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Falkson CB, Vella ET, Ellis PM, Maziak DE, Ung YC, Yu E. Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review. J Thorac Oncol 2023; 18:299-312. [PMID: 36343922 DOI: 10.1016/j.jtho.2022.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Thymic epithelial tumors are rare and are classified as thymoma, thymic carcinoma, and thymic neuroendocrine tumors. The objective of this systematic review was to evaluate the treatment options for patients with thymic epithelial tumors. METHODS This systematic review was developed by Ontario Health (Cancer Care Ontario)'s Program in Evidence-Based Care and by the Lung Cancer Disease Site Group. MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing surgical, radiotherapy, or systemic treatments against any combination of these treatments in patients with thymic epithelial tumors. Meta-analyses were conducted with clinically homogenous studies. RESULTS A total of 106 studies were included, mainly from observational studies. There was an overall survival benefit with postoperative radiotherapy for patients with thymic carcinoma (hazard ratio = 0.65, 95% confidence interval: 0.47-0.89) and for patients with thymoma (hazard ratio = 0.70, 95% confidence interval: 0.59-0.82), especially for those with a high risk for mortality. Patients with thymic carcinoma or thymoma had a response to chemotherapy. Selection bias affected the results for studies that evaluated neoadjuvant chemotherapy or minimally invasive surgical techniques. Furthermore, the overall survival benefit found for adjuvant chemotherapy may have been confounded by the administration of postoperative radiotherapy. CONCLUSIONS For patients with thymoma or thymic carcinoma, the literature is of low quality and subject to bias. There were overall survival benefits with postoperative radiotherapy. The results of this systematic review were used to inform treatment recommendations in a clinical practice guideline. Future large-scale prospective studies that control for confounders are needed.
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Affiliation(s)
- Conrad B Falkson
- Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada
| | - Emily T Vella
- Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | - Peter M Ellis
- Medical Oncology, Juravinski Cancer Centre and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Donna E Maziak
- Thoracic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Yee C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Edward Yu
- Radiation Oncology, London Regional Cancer Centre and Western University, London, Ontario, Canada
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Lin LM, Li YM, Huang YX, Zhang ZK, Dai YQ, Liu J, Lin Q. Evaluation of the role of postoperative radiotherapy in locally invasive thymoma: A propensity-matched study based on the SEER database. PLoS One 2023; 18:e0283192. [PMID: 37053227 PMCID: PMC10101529 DOI: 10.1371/journal.pone.0283192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/03/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES No consensus was reached on the efficacy of postoperative radiotherapy (PORT) in locally invasive thymomas because of the rarity of the thymic epithelial and the variations of study results. Therefore, we aimed to explore the efficacy of PORT in locally invasive thymomas using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients diagnosed with thymomas from 2004 to 2016 were identified using the SEER database. Prognostic factors of cancer-specific survival (CSS) and overall survival (OS) were identified using univariate and multivariate Cox regression analyses.Propensity score matching (PSM) was performed to balance the baseline characteristics. RESULTS A total of 700 eligible patients were identified. After PSM, 262 paired patients were selected from the two groups, those who received or did not receive PORT. Receiving PORT improved CSS and OS before and after PSM. In the matched population, the multivariate analyses showed that tumour invasion into adjacent organs/structures and non-utilisation of PORT were independent poor prognostic factors for CSS, whereas age ≥62 years,tumour invasion into adjacent organs/structures, and non-utilisation of PORT were independently associated with poorer OS. The subgroup analysis revealed that PORT improved CSS and OS in Masaoka-Koga stage III thymoma, but showed no OS benefit in Masaoka-Koga stage IIB thymoma. CONCLUSION Based on the SEER database, we found that PORT provides a significant survival benefit in Masaoka-Koga stage III thymoma with complete or incomplete resection. The role of PORT in thymoma requires further evaluation.
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Affiliation(s)
- Li-Mei Lin
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yi-Min Li
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yun-Xia Huang
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zong-Kai Zhang
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Ya-Qing Dai
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jun Liu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
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Li Y, Tang Z, Zhu X, Tian H. Nomogram based on TNM stage to predict the prognosis of thymic epithelial tumors (TETs) patients undergoing extended thymectomy. Front Surg 2023; 10:1136166. [PMID: 36936648 PMCID: PMC10020510 DOI: 10.3389/fsurg.2023.1136166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Background Thymomas and thymic carcinoma are thymic epithelial tumors (TETs) of the anterior mediastinum. On the basis of The AJCC 8th Edition of TNM classification, no prognostic prediction model has been established for TETs patients undergoing surgical resection. In this study, based on data from Qilu Hospital of Shandong University, we identified prognostic factors and developed a nomogram to predict the prognosis for TETs patients undergoing extended thymectomy. Methods Patients with TETs who underwent thymectomy between 2010 and 2020 were consecutively enrolled. An analysis of multivariate Cox regression and stepwise regression using the Akaike information criterion (AIC) was conducted to identify prognostic factors, and a nomogram for TETs was derived from the results of these analyses. The model was validated internally with the Kaplan-Meier curves, ROC curves and calibration curves. Results There were 350 patients with TETs enrolled in the study, and they were divided into a training group (245,0.7) and a validation group (105,0.3). Age, histological type, tumor size, myasthenia gravis, and TNM stage were independent prognostic factors for CSS. The Kaplan-Meier curves showed a significant difference between high nomorisk group and low nomorisk group. A nomogram for CSS was formulated based on the independent prognostic factors and exhibited good discriminative ability as a means of predicting cause-specific mortality, as evidenced by the area under the ROC curves (AUCs) of 3-year, 5-year, and 10-year being 0.946, 0.949, and 0.937, respectively. The calibration curves further revealed excellent consistency between the predicted and actual mortality when using this nomogram. Conclusion There are several prognostic factors for TETs. Based on TNM stage and other prognostic factors, the nomogram accurately predicted the 3-, 5-, and 10-year mortality rates of patients with TETs in this study. The nomogram could be used to stratify risk and optimize therapy for individual patients.
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The Prognostic Value of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma: A Propensity-Matched Study Based on SEER Database. Cancers (Basel) 2022; 14:cancers14194938. [PMID: 36230861 PMCID: PMC9563976 DOI: 10.3390/cancers14194938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Objectives: The effect of postoperative radiotherapy (PORT) for thymoma and thymic carcinoma remains controversial. This study aimed to investigate the prognostic value of PORT for thymoma and thymic carcinoma in a population-based registry. (2) Methods: This retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with thymoma and thymic carcinoma between 2010 and 2019. Propensity score matching was performed to adjust statistical influences between the PORT and non-PORT groups. (3) Results: A total of 2558 patients with thymoma (n = 2138) or thymic carcinoma (n = 420) were included. In the multivariate analysis, PORT was an independent prognostic factor for OS (overall survival; p < 0.001) and CSS (cancer-specific survival; p = 0.001) in thymoma and an independent prognostic factor for OS in thymic carcinoma (p = 0.018). Subgroup analyses revealed that PORT was beneficial to OS and CSS in patients with Masaoka-Koga stage IIB-IV thymoma (OS: IIB, p < 0.001; III-IV, p = 0.005; CSS: IIB, p = 0.015; III-IV, p = 0.002) and stage IIB thymic carcinoma (OS: p = 0.012; CSS: p = 0.029). (4) Conclusion: This propensity-matched analysis identified the prognostic value of PORT in thymoma and thymic carcinoma based on the SEER database. For patients with stage IIB-IV thymoma and stage IIB thymic carcinoma, PORT was associated with improved OS and CSS. A more positive attitude towards the use of PORT for nonlocalized thymoma and thymic carcinoma may be appropriate.
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Angrisani A, Houben R, Marcuse F, Hochstenbag M, Maessen J, De Ruysscher D, Peeters S. "Radiotherapy for thymic epithelial tumors: What is the optimal dose? A systematic review.". Clin Transl Radiat Oncol 2022; 34:67-74. [PMID: 35360004 PMCID: PMC8960904 DOI: 10.1016/j.ctro.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022] Open
Abstract
Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. Current guidelines on RT are based on studies with a low level of evidence, where 2D RT was widely used. We aim to shed light on the optimal radiation dose for patients with TETs undergoing RT through a systematic review of the recent literature, including reports using modern RT techniques such as 3D-CRT, IMRT/VMAT, or proton-therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with < 20 patients, 2D-RT use only, median follow-up time < 5 years, and reviews were excluded. Two studies fulfilled all the criteria and therefore were included. Loosening the follow-up time criteria to > 3 years, three additional studies could be evaluated. A total of 193 patients were analyzed, stratified for prognostic factors (histology, stage, and completeness of resection), and synthesized according to the synthesis without meta-analysis (SWIM) method. The paucity and heterogeneity of eligible studies led to controversial results. The optimal RT dose neither for postoperative, nor primary RT in the era of modern RT univocally emerged. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.
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Affiliation(s)
- A. Angrisani
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - R. Houben
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - F. Marcuse
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - M. Hochstenbag
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - J. Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - D. De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - S. Peeters
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
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Lideståhl A, Johansson G, Siegbahn A, Lind PA. Estimated Risk of Radiation-Induced Cancer after Thymoma Treatments with Proton- or X-ray Beams. Cancers (Basel) 2021; 13:cancers13205153. [PMID: 34680302 PMCID: PMC8533682 DOI: 10.3390/cancers13205153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Thymic tumors, i.e., thymomas and thymic carcinomas, are rare tumors that derive from the remnant of the thymus gland. Although surgery is the first treatment of choice, some patients will be treated with radiotherapy. For many patients the prognosis is good, hence it is important to avoid treatment related complications such as radiation-induced secondary malignancies. Radiotherapy can be delivered with different techniques and with different particles. In the present study, we compare the calculated (estimated) risks for secondary malignancies after treatment of thymic tumors with two different photon (x-ray) radiotherapy techniques or with proton beam therapy. We use a commonly used radiobiological model to calculate the risks for radiation induced secondary malignancies for each treatment modality. In conclusion, proton beam therapy was shown to provide the potential for reducing the risk of secondary malignancies, compared to photon radiotherapy, after treatment of thymic tumors. Abstract We compared the calculated risks of radiation-induced secondary malignant neoplasms (SMNs) for patients treated for thymic tumors with 3D-CRT, IMRT, or single-field uniform dose (SFUD) proton beam therapy (PBT) using the pencil beam scanning (PBS) technique. A cancer-induction model based on the organ equivalent dose (OED) concept was used. For twelve patients, treated with 3D-CRT for thymic tumors, alternative IMRT and SFUD plans were retrospectively prepared. The resulting DVHs for organs at risk (OARs) were extracted and used to estimate the risk of SMNs. The OED was calculated using a mechanistic model for carcinoma induction. Two limit cases were considered; the linear-exponential model, in which the repopulation/repair of the cells is neglected, and the plateau model, in which full repopulation/repair of the irradiated cells is assumed. The calculated risks for SMNs for the different radiation modalities and dose-relation models were used to calculate relative risks, which were compared pairwise. The risks for developing SMNs were reduced for all OARs, and for both dose-relation models, if SFUD was used, compared to 3D-CRT and IMRT. In conclusion, PBS shows a potential benefit to reduce the risk of SMNs compared to 3D-CRT and IMRT in the treatment of thymic tumors.
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Affiliation(s)
- Anders Lideståhl
- Department of Oncology-Pathology, Karolinska Institutet, 17177 Stockholm, Sweden
- Correspondence:
| | - Gracinda Johansson
- Department of Oncology, Södersjukhuset, 11883 Stockholm, Sweden; (G.J.); (A.S.)
| | - Albert Siegbahn
- Department of Oncology, Södersjukhuset, 11883 Stockholm, Sweden; (G.J.); (A.S.)
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 17177 Stockholm, Sweden;
| | - Pehr A. Lind
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 17177 Stockholm, Sweden;
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Wu S, Peng G, Liang W, He J. Impact of prior cancer history on outcomes in thymoma: a propensity score, population-based study. Gland Surg 2021; 10:1618-1626. [PMID: 34164306 DOI: 10.21037/gs-20-880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prior cancer history is a common exclusion in thymoma trials. However, whether prior cancer impacts the survival of thymoma patients and the outcomes of clinical trials remains uncertain. The aim of this study is to identify the impact of prior cancer on outcomes in thymoma. Methods Patients with thymoma diagnosed between 1975 to 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Age, histologic types, and thymoma size were stratified to analyze. Propensity score matching (PSM), Kaplan-Meier methods and Cox proportional hazard models were used to analyze the prognostic effect of prior cancer on overall survival (OS). Results A total of 3,827 thymoma patients were enrolled, of whom 13.22% had a prior cancer history. The Kaplan-Meier curves showed statistically significantly different survival before (P<0.001) and after PSM (P=0.0003). Subgroup analyses stratified by histologic types and thymoma size showed that thymoma patients with prior cancer had inferior survival. But thymoma patients with prior cancer displayed similar OS among patients older than 65 years (P=0.693). In multivariate analyses, patients with prior cancer displayed inferior OS [hazard ratio (HR) =1.39, 95% confidence interval (CI), 1.18 to 1.63]. Conclusions Prior cancer conveys an inferior OS among patients with thymoma. But it does not affect the survival adversely in older patients thus broader inclusion trial criteria may be adopted in thymoma patients with a prior cancer history.
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Affiliation(s)
- Shilong Wu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Guilin Peng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Bruni A, Stefani A, Perna M, Borghetti P, Giaj Levra N, D'Angelo E, D'Onofrio A, Rubino L, Frassinelli L, Salvestrini V, Mariotti M, Alongi F, Gonfiotti A, Livi L, Scotti V. The role of postoperative radiotherapy for thymomas: a multicentric retrospective evaluation from three Italian centers and review of the literature. J Thorac Dis 2020; 12:7518-7530. [PMID: 33447442 PMCID: PMC7797870 DOI: 10.21037/jtd-2019-thym-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Thymoma is a rare mediastinal neoplasia. Surgery is the backbone of the treatment, but the role of postoperative radiotherapy (PORT) remains controversial. We aimed to obtain data on survival and safety in patients treated with PORT in three different Italian institutions. Methods We retrospectively analyzed 183 consecutive patients who underwent surgery from 1981 to 2015. According to the Masaoka-Koga staging system, 39.3%, 32.7%, 18.6% and 9.8% patients were in stage I, II, III and IV of disease, respectively. PORT was indicated in 114 patients (62.3%), while 69 subjects underwent surgery alone. Complete resection was obtained in 68 patients who underwent PORT. Adverse events (AEs) were graded according to CTCAE v4.0. We analyzed the recent literature to describe the current reports on PORT for resected thymoma. Results Mean follow-up was 130 months (range, 3–417 months). Overall survival (OS) at 1-, 5- and 10-year from surgery was 98.3%, 90.2% and 69.7% respectively. One-, 5- and 10-year disease specific survival (DSS) was 98.9%, 92.3% and 89.8% respectively. Disease free survival (DFS) at 1, 5 and 10 years from surgery was 96.7%, 88.3% and 82.8% respectively. Univariate analysis showed that complete resection, cell histology A-AB-B1 and stages I–II were significant predictors of better DSS and DFS. Multivariate analysis showed that sex, R0 margins and WHO histology was independent prognostic factors. Among patients treated with PORT, a trend towards better OS was evident with Masaoka stage I–II (P=0.09). Patients with R0 margins treated with PORT showed better OS and DSS (P=0.05). No differences in DSS for performance status (P=0.70), WHO histology (P=0.19), paraneoplastic syndrome (P=0.23) and surgical procedure (P=0.53) were evident. Patients treated with PORT had a higher level of acute AEs compared to surgery alone, but none of these was graded ≥3. Conclusions Our results confirmed that patients with incompletely resected thymoma had the worst OS and DSS. High grade acute toxicity was not different between PORT and surgery alone. Other trials reported a significant benefit in OS, DSS and DFS in stage IIb–IV thymoma treated with PORT.
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Affiliation(s)
- Alessio Bruni
- Radiotherapy Unit, Hematology and Oncology Department, University Hospital of Modena, Modena, Italy
| | - Alessandro Stefani
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Perna
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, Spedali Civili of Brescia, Brescia, Italy
| | - Niccolò Giaj Levra
- Department of Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.,Department of Oncology, University of Turin, Torino, Italy
| | - Elisa D'Angelo
- Radiotherapy Unit, Hematology and Oncology Department, University Hospital of Modena, Modena, Italy
| | | | - Laura Rubino
- Radiotherapy Unit, Hematology and Oncology Department, University Hospital of Modena, Modena, Italy
| | - Luca Frassinelli
- Radiotherapy Unit, Hematology and Oncology Department, University Hospital of Modena, Modena, Italy
| | - Viola Salvestrini
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Matteo Mariotti
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Filippo Alongi
- Department of Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.,Department of Oncology, University of Turin, Torino, Italy
| | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
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Su Y, Chen Y, Tian Z, Lu C, Chen L, Ma X. lncRNAs classifier to accurately predict the recurrence of thymic epithelial tumors. Thorac Cancer 2020; 11:1773-1783. [PMID: 32374079 PMCID: PMC7327696 DOI: 10.1111/1759-7714.13439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Long non‐coding RNAs (lncRNAs), which have little or no ability to encode proteins, have attracted special attention due to their potential role in cancer disease. In this study we aimed to establish a lncRNAs classifier to improve the accuracy of recurrence prediction for thymic epithelial tumors (TETs). Methods TETs RNA sequencing (RNA‐seq) data set and the matched clinicopathologic information were downloaded from the Cancer Genome Atlas. Using univariate Cox regression and least absolute shrinkage and selection operator (LASSO) analysis, we developed a lncRNAs classifier related to recurrence. Functional analysis was conducted to investigate the potential biological processes of the lncRNAs target genes. The independent prognostic factors were identified by Cox regression model. Additionally, predictive ability and clinical application of the lncRNAs classifier were assessed, and compared with the Masaoka staging by receiver operating characteristic (ROC) analysis and decision curve analysis (DCA). Results Four recurrence‐free survival (RFS)‐related lncRNAs were identified, and the classifier consisting of the identified four lncRNAs was able to effectively divide the patients into high and low risk subgroups, with an area under curve (AUC) of 0.796 (three‐year RFS) and 0.788 (five‐year RFS), respectively. Multivariate analysis indicated that the lncRNAs classifier was an independent recurrence risk factor. The AUC of the lncRNAs classifier in predicting RFS was significantly higher than the Masaoka staging system. Decision curve analysis further demonstrated that the lncRNAs classifier had a larger net benefit than the Masaoka staging system. Conclusions A lncRNAs classifier for patients with TETs was an independent risk factor for RFS despite other clinicopathologic variables. It generated more accurate estimations of the recurrence probability when compared to the Masaoka staging system, but additional data is required before it can be used in clinical practice.
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Affiliation(s)
- Yongchao Su
- Department of Thoracic Surgery, Sanya Central Hospital, Sanya, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zuochun Tian
- Department of Thoracic Surgery, Sanya Central Hospital, Sanya, China
| | - Chuangang Lu
- Department of Thoracic Surgery, Sanya Central Hospital, Sanya, China
| | - Liang Chen
- Department of Respiratory Medicine, Sanya Central Hospital, Sanya, China
| | - Ximiao Ma
- Department of Thoracic Surgery, Haikou People's Hospital, Haikou, China
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Lee MC, Hsiao TH, Chuang HN, Lee LW, Chi PL, Tsai HM, Mao CL, Hsu CP. Molecular profiling of thymoma with myasthenia gravis: Risk factors of developing myasthenia gravis in thymoma patients. Lung Cancer 2019; 139:157-164. [PMID: 31809976 DOI: 10.1016/j.lungcan.2019.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/19/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Thymoma is a rare epithelial tumor arising from the thymus in the anterior mediastinum. Nearly 50% of patients with thymoma develop myasthenia gravis, which is an indication of a poor long-term prognosis. Here, we identified specific and effective molecular markers for predicting in the development of myasthenia gravis patients with thymoma. MATERIAL AND METHODS We investigated molecular profiling based on RNA-sequencing (RNA-seq) for myasthenia gravis development in patients with thymoma. RNA was extracted from 34 patients with thymoma, 16 of whom had myasthenic and 18 of whom did not, and transcriptome profiles were analyzed through next-generation sequencing. RESULTS We discovered 140 differential expressed genes associated with myasthenia gravis in thymoma patients. The four genes, hypoxia-inducible factor 3 alpha (HIF3A), insulin-like growth factor-binding protein 1, pyruvate dehydrogenase kinase, and Krüppel-like factor 15 were differentially expressed in patients with thymoma who has myasthenia gravis and were validated by quantitative polymerase chain reaction. HIF3A expression was significantly higher in patients with myasthenia gravis than in those without. CONCLUSION HIF3A is aberrantly expressed in patient with thymoma who has myasthenia gravis and may be involved in the development of myasthenia gravis in thymoma patient.
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Affiliation(s)
- Ming-Ching Lee
- Division of Thoracic Surgery, Department of Surgery, Taichung Veteran General Hospital, Taichung, 40705, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan; Department of Public Health, Fu Jen Catholic University, New Taipei City, 24205, Taiwan; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Han-Ni Chuang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Li-Wen Lee
- Division of Thoracic Surgery, Department of Surgery, Taichung Veteran General Hospital, Taichung, 40705, Taiwan
| | - Pei-Ling Chi
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, 81362, Taiwan; Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 81362, Taiwan
| | - Hui-Mei Tsai
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chien-Lin Mao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chung-Ping Hsu
- Division of Thoracic Surgery, Department of Surgery, Taichung Veteran General Hospital, Taichung, 40705, Taiwan; School of Medicine, Tzu Chi University, Hualien 77002, Taiwan; Division of Thorcic Surgery, Department of Surgery, Buddist Tzu Chi Hospital, Hualien, 97002, Taiwan.
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Maruyama N, Sasaki T, Arasaki A, Matsuzaki A, Nakasone T, Teruya T, Matayoshi A, Maruyama T, Karube K, Fujita J, Yoshimi N, Kuniyoshi Y, Nishihara K. Thymoma appearing 9 years after the resection of squamous cell carcinoma of the lip: A case report of triple primary tumors and literature review. Oncol Lett 2019; 18:2777-2788. [PMID: 31452756 PMCID: PMC6704295 DOI: 10.3892/ol.2019.10675] [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: 11/18/2018] [Accepted: 04/09/2019] [Indexed: 11/06/2022] Open
Abstract
The occurrence of second primary tumor (SPT)following malignancy treatment is common. In patients with head and neck (H&N) cancer, SPTs principally occur in the H&N region, lungs or esophagus. Therefore, patient follow-up after cancer treatment is important in order to detect recurrence, metastasis and new primary tumors. However, no standard guidelines on lifelong follow-up imaging are available. Herein, we report a patient who presented with three metachronous primary tumors-squamous cell carcinoma (SCC) of the tongue, SCC of the lip and type A thymoma. The third tumor was incidentally detected during follow-up using contrast-enhanced computed tomography (CT) 9 years following resection of the second tumor. To the best of our knowledge, this specific combination of metachronous tumors has not yet been reported. Based on the literature review, we observed that thymoma occurs following H&N cancer treatment. Therefore, to ensure that the presence of subsequent thymomas is not overlooked, we suggest regular lifelong follow-up using contrast-enhanced CT in patients who had previously been diagnosed with H&N cancer. The literature review revealed that thymomas occur in patients with H&N cancer and should be detected at the earliest convenience.
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Affiliation(s)
- Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takanobu Sasaki
- Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi 983-8512, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akiko Matsuzaki
- Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takao Teruya
- Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Tessho Maruyama
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Molecular Microbiology Group, Tropical Biosphere Research Center, University of the Ryukyus, Nishihara, Okinawa 903-0213, Japan
| | - Kennosuke Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine (The First Department of Internal Medicine), University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Naoki Yoshimi
- Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yukio Kuniyoshi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
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Treatments and outcomes of spinal metastasis from thymic epithelial tumors: 10-year experience with 15 patients in a single center. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1520-1528. [DOI: 10.1007/s00586-019-05982-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/19/2019] [Indexed: 12/26/2022]
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Zhao M, Yin J, Yang X, Jiang T, Lu T, Huang Y, Li M, Yang X, Lin M, Niu H, Zhan C, Feng M, Wang Q. Nomogram to predict thymoma prognosis: A population-based study of 1312 cases. Thorac Cancer 2019; 10:1167-1175. [PMID: 30957407 PMCID: PMC6500983 DOI: 10.1111/1759-7714.13059] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 12/04/2022] Open
Abstract
Background A thymoma is a common cancer within the anterior mediastinum; however, the prognostic characteristics have not been established. The aim of this study was to identify the prognostic factors and develop a nomogram for the prognostic prediction of patients with thymoma based on data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with thymomas diagnosed between 1983 and 2014 were selected. Overall survival (OS) was estimated using the Kaplan–Meier method with the log‐rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors, from which a nomogram for thymomas was created. External validation of the nomogram was performed using data from our center. Results A total of 1312 patients with thymomas were enrolled. Age, tumor size, Masaoka–Koga stage, chemotherapy administered, and surgery type were independent prognostic factors for OS. A nomogram for OS was formulated based on the independent prognostic factors and validated using an internal bootstrap resampling approach, which showed that the nomogram exhibited a sufficient level of discrimination according to the C‐index in training (0.713, 95% confidence interval 0.685–0.741) and (0.746, 95% confidence interval 0.625–0.867) validation cohorts. Conclusion Several prognostic factors for thymomas were identified. The nomogram developed in this study accurately predicted the 5‐year and 10‐year OS rates of patients with thymomas based on individual characteristics. Risk stratification using the survival nomogram could optimize individual therapy and follow‐up.
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Affiliation(s)
- Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiacheng Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Eight-year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Eight-year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Niu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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