epithelial tumors (TET) including thymomas and thymic carcinomas are rare, but they are common primary tumors in the anterior mediastinum. The etiology and tumorigenesis of TET remain unclear. To better understand the novel aberrations of this rare tumor and provide more significant mutation sites for targeted therapy, we performed next-generation sequencing detection on 55 patients with TET. Our results showed that most genes in 12 core pathways harbored aberrations of indeterminate potential. In 4 genes (ARID1A, KMT2C, TGFBR2 and MAP3K1), the indel frequency was above 90%. Dozens of genes, including TGFBR2, KMT2C, PRKDC, ATR, CHD2, SDHA, KDM5A, CHEK1, MSH6 and POLE, possessed frameshift indel with different frequencies in different hotspot sites, which could be the new targets of therapy for TET. For the first time, we revealed a strong correlation between the tumor mutational burden and single nucleotide variations, but not frameshift, on DNA mismatch repair gene MSH6 in TET.
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Affiliation(s)
- Kai Chen
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Jiaming Che
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Xianfei Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
| | - Yonghua Sun
- Shanghai YunYing Medical Technology CO., LTD, Shanghai, 201600, China
| | - Ziying Gong
- Shanghai YunYing Medical Technology CO., LTD, Shanghai, 201600, China.
| | - Daoyun Zhang
- Shanghai YunYing Medical Technology CO., LTD, Shanghai, 201600, China.
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China.
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16
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Terra RM, Milanez-de-Campos JR, Haddad R, Trindade JRM, Lauricella LL, Bibas BJ, Pêgo-Fernandes PM. Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience. J Bras Pneumol 2019; 46:e20180315. [PMID: 31851218 PMCID: PMC7462674 DOI: 10.1590/1806-3713/e20180315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/20/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.
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Affiliation(s)
- Ricardo Mingarini Terra
- . Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - José Ribas Milanez-de-Campos
- . Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rui Haddad
- . Disciplina de Cirurgia Torácica, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Juliana Rocha Mol Trindade
- . Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Leticia Leone Lauricella
- . Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Benoit Jacques Bibas
- . Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo Manuel Pêgo-Fernandes
- . Disciplina de Cirurgia Torácica, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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17
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Prognostic factors after treatment for iterative thymoma recurrences: A multicentric experience. Lung Cancer 2019; 138:27-34. [DOI: 10.1016/j.lungcan.2019.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/14/2019] [Accepted: 09/28/2019] [Indexed: 11/23/2022]
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18
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PD-L1 Expression and Tumor-Infiltrating Lymphocytes in Thymic Epithelial Neoplasms. J Clin Med 2019; 8:jcm8111833. [PMID: 31683962 PMCID: PMC6912585 DOI: 10.3390/jcm8111833] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
Thymic epithelial tumors (TETs) are rare malignant mediastinal tumors that are difficult to diagnose and treat. The programmed death 1 (PD-1) receptor and its ligand (PD-L1) are expressed in various malignant tumors and have emerged as potential immunotherapeutic targets. However, the immunobiology of TETs is poorly understood. We evaluated PD-L1 expression and the presence of tumor-infiltrating lymphocytes (CD8 and CD3 expression) in surgical TET specimens from 39 patients via immunohistochemistry and determined their relation to clinicopathological parameters. Cases with membranous reactivity of the PD-L1 antibody in ≥1% of tumor cells were considered positive. Positive PD-L1 expression was observed in 53.9% of cases. Histologically, PD-L1 expression was positive in 2/6 type A, 2/6 type AB, 3/9 type B1, 4/4 type B2, 5/6 type B3, and 5/8 type C TET cases. Thus, the number of cases with PD-L1 expression and the percent expression of PD-L1 were significantly higher in more aggressive thymomas (type B2 or B3). CD3+ and CD8+ tumor-infiltrating lymphocytes were diffusely and abundantly distributed in all cases. These data suggest that a PD-1/PD-L1 blockade is a promising treatment for TETs, with more beneficial treatment effects for aggressive thymomas such as type B2 or B3.
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19
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Yang X, Zhuo M, Shi A, Yang S, Wang Z, Wu M, An T, Wang Y, Li J, Zhong J, Chen H, Jia B, Dong Z, Zhao J. Optimal first-line treatment for advanced thymic carcinoma. Thorac Cancer 2019; 10:2081-2087. [PMID: 31574576 PMCID: PMC6825903 DOI: 10.1111/1759-7714.13181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022] Open
Abstract
Background Thymic carcinomas (TCs) are rare aggressive tumors with no standard first‐line treatment. This study was conducted to determine the optimal chemotherapy regimen for advanced TC. Methods This retrospective study included 67 patients treated for stage IV TC in 2006–2015. The primary endpoints were the objective response rate (ORR) and progression‐free survival (PFS) with different chemotherapy regimens. Multivariate Cox regression analysis was used to identify factors associated with PFS, including metastatic status, radiotherapy post‐chemotherapy, primary lesion resection before chemotherapy, and chemotherapy regimen. Results A total of 36 patients received a paclitaxel‐platinum regimen, 31 received a gemcitabine‐platinum regimen, 14 underwent primary lesion resection, and 33 underwent radiotherapy. ORR was 31% (11/36) and 29% (9/31) in the paclitaxel‐platinum and gemcitabine‐platinum groups, respectively (P = 0.890). Median PFS, one‐year PFS rate, and two‐year PFS rate were 7.0 months, 26%, and 6% with paclitaxel‐platinum treatment and 12 months, 48%, and 24% with gemcitabine‐platinum treatment (log‐rank P = 0.030). Median PFS, one‐year PFS rate, and two‐year PFS rate were 18.0 months, 57%, and 33% with surgical resection and 7.3 months, 31%, and 7% without resection (log‐rank P = 0.030). Median PFS, one‐year PFS rate, and two‐year PFS rate were 13.0 months, 52%, and 20% with radiotherapy and 4.3 months, 22%, and 7% without radiotherapy (log‐rank P = 0.001). In multivariate analysis, metastatic status (hazard ratio [HR], 0.33, P = 0.004), surgical resection (HR, 0.32; P = 0.004), and radiotherapy (HR, 0.32; P < 0.001) were associated with superior PFS. Conclusions Both gemcitabine‐platinum and paclitaxel‐platinum regimens were efficacious for advanced TC. Primary lesion resection and radiotherapy may also benefit selected patients.
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Affiliation(s)
- Xue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Minglei Zhuo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Anhui Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shengnan Yang
- Department of Geriatric Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziping Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Meina Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tongtong An
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuyan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianjie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jia Zhong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hanxiao Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bo Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhi Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing, China
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20
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Sinyagovskiy P, Abdalla M, Raja A, Abdelghani A. Spontaneous rupture of thymoma. Respir Med Case Rep 2018; 26:56-58. [PMID: 30533378 PMCID: PMC6260445 DOI: 10.1016/j.rmcr.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/26/2022] Open
Abstract
We report a case of patient who presented to the hospital due to shoulder pain and was later diagnosed with ruptured thymoma. Shortly after being admitted to the hospital for the work up patient developed respiratory distress and underwent emergent endotracheal intubation. CT scan of the chest showed anterior mediastinal mass with associated right sided hemothorax. He subsequently underwent medial sternotomy with resection of the mass which turned out to be thymoma.
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21
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Corona-Cruz JF, López-Saucedo RA, Ramírez-Tirado LA, Pérez-Montiel D, González-Luna JA, Jiménez-Fuentes E, Arrieta O. Extended resections of large thymomas: importance of en bloc thymectomy. J Thorac Dis 2018; 10:3473-3481. [PMID: 30069343 DOI: 10.21037/jtd.2018.05.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary tumors of the thymus are rare; the most common histologic type is thymoma. Most important prognostic factors are anatomical extent of tumor and completeness of surgical resection. Large size has not been directly associated with survival, but is strongly associated with advanced disease and high rates of incomplete resections. Methods A retrospective cohort of patients who underwent thymectomy for thymomas of 5 cm or larger at the National Cancer Institute (INCan) of México from January 2005 to December 2016 was analyzed. Primary end-points were rate of complete resection, morbidity and mortality of thymectomy. Secondary end-points were overall survival (OS) and disease-free survival (DFS). Results A total of 25 patients were identified and included in the final analysis. Mean age was 56.6 years (27-82 years). Median size of thymoma was 8.3 cm (5-14 cm). Transesternal approach was used in 72% of cases, most of cases (68%) required an extended resection to achieve negative margins. Complete resection was achieved on 23 cases (92%). A 90-day morbidity of 24% and mortality of 8% was found, with a median follow-up of 34.5 months (1-113 months). The only factor associated with OS was completeness of surgical resection (P<0.0001). Conclusions Size of thymomas should not be considered as a contraindication for surgical treatment. Our data suggest that extended surgery is feasible even in advanced cases and provides the best chance for cure. Complete resection remains as one of the most important prognostic factor in thymomas and is associated with prolonged DFS and OS.
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Affiliation(s)
- José Francisco Corona-Cruz
- Thoracic Surgery Department, Instituto Nacional de Cancerologia, México City, México.,Thoracic Oncology Unit, Instituto Nacional de Cancerologia, México City, México
| | - Raúl Alejandro López-Saucedo
- Thoracic Surgery Department, Instituto Nacional de Cancerologia, México City, México.,Thoracic Oncology Unit, Instituto Nacional de Cancerologia, México City, México
| | | | - Delia Pérez-Montiel
- Pathology Department, Instituto Nacional de Cancerologia, México City, México
| | - Josué Andrés González-Luna
- Thoracic Surgery Department, Instituto Nacional de Cancerologia, México City, México.,Thoracic Oncology Unit, Instituto Nacional de Cancerologia, México City, México
| | - Edgardo Jiménez-Fuentes
- Thoracic Surgery Department, Instituto Nacional de Cancerologia, México City, México.,Thoracic Oncology Unit, Instituto Nacional de Cancerologia, México City, México
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerologia, México City, México
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22
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Voulaz E, Veronesi G, Infante M, Cariboni U, Testori A, Novellis P, Bottoni E, Passera E, Morenghi E, Alloisio M. Radical thymectomy versus conservative thymomectomy in the surgical treatment of thymic malignancies. J Thorac Dis 2018; 10:4127-4136. [PMID: 30174857 DOI: 10.21037/jtd.2018.06.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Complete thymectomy is recommended for thymic malignancies to reduce local recurrence and the likelihood of the long-term development of myasthenia gravis (MG). Thymus-conserving surgery (thymomectomy) seems to yield similar results, but evidence is still limited. The objective of this study was to assess if the oncological outcome, in terms of overall survival (OS) and disease-free survival (DFS), are comparable between radical thymectomy vs. conservative thymomectomy patients, and to assess if the outcome of the video-assisted thoracoscopic surgery (VATS) approach was similar to open surgery approach. Methods We retrospectively analyzed 157 consecutive patients with either resectable thymoma or thymic carcinoma from two Italian centers (Humanitas Research Hospital, Milan, and Humanitas Gavazzeni, Bergamo) between 1997 and 2013 who underwent thymomectomy or extended thymectomy with the VATS or open approach; the patients with Miastenia Gravis underwent radical thymectomy. The patients were followed through physical examinations and phone interviews. Results Thymomectomy and thymectomy were performed on 86 (54.8%) and 71 (45.2%) patients, respectively. Prognostic factors and comorbidities were comparable in the two groups. The median follow-up was 77 months. Cox proportional hazards model revealed that Masaoka advanced stage and thymic carcinoma of WHO classification were independent predictive factors for overall survival, but that the extent of surgery and the approach used (minimally invasive versus open) were not. Notably, five- and ten-year survival rates were similar in the two groups. Conclusions In our experience, radical thymectomy and conservative thymomectomy did not differ in terms of disease-free and overall survival rates. In nonmyasthenic patients with early-stage resectable thymic malignancy, minimally invasive thymomectomy provided equivalent results to open thymectomy. Our results should be interpreted with caution due to the retrospective nature of the study. Well-designed, adequately-powered studies should be very welcome to increase the quantity and the quality of clinical evidence before incorporating this procedure in future guidelines.
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Affiliation(s)
- Emanuele Voulaz
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulia Veronesi
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maurizio Infante
- Thoracic Surgery Department, University Hospital Borgo Trento, Verona, Italy
| | - Umberto Cariboni
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alberto Testori
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edoardo Bottoni
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Eliseo Passera
- Thoracic Surgery Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Alloisio
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
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23
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Robotic-assisted thymectomy for early-stage thymoma: a propensity-score matched analysis. J Robot Surg 2018; 12:719-724. [PMID: 29705833 DOI: 10.1007/s11701-018-0816-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
The aim of this study was to analyse the feasibility and safety of robotic-assisted thymectomy (RoT) in patients with clinically early stage thymoma, investigating clinical and early oncological results. Between 1998 and 2017, we retrospectively reviewed 76 (42.2%) patients who underwent radical thymectomy for clinically early stage thymoma (Masaoka-Koga I and II), identifying all patients who underwent RoT (n = 28) or open thymectomy (OT) with eligibility criteria for robotic surgery (n = 48). Using a propensity-score matched for tumor size (3.9 ± 1.8 cm) and stage (35% stage I, 42% stage IIA, 23% stage IIB), we paired 24 patients who had RoT with 24 patients undergoing OT. RoT was left-sided in 19 (79.2%) patients. None of the patients required conversion to open surgery. OT was via sternotomy in 21 (87.5%) patients and thoracotomy in 3 (12.5%). Mean operating time was shorter in the RoT group (117 ± 40 min) than in the OT (141 ± 46 min) (p = 0.06), even if not statistically significant. Length of stay was significantly shorter in the RoT group (mean 4.0 ± 1.9 days) than in the OT (mean 5.9 ± 1.7 days) (p = 0.0009). No significant difference between the two groups regarding post-operative complications. Five patients died in the OT group after a median follow-up of 6.1 years (only one for recurrence). After a median follow-up of 1.3 years, all patients in the RoT group were alive without disease. RoT is feasible and safe for early stage thymoma with clear advantage compared to OT in term of short term outcomes. A longer follow-up is needed to better evaluate the oncological results.
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24
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Janik S, Raunegger T, Hacker P, Ghanim B, Einwallner E, Müllauer L, Schiefer AI, Moser J, Klepetko W, Ankersmit HJ, Moser B. Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome. Oncotarget 2018; 9:21861-21875. [PMID: 29774108 PMCID: PMC5955144 DOI: 10.18632/oncotarget.25076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/22/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Peripheral blood-derived inflammation-based markers, such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Fibrinogen have been identified as prognostic markers in various solid malignancies. Here we aimed to investigate the prognostic and diagnostic impact of NLR, PLR, and Fibrinogen in patients with thymic epithelial tumors (TETs). RESULTS Pretreatment Fibrinogen serum concentrations, NLRs and PLRs were highest in patients with TCs and advanced tumor stages. High pretreatment Fibrinogen serum concentration (≥452.5 mg/dL) was significantly associated with worse cause specific survival (CSS; p = 0.001) and freedom from recurrence (FFR; p = 0.043), high NLR (≥4.0) with worse FFR (p = 0.008), and high PLR (≥136.5) with worse CSS (p = 0.032). Longitudinal analysis revealed that compared to patients without tumor recurrence, patients with tumor recurrence had significantly higher NLR (11.8 ± 4.0 vs. 4.70 ± 0.5; p = 0.001) and PLR (410.8 ± 149.1 vs. 228.3 ± 23.7; p = 0.031). CONCLUSION Overall, Fibrinogen serum concentrations, NLRs, and PLRs were associated with higher tumor stage, more aggressive tumor behavior, recurrence, and worse outcome. Prospective multicenter studies of the diagnostic and prognostic potential of Fibrinogen, NLR, and PLR are warranted. METHODS This retrospective analysis included 122 patients with TETs who underwent surgical resection between 1999-2015. Fibrinogen serum concentrations, NLRs, and PLRs were measured in patients preoperatively, postoperatively, and later during follow-up. These markers were analyzed for association with several clinical variables, including tumor stage, tumor subtype, FFR, and CSS and to evaluate their prognostic and diagnostic impact for detecting tumor recurrence.
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Affiliation(s)
- Stefan Janik
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
- Christian Doppler Laboratory for Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Vienna, Austria
| | - Thomas Raunegger
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
- Christian Doppler Laboratory for Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Vienna, Austria
| | - Philipp Hacker
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
- Christian Doppler Laboratory for Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Vienna, Austria
| | - Bahil Ghanim
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
| | - Elisa Einwallner
- Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - Ana-Iris Schiefer
- Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - Julia Moser
- Departments of Dermatology and Venereology and Karl Landsteiner Institute of Dermatological Research, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
- Christian Doppler Laboratory for Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Vienna, Austria
- Head FFG Project “APOSEC“, FOLAB Surgery, Medical University Vienna, Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria
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Owen D, Chu B, Lehman AM, Annamalai L, Yearley JH, Shilo K, Otterson GA. Expression Patterns, Prognostic Value, and Intratumoral Heterogeneity of PD-L1 and PD-1 in Thymoma and Thymic Carcinoma. J Thorac Oncol 2018; 13:1204-1212. [PMID: 29702286 DOI: 10.1016/j.jtho.2018.04.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) including thymoma and thymic carcinoma are rare tumors with little data available to guide treatment. Immunotherapy with checkpoint blockade has shown promising activity, but data regarding the expression patterns and prognostic implications of programmed death 1 (PD-1) and its ligand (PD-L1) in TETs have yielded conflicting results. Intratumoral heterogeneity of PD-1/L1 expression has been shown in other cancers, but has not been described in the TET literature. METHODS We performed a retrospective single-center review of 35 patients with resected TET. PD-1/L1 expression was assessed by immunohistochemistry using PD-1 clone: NAT105 and PD-L1 clone: 22C3. Tumor samples from 35 patients were evaluated including 32 patients with thymoma and 3 patients with thymic carcinoma. RESULTS PD-L1 expression was detected in 83% (29 of 35) tumor samples, including 100% (3 of 3) of thymic carcinoma patients and 81% (26 of 32) of thymoma patients. PD-1 expression was detected in 77% (27 of 35), including 33% (1 of 3) of thymic carcinoma patients and 81% (26 of 32) thymoma patients. High PD-1 expression was associated with lower grade tumors. Unlike prior studies, PD-L1 expression was not associated with higher grade tumors or higher stage. Neither PD-L1 nor PD-1 expression was significantly associated with survival. Three patients with thymoma had multiple tumor sections evaluated for expression of PD-1/L1, with differing expression patterns of both PD-L1 and PD-1 observed in two patients. CONCLUSIONS This study confirms high expression of PD-L1 and PD-1 in TET and shows for the first time intratumoral heterogeneity of PD-L1 and PD-1 in thymoma patients.
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Affiliation(s)
- Dwight Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Benjamin Chu
- Helen and Gary Gray Cancer Center, Hartford Hospital, and University of Connecticut School of Medicine, Hartford, Connecticut
| | - Amy M Lehman
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | | | | | - Konstantin Shilo
- Department of Pathology, Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
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Correlation between the Expression of PD-L1 and Clinicopathological Features in Patients with Thymic Epithelial Tumors. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5830547. [PMID: 29850538 PMCID: PMC5937579 DOI: 10.1155/2018/5830547] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/07/2018] [Accepted: 03/13/2018] [Indexed: 12/30/2022]
Abstract
The incidence of thymic epithelial tumors (TETs) in the Chinese population was much higher than that in the North American population. In clinical treatment, the prognosis of benign tumors after surgical resection was significantly better than that of malignant tumors. Currently, the commonly used clinical indicators for TET staging included Masaoka staging and WHO (2015) pathological criteria; however, the distinction between the benign and malignant tumors and diagnosis is yet to be explored. The current study demonstrated that the expression of PD-L1 in tumor cells was correlated with the degree of TET malignancy. The quantitative analysis of PD-L1 expression in 70 cases of TET tumor samples revealed that the positive rate of PD-L1 expression in types A, AB, B1, and B2 of thymoma (40 cases) was 37.5% (15/40), which was significantly lower than that in type B3 thymoma and thymic carcinoma (76.67%, 30 cases, 23/30) as demonstrated by chi-square test (P < 0.05). In addition, the two methods were analyzed for the quantitative detection of PD-L1 expression. The results from the estimation of transcriptional RNA expression and quantitative protein immunohistochemistry were consistent (r = 0.745). Furthermore, we also analyzed PD-L1 expression level in different types of TETs from TCGA database and observed that higher PD-L1 expression was in thymic carcinoma than in thymoma. Therefore, it could be concluded that PD-L1 expression in TET cells was correlated with the degree of malignancy, whereas the estimation of PD-L1 expression was potentially applicable in the clinical staging of TETs.
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27
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Rare Thymoma Metastases to the Spine: Case Reports and Review of the Literature. World Neurosurg 2018; 110:423-431. [DOI: 10.1016/j.wneu.2017.11.161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 12/28/2022]
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28
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Chaudhuri T, Lakshmaiah KC, Babu G, Dasappa L, Jacob L, Babu MCS, Rudresha AH, Lokesh KN, Rajeev LK. Metastatic thymic epithelial tumors: A regional cancer center experience. Indian J Cancer 2018; 55:288-291. [DOI: 10.4103/ijc.ijc_524_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Di Crescenzo VG, Napolitano F, Panico C, Di Crescenzo RM, Zeppa P, Vatrella A, Laperuta P. Surgical approach in thymectomy: Our experience and review of the literature. Int J Surg Case Rep 2017; 39:19-24. [PMID: 28787670 PMCID: PMC5545819 DOI: 10.1016/j.ijscr.2017.07.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Abstract
Aim Thymectomy is the main treatment for thymoma and patients with myasthenia gravis (MG). The traditional approach is through a median sternotomy, but, recently, thymectomy through minimally invasive approaches is increasingly performed. Our purpose is an analysis and discussion of the clinical presentation, the diagnostic procedures and the surgical technique. We also consider post-operative complications and results, over a period of 5 years (May 2011–June 2016), in thymic masses admitted in our Thoracic Surgery Unit. Methods We analyzed 8 patients who underwent surgical treatment for thymic masses over a period of 5 years. 6 patients (75%) had thymoma, 2 patients (25%) had thymic carcinomas. 2 patients with thymoma (33%) had myasthenia gravis. We performed a complete surgical resection with median sternotomy as standard approach. Results One patient (12%) died in the postoperative period. The histological study revealed 6 (75%) thymoma and 2 (25%) thymic carcinomas. Post-operative morbidity occurred in 2 patients (25%) and were: pneumonia in 1 case (12%), atrial fibrillation and pleural effusion in 2 patients (25%). One patient with thymoma type A recurred at skeletal muscle 2-years after surgery. Conclusions Thymic malignancies are rare tumors. Surgical resection is the main treatment, but a multimodal approach is useful for many patients. Radical thymectomy is completed removing all the soft tissue in the anterior mediastinum between the two phrenic nerves and this is the most important factor in controlling myasthenia and influencing survival in patients with thymoma. Open (median sternotomy) approach has been the standard approach for thymectomy for the better visualization of the anatomical structures. Actually, video-assisted thoracoscopic surgery (VATS) thymectomy and robotic video-assisted thoracoscopic (R-VATS) approach versus open surgery has an equal if not superior oncological efficacy, better perioperative complications and survival outcomes.
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Affiliation(s)
| | - Filomena Napolitano
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Claudio Panico
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Rosa Maria Di Crescenzo
- Department of Medicine and Surgery, Pathology Unit, Federico II University of Naples, Italy.
| | - Pio Zeppa
- Department of Medicine and Surgery, Pathology Unit, University of Salerno, Italy.
| | - Alessandro Vatrella
- Department of Medicine and Surgery, Section of Respiratory Diseases, University of Salerno, Salerno, Italy.
| | - Paolo Laperuta
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
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Inferior Vena Cava and Renal Vein Thrombosis Associated with Thymic Carcinoma. Case Rep Med 2017; 2017:1793952. [PMID: 28163719 PMCID: PMC5259596 DOI: 10.1155/2017/1793952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/11/2016] [Accepted: 12/25/2016] [Indexed: 12/12/2022] Open
Abstract
Thymic tumors are rare mediastinal tumors that can present with a wide variety of symptoms. They can cause distant manifestations and are frequently associated with paraneoplastic syndromes. In our case, we describe the evolution of a 68-year-old male whose first manifestation was thrombosis of the inferior vena cava and renal veins. Thrombosis of large abdominal veins is rare, especially without being associated with any other comorbidity or risk factors.
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Abstract
Thymomas are uncommon tumors that can present as locally advanced tumors in approximately 30% of the patients. Stage and complete resection are the strongest prognostic factors. For locally advanced tumors, induction treatment may improve the ability to achieve a complete resection. Combination treatment with cisplatin, doxorubicin, and cyclophosphamide is the most commonly used induction regimen. Similar rates of resectability are noted with the use of induction chemotherapy and chemoradiation therapy; however, more tumor necrosis is noted with the addition of radiation.
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Affiliation(s)
- Usman Ahmad
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA.
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Kirzinger L, Boy S, Marienhagen J, Schuierer G, Neu R, Ried M, Hofmann HS, Wiebe K, Ströbel P, May C, Kleylein-Sohn J, Baierlein C, Bogdahn U, Marx A, Schalke B. Octreotide LAR and Prednisone as Neoadjuvant Treatment in Patients with Primary or Locally Recurrent Unresectable Thymic Tumors: A Phase II Study. PLoS One 2016; 11:e0168215. [PMID: 27992479 PMCID: PMC5161359 DOI: 10.1371/journal.pone.0168215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022] Open
Abstract
Therapeutic options to cure advanced, recurrent, and unresectable thymomas are limited. The most important factor for long-term survival of thymoma patients is complete resection (R0) of the tumor. We therefore evaluated the response to and the induction of resectability of primarily or locally recurrent unresectable thymomas and thymic carcinomas by octreotide Long-Acting Release (LAR) plus prednisone therapy in patients with positive octreotide scans. In this open label, single-arm phase II study, 17 patients with thymomas considered unresectable or locally recurrent thymoma (n = 15) and thymic carcinoma (n = 2) at Masaoka stage III were enrolled. Octreotide LAR (30 mg once every 2 weeks) was administered in combination with prednisone (0.6 mg/kg per day) for a maximum of 24 weeks (study design according to Fleming´s one sample multiple testing procedure for phase II clinical trials). Tumor size was evaluated by volumetric CT measurements, and a decrease in tumor volume of at least 20% at week 12 compared to baseline was considered as a response. We found that octreotide LAR plus prednisone elicited response in 15 of 17 patients (88%). Median reduction of tumor volume after 12 weeks of treatment was 51% (range 20%-86%). Subsequently, complete surgical resection was achieved in five (29%) and four patients (23%) after 12 and 24 weeks, respectively. Octreotide LAR plus prednisone treatment was discontinued in two patients before week 12 due to unsatisfactory therapeutic effects or adverse events. The most frequent adverse events were gastrointestinal (71%), infectious (65%), and hematological (41%) complications. In conclusion, octreotide LAR plus prednisone is efficacious in patients with primary or recurrent unresectable thymoma with respect to tumor regression. Octreotide LAR plus prednisone was well tolerated and adverse events were in line with the known safety profile of both agents.
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Affiliation(s)
- Lukas Kirzinger
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sandra Boy
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jörg Marienhagen
- Department of Nuclear Medicine, University of Regensburg, Regensburg, Germany
| | | | - Reiner Neu
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Karsten Wiebe
- Department of Cardiac and Thoracic Surgery, University of Muenster, Muenster, Germany
| | - Philipp Ströbel
- Institute of Pathology, University of Goettingen, Goettingen, Germany
| | | | | | | | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Berthold Schalke
- Department of Neurology, University of Regensburg, Regensburg, Germany
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Zhang Z, Cui Y, Jia R, Xue L, Liang H. Myasthenia gravis in patients with thymoma affects survival rate following extended thymectomy. Oncol Lett 2016; 11:4177-4182. [PMID: 27313762 DOI: 10.3892/ol.2016.4528] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/18/2016] [Indexed: 12/21/2022] Open
Abstract
Thymomas are the most common adult tumors in the anterior mediastinal compartment, and a significant amount of thymomas are complicated by myasthenia gravis (MG). Extended thymectomy (ET) is the primary treatment method for thymomas and is used to completely resect possible ectopic thymus to avoid recurrence. Studies on the effect of MG in thymoma patients following ET are limited. The aim of the present study was to determine whether the presence of MG affects the prognosis of patients with thymoma. The present study consisted of 104 patients with thymoma that underwent ET; 61 men (58.7%) and 43 women (41.3%) (mean age, 54.6 years). In total, 38 patients had MG (36.5%). MG was most frequently observed in World Health Organization (WHO) classification type B2 thymoma compared with other types of thymoma. During the 5-year follow-up period, 11 patients succumbed to a recurrence of thymoma or respiratory failure due to MG. The overall 5-year survival rate in patients without MG or with MG was 89.1 and 76.0%, respectively. The overall survival (OS) rate in patients with Masaoka stages I + II and III + IV was 90.0 and 68.0%, respectively. The OS rate in patients with WHO type A + AB + B1 and type B2 + B3 was 96.9 and 76.8%, respectively. The patients with MG (P=0.026), Masaoka stages III + IV (P=0.008) and WHO type B2 + B3 (P=0.032) had a poorer prognosis compared with patients without these characteristics. Furthermore, multivariate analysis by Cox regression revealed that age [P=0.032; relative risk (RR)=1.097; 95% confidence interval (CI)=1.097-1.192] and MG (P=0.042; RR=0.167; 95% CI=0.037-0.940) significantly affected OS rate. In summary, ET is a reliable method for the treatment of thymoma. Long-term survival is expected for patients at early Masaoka stages, and for patients without MG. The prognosis of patients with thymomas with MG is poorer compared with patients without MG. The present findings provide useful information for the future management of patients with thymomas.
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Affiliation(s)
- Zhefeng Zhang
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Youbin Cui
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Rui Jia
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Lei Xue
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
| | - Huagang Liang
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei 066000, P.R. China
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Zhu L, Zhang J, Marx A, Weiss C, Fang WT. Clinicopathological analysis of 241 thymic epithelial tumors-experience in the Shanghai Chest Hospital from 1997-2004. J Thorac Dis 2016; 8:718-26. [PMID: 27114840 DOI: 10.21037/jtd.2016.03.24] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To assess the correlation of WHO histological classification of thymomas and thymic carcinomas (TCs) with prognosis in recently treated patient cohort compared to a historical one from a single institution. METHODS Retrospective review of clinical charts and histological sections of 241 patients treated during 1997-2004. Univariate and multivariate analysis of associations between risk factors including gender, age, tumor size, myasthenia gravis, WHO histological subtype, Masaoka stage, resection status, (neo-)adjuvant therapies, and survival. RESULTS The 5-year overall survival (OS) of A, AB, B1, B2, B3 thymomas and TCs patients was 100%, 100%, 94%, 80%, 94% and 45%. Five-year progression-free survival (PFS) was 100%, 96%, 78%, 80%, 78% and 39%, respectively. The 5-year OS of patients with Masaoka stage I, II, III and IV thymomas and TCs was 96%, 89%, 59% and 50%. (Neo-)adjuvant therapies were administered more often than in the historical cohort. Tumor-related death mainly occurred in patients with stage III, IV and B2, B3 thymomas and TCs. By univariate analysis, gender, tumor size, myasthenia gravis (MG) status, histotype, Masaoka stage, resection status and treatment were associated with OS. By multivariate analysis, histological subtype, Masaoka stage, and (neo-)adjuvant therapy were revealed as independent prognostic indicators. CONCLUSIONS WHO histological subtype, Masaoka stage and (neo-)adjuvant treatment have remained independent determinants of OS in patients with thymomas and TCs. Compared with the historical cohort during 1969-1996, prognosis of patients with B2, B3 thymomas has improved, which may be partly due to the increased use of adjuvant therapies. Prognosis of patients with TCs remained unsatisfactory, suggesting that neoadjuvant treatment should be tested to improve survival.
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Affiliation(s)
- Lei Zhu
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Jie Zhang
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Alexander Marx
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Christel Weiss
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Wen-Tao Fang
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
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Darwish D. Single Institution Experience of Thymic Tumor Treatment and Survival in Egypt. Asian Pac J Cancer Prev 2016; 17:771-4. [PMID: 26925678 DOI: 10.7314/apjcp.2016.17.2.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Thymic tumors are the most common tumors in the anterior mediastinum. Total resection is the main treatment and predictor of longer survival. Adjuvant radiotherapy alone or in combination with chemotherapy is recommended with incomplete excision or advanced disease. Thirty seven patients with thymic tumors were included in this retrospective study from January 2001 till December 2012. They were studied regarding age, sex, performance status, tumor size and invasion, stage, pathology, treatment given, overall and progression free survival. Myasthenia gravis was present in 18.1% of the patients. Masaoka stage III was diagnosed in 40.5% of the cases followed by stage II in 24.3% and the other stages with lower percentages. Pathology type B3 was the most frequent followed by B2 and B1 with percentages of 27, 24.3 and 21.7 respectively. Complete resection was conducted in 11 cases (29.75%). Partial resection or debulking was done in 15 (40.5%) and a biopsy was taken in 11 cases (29.8%) Adjuvant chemotherapy was given to 14 patients (37.8%) and neoadjuvant to 13 (35.2%). Adjuvant radiotherapy was given to 17 patients (46%) and neoadjuvant to 14 (37.8%). The 5-year overall survival by was 83% for stage I, 71% for stage II, 60% for stage III, and 44% for stage IV (p=0.0426). Five year progression free survival was 71% for stage I, 62% stage II, 42% stage III, and 37% for stage IV (p= 0.0532). In conclusion with the rare thymic tumors early stage and complete resection have the highest impact on overall and progression free survival.
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Affiliation(s)
- Dalia Darwish
- Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, faculty of medicine, Cairo University, Cairo, Egypt E-mail :
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Ruffini E, Venuta F. Management of thymic tumors: a European perspective. J Thorac Dis 2014; 6 Suppl 2:S228-37. [PMID: 24868441 DOI: 10.3978/j.issn.2072-1439.2014.04.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/15/2014] [Indexed: 12/13/2022]
Abstract
Thymic tumors are rare mediastinal tumors, which are considered as orphan diseases due to their low prevalence. The most recent histologic classification divides thymic tumors into thymomas, thymic carcinomas (TC) and neuroendocrine thymic tumors (NETT). Until recently, clinical research on thymic tumors has been primarily represented by single-institution experiences usually scattered over a long time period in order to accumulate a sufficient number of patients for clinical analysis. Europe has played a pivotal role in the advancement of the clinical research on thymus in the past years. In the last decade, there has been an increased interest in thymic malignancies in the scientific community. The European Society of Thoracic Surgeons (ESTS), the most representative society of general thoracic surgeons in the world, established a dedicated thymic working group in 2010 with the intent to provide a platform among ESTS members with a specific interest in thymic malignancies. The present review is intended to provide, through the description of the activity of the ESTS thymic working group and its published results, an overview of the European contribution to the thymic research. A brief overview of the state-of-the-art of clinical presentation, diagnosis, staging and histologic classification of thymic tumors is also provided, along with the most recent therapeutic advancements.
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Affiliation(s)
- Enrico Ruffini
- 1 Section of Thoracic Surgery, Department of Surgery, University of Torino, Torino, Italy ; 2 Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy
| | - Federico Venuta
- 1 Section of Thoracic Surgery, Department of Surgery, University of Torino, Torino, Italy ; 2 Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy
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Kent MS, Wang T, Gangadharan SP, Whyte RI. What is the Prevalence of a “Nontherapeutic” Thymectomy? Ann Thorac Surg 2014; 97:276-82; discussion 82. [DOI: 10.1016/j.athoracsur.2013.07.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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Rashid OM, Cassano AD, Takabe K. Thymic neoplasm: a rare disease with a complex clinical presentation. J Thorac Dis 2013; 5:173-83. [PMID: 23585946 DOI: 10.3978/j.issn.2072-1439.2013.01.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/31/2013] [Indexed: 01/08/2023]
Abstract
Thymic neoplasms constitute a broad category of rare lesions with a wide spectrum of pathologic characteristics and clinical presentations which therefore require a high index of suspicion to diagnose. The natural history of the disease is seldom predictable, anywhere from an indolent to an aggressively malignant course. Although the classification and staging of these lesions are complex and controversial, complete radical surgical resection remains the gold standard of therapy. Radiation and chemotherapy are important elements of the multimodality approach to treating these patients and it is important for thoracic surgeons to work closely with their colleagues in other disciplines in the management of and future research endeavors in thymic neoplasm. In this review, we discuss the evaluation of the patient with an anterior mediastinal mass, the classification and staging of thymic neoplasms, the role of surgery, radiation and chemotherapy in treating this disease, as well as future directions in research for novel targeted therapies.
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Affiliation(s)
- Omar M Rashid
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia, USA
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Schneiter D, Tomaszek S, Kestenholz P, Hillinger S, Opitz I, Inci I, Weder W. Minimally invasive resection of thymomas with the da Vinci® Surgical System. Eur J Cardiothorac Surg 2012; 43:288-92. [PMID: 22851662 DOI: 10.1093/ejcts/ezs247] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The resection of thymic tumours requires completeness and may be technically challenging due to the anatomical proximity of the delicate mediastinal structures. An open approach by sternotomy is still recommended in all cases with locally extended disease. Video-assisted thoracoscopic surgery is feasible, but limited by the two-dimensional vision and the impaired mobility of the instruments. We evaluated the da Vinci® Surgical System for the resection of various mediastinal pathologies, particularly thymomas. METHODS Among 105 patients operated on by robotic assisted thoracoscopic surgery (RATS) for mediastinal tumours between 27 August 2004 and 12 July 2011, 20 patients with thymomas were studied prospectively. Of these, 10 males with a median age of 53 years, with a well-circumscribed thymic lesion on computed tomography (CT) and a diameter of <6 cm were resected by RATS alone, and selected ones (n = 3), with a diameter of >6 cm, underwent a hybrid procedure with a contralateral thoracotomy on the side of the main tumour extension. A regular follow-up with chest CT scans was performed every 6 months. RESULTS Thymoma resection was complete in all patients. Partial pericardial resection was needed in five and pulmonary resection in two patients. Eighty-five percent of patients had an R0 resection. Histological classifications included thymoma WHO type A (n = 3), AB (n = 8), B1-2 (n = 5) and B3 (n = 4). All B3 thymomas received adjuvant radiotherapy. No intraoperative complications occurred. The median hospitalization time was 5 days (range 2-14 days). There were no local, but two pleural, recurrences. After a median observation time of 26 months, 19 patients (95%) are alive. CONCLUSIONS Well-circumscribed thymomas can be safely and completely resected with the da Vinci® Surgical System with excellent short- and mid-term outcomes. Selected tumours with large diameters may be resectable using a hybrid procedure combining RATS with a thoracotomy.
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Affiliation(s)
- Didier Schneiter
- Department of Surgery, Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
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Vallés Torres J, Abadía Álvarez B, Garafulla García J, Izquierdo Villarroya B, Lacosta Torrijos L, Embún Flor R. [Pulmonary oedema due to re-expansion after resection of a giant thymoma]. ACTA ACUST UNITED AC 2012; 60:275-8. [PMID: 22695204 DOI: 10.1016/j.redar.2012.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 04/23/2012] [Indexed: 11/30/2022]
Abstract
A 36 year-old woman was subjected to resection of a giant thymoma that occupied a large area of the left hemithorax. After resection of the tumour and insufflation of the left lung there was pulmonary oedema due to early re-expansion. She was treated with diuretics and corticoids and was kept on mechanical ventilation. The patient progressed favourably. Although pulmonary oedema due to re-expansion is an uncommon complication it has a high mortality. It is essential to be aware of the factors involved in its aetiopathogenesis. It should be diagnosed and treated immediately.
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Affiliation(s)
- J Vallés Torres
- Servicio de Anestesiología y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España.
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Induction therapy for thymic malignancies. Thorac Surg Clin 2011; 22:83-9, vii. [PMID: 22108692 DOI: 10.1016/j.thorsurg.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thymic malignancies are rare tumors of the chest that express a broad range of biological behaviors. Surgery remains the mainstay of therapy, and complete surgical resection is the primary predictor of long-term survival. Although there is a paucity of clinical trials assessing the role of induction/adjuvant chemotherapy and/or radiation therapy in the treatment of thymic malignancies, existing data suggest that induction therapy should be offered for the treatment of advanced-stage disease, and postoperative radiation for specific stages.
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