1
|
Zhang B, Liu Y, Chen Z, Chen J, Yu H, Li M, Ma S, Cheng C, Chen L. Chemotherapy versus chemotherapy plus immune checkpoint inhibitors for the first-line treatment of unresectable thymic carcinoma: A multicenter retrospective study. Int J Cancer 2024; 155:710-718. [PMID: 38608177 DOI: 10.1002/ijc.34948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024]
Abstract
Thymic carcinoma (TC) is a rare malignant tumor with a poor prognosis, and there is currently limited data on the use of immunotherapy in patients with unresectable TC. In this study, data of patients with unresectable TC diagnosed from January 2017 were retrospectively collected from multiple centers. Treatment response, progression-free survival (PFS), overall survival (OS), survival-independent prognostic factor, and adverse events (AEs) were further analyzed. As a result, a total of 93 patients with unresectable TC were enrolled, of which 54 received first-line chemotherapy, and 39 received chemotherapy plus immune checkpoint inhibitors (ICIs). The objective response rate was 50% (27/54) in the chemotherapy group and 76.9% (30/39) in the chemotherapy plus ICIs group. The chemotherapy plus ICIs group achieved significant median PFS benefit (8.8 vs. 34.9 months, p < .001) and median OS benefit (41.8 months vs. not reached, p = .025). Multivariate analysis showed that ICIs and local therapy were independent prognostic factors for PFS. In addition, 17 patients developed immune-related AEs (IRAEs), of which 15 (38.5%) had Grade 1 or 2 IRAEs and 2 (5.1%) had Grade 3 IRAEs in the chemotherapy plus ICIs group. In conclusion, the efficacy of chemotherapy plus ICIs is superior to chemotherapy, and the adverse effects are manageable in patients with unresectable TC.
Collapse
Affiliation(s)
- Baishen Zhang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Yao Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhiting Chen
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Hui Yu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Meichen Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Shudong Ma
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chao Cheng
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Likun Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| |
Collapse
|
2
|
Yanagihara T, Kawamura T, Maki N, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Practical methods to differentiate thymic malignancies by positron-emission tomography and tumor markers. Surg Today 2024; 54:899-906. [PMID: 38411770 DOI: 10.1007/s00595-024-02801-5] [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: 08/30/2023] [Accepted: 12/24/2023] [Indexed: 02/28/2024]
Abstract
PURPOSE An accurate diagnosis of thymic malignancies is important, but challenging due to the broad range of differential diagnoses. This study aims to evaluate the efficacy of PET/CT and tumor markers for diagnosing thymic malignancies. METHODS Patients admitted to our department between January 2012 and December 2021 with primary anterior mediastinal tumors were retrospectively evaluated. We evaluated the relationship between the maximum standardized uptake value (SUVmax), tumor markers, and pathological diagnosis in four groups: thymic carcinoma, thymoma, lymphoma, and others. RESULTS In total, 139 patients were included in this study. The SUVmax was significantly higher in lymphoma, thymic carcinoma, and thymoma, in that order. The cytokeratin 19 fragment (CYFRA 21-1) was significantly higher in thymic carcinoma than in the other groups. An ROC curve analysis indicated that the optimal cut-off values of SUVmax for thymic carcinoma plus lymphoma and CYFRA 21-1 for thymic carcinoma were 7.97 (AUC = 0.934) and 2.95 (AUC = 0.768), respectively. Using a combination of cut-off values (SUVmax = 8, CYFRA 21-1 = 3), the accuracy rate for diagnosing thymic carcinoma was 91.4%. CONCLUSIONS The SUVmax and CYFRA 21-1 levels are significant indicators for the diagnosis of thymic carcinoma. Combining these indicators resulted in a more accurate diagnosis of thymic malignancies, which could facilitate the decision-making process for determining the optimal treatment strategies.
Collapse
Affiliation(s)
- Takahiro Yanagihara
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naoki Maki
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| |
Collapse
|
3
|
Yang Y, Yu Y, Fan Y, Li H. Evolving treatment landscape in thymic epithelial tumors: From mechanism to therapy. Biochim Biophys Acta Rev Cancer 2024; 1879:189145. [PMID: 38942215 DOI: 10.1016/j.bbcan.2024.189145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/19/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
Thymic epithelial tumors (TETs) are rare neoplasms of the anterior mediastinum that arise from thymic epithelial cells. Although surgery is the preferred treatment for resectable TETs, the options for unresectable or recurrent advanced-stage TETs are limited beyond platinum-based chemotherapy. The evolving landscape of TET treatments is marked by significant advancements in targeted therapies and immunotherapies, particularly with anti-angiogenic agents and immune checkpoint inhibitors (ICIs). While monotherapies demonstrated certain efficacy, the development of combination strategies is vital for improving patient outcomes. This review consolidates progress in anti-angiogenic therapies and ICIs, emphasizing the evolution of combination therapies of TETs. Furtherly, we particularly discuss new first-line strategies based on these advancements and emphasizes exploring novel treatments like antibody-drug conjugates, immunomodulatory drugs and cytokine-based agents for TETs. Mechanistically, the molecular features of TETs integrated with clinical diagnosis and targeted therapy, and immunophenotyping of TETs along with its impact on the efficacy and safety of immunotherapy are discussed. Thus, this review systemizes the development in the treatment landscape of TETs, integrating the corresponding molecular and immune mechanisms, aiming to provide new references for the treatment of TETs.
Collapse
Affiliation(s)
- Yehao Yang
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Ying Yu
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Yun Fan
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
| | - Hui Li
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
| |
Collapse
|
4
|
Ajimizu H, Sakamori Y. Narrative review of indication and management of induction therapy for thymic epithelial tumors. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:44. [PMID: 39161586 PMCID: PMC11330911 DOI: 10.21037/med-23-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/01/2024] [Indexed: 08/21/2024]
Abstract
Background and Objective Thymic epithelial tumors (TETs) are rare and originate from the thymus. Thymomas and thymic carcinomas are the most common types of TETs. Of the two, thymomas tend to have a better prognosis and are typically localized, while thymic carcinomas have a worse prognosis and are more likely to spread. The Masaoka-Koga staging system is commonly used to determine the stage of TETs. Complete resection is the preferred treatment option, but treating locally advanced TETs can be challenging due to the invasion of surrounding structures. In such cases, induction therapy is administered to downstage the tumors and enable complete resection. We conducted this narrative review to evaluate the current progress in induction treatment for locally advanced TETs. Methods The literature search was performed using PubMed and Web of Science in June 2023. Prospective and retrospective published trials, systemic and narrative reviews, and meta-analyses were included. Key Content and Findings Induction chemotherapy is often used as a preoperative treatment for advanced TETs. Platinum and anthracycline-based chemotherapy regimens are commonly used for treating thymoma (response rate, 37-100%), and complete resection is highly common. Treatment with cisplatin and etoposide, carboplatin and paclitaxel, docetaxel and cisplatin have also demonstrated effectiveness, particularly in patients with thymic carcinoma or thymoma who cannot tolerate anthracycline regimens. The emergence of immunotherapy and targeted therapies may provide additional options for the treatment of TETs. Induction radiotherapy, as the sole treatment for TETs, is not widely practiced due to concerns about potential damage to surrounding tissues. However, combining modern radiation techniques with surgery has shown promising results in selected patients. Induction chemoradiotherapy, which combines chemotherapy and radiation, is an emerging approach for treating TETs. Despite the lack of randomized trials comparing chemotherapy with chemoradiotherapy, concurrent chemoradiation with radiation doses of 40-50 Gy is often considered the optimal induction therapy for thymic carcinoma patients or in more advanced special situations, such as great vessel invasion. Conclusions Overall, the optimal treatment for locally advanced TETs remains controversial. Induction therapy, including chemotherapy, radiotherapy, or chemoradiotherapy, is administered to downstage tumors and improve resectability. The choice of treatment depends on individual factors such as tumor stage, histology, and overall patient condition. However, further research and well-designed studies are needed to determine the most effective treatment strategies for locally advanced TETs.
Collapse
Affiliation(s)
- Hitomi Ajimizu
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| |
Collapse
|
5
|
Fang W, Yu Z, Chen C, Chen G, Chen K, Fu J, Han Y, Fu X, Wang J, Mao T, Gu Z, Xu N. China Anti-Cancer Association Guidelines for the diagnosis, treatment, and follow-up of thymic epithelial tumors (2023). MEDIASTINUM (HONG KONG, CHINA) 2024; 8:27. [PMID: 38881812 PMCID: PMC11176998 DOI: 10.21037/med-23-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/26/2024] [Indexed: 06/18/2024]
Abstract
Background Thymic epithelial tumors (TETs) are a relatively rare type of thoracic tumors with higher incidence in Asians. The diagnosis and treatment pattern has long been based mainly on clinical experience and expert consensus. In recent years, with an increasing number of TETs detected in physical examinations, there is an urgent need to develop the guidelines that apply to the Chinese population. Thus, we intend to develop a holistic integrative guideline for TETs. Methods Under the leadership of the Chinese Anti-Cancer Association (CACA) Mediastinal Tumor Committee, a multidisciplinary guideline development group was established. Systemic literature review and two rounds of questionnaires regarding key clinical issues were carried out. The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations. Results The CACA guideline provides recommendations for the clinical differential diagnosis of anterior mediastinal lesions, management of asymptomatic small anterior mediastinal nodules, pathological classification and staging systems of TETs, as well as principles of surgery, neoadjuvant and adjuvant therapies, systemic therapies for advanced TETs, and follow-up strategies after surgical resection. Conclusions This guideline provides holistic integrative management strategies for TETs and would be a useful tool for clinicians on decision-making.
Collapse
Affiliation(s)
- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhentao Yu
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Gang Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Teng Mao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
6
|
Cabezón-Gutiérrez L, Pacheco-Barcia V, Carrasco-Valero F, Palka-Kotlowska M, Custodio-Cabello S, Khosravi-Shahi P. Update on thymic epithelial tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:33. [PMID: 38881809 PMCID: PMC11176988 DOI: 10.21037/med-23-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/14/2024] [Indexed: 06/18/2024]
Abstract
Background and Objective Thymoma, thymic carcinoma and thymic neuroendocrine tumors originate from the epithelial cells of the thymus and account for the thymic epithelial tumors (TETs). Although TETs are uncommon, they are the most frequent tumor type in the anterior mediastinum. Multidisciplinary approach is essential for their correct management. The aim of the present review is to summarize the update management for TETs. Methods For this review, we searched in Excerpta Medica database (EMBASE) and MEDLINE until 6 September 2023. The terms used in the search included thymoma, thymic carcinoma, thymic epithelial tumors, management, immunotherapy, multiple tyrosine kinases inhibitors. Key Content and Findings The therapeutic approach is based on histology and tumor stage and may involve surgery with or without neoadjuvant or adjuvant treatment. In the metastatic setting, platinum-based chemotherapy is the standard of care and patients who do not respond to first-line treatment have limited treatment options mainly because of the poor efficacy shown in subsequent lines of therapy. Conclusions Future research should focus on identifying predictive biomarkers for patients with TETs, and should implement multicenter collaborations and appropriate clinical trials tailored for rare tumor types. Immune check point inhibitors, mammalian target of rapamycin (mTOR) and antiangiogenic multikinase inhibitors have also been studied in this clinical setting.
Collapse
Affiliation(s)
- Luis Cabezón-Gutiérrez
- Medical Oncology, Torrejón University Hospital, Madrid, Spain
- Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
7
|
Kishi N, Matsuo Y. Postoperative radiotherapy for thymic epithelial tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:40. [PMID: 39161587 PMCID: PMC11330913 DOI: 10.21037/med-23-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 08/21/2024]
Abstract
Background and Objective Thymic epithelial tumors (TETs), including thymomas and thymic carcinomas, are rare mediastinal tumors. Surgical resection is the treatment strategy for resectable TETs, and postoperative radiotherapy (PORT) is administered to improve local control in patients with a high risk of recurrence. The rarity of TETs has led to a lack of randomized controlled trials, and the current indications for PORT rely largely on retrospective studies. This review analyzes the literature on TETs, highlighting PORT, to guide current research and future investigations. Methods Studies that focused on TETs, addressed topics on PORT, and had English abstracts accessible online were eligible for inclusion in our review. We excluded case reports or review articles, articles written in languages other than English, articles published >30 years ago, and articles concerning thymic neuroendocrine tumors. Key Content and Findings Masaoka or Masaoka-Koga staging, World Health Organization (WHO) histological subtype, and resection status indicate PORT in resected TETs. Current literature suggests that PORT does not improve overall survival in stage I-IIA TETs, with inconsistent results for stage IIB-III TETs. Patients with a higher risk, such as carcinomas or WHO type B, might benefit from PORT if they do not develop distant metastasis. Determining which patients will benefit most from PORT requires further investigation. For recurrent TETs, the significance of applying PORT is unclear because available data are limited. Given the long-term survival of TETs, late toxicities, including radiation pneumonitis, radiation-induced cardiotoxicities, and secondary malignancies, must be addressed. Proton beam radiotherapy might reduce toxicities by sparing organs at risk compared to conventional photon beam radiotherapy. The use of high-precision radiation therapy, along with emerging immunotherapy, targeted therapy, and minimally invasive surgery, could improve TET outcomes. Conclusions This review consolidates the literature on PORT for TETs, factoring in the Masaoka-Koga staging, WHO histological subtypes, and resection status. Varying results regarding PORT efficacy have led to an undefined strategy for stage IIB-III TETs. Although advanced radiotherapy techniques promise to reduce radiation-induced toxicities, further research is needed to investigate the efficacy of PORT and combination therapy.
Collapse
Affiliation(s)
- Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| |
Collapse
|
8
|
von der Thüsen J. Thymic epithelial tumours: histopathological classification and differential diagnosis. Histopathology 2024; 84:196-215. [PMID: 37994555 DOI: 10.1111/his.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
Collapse
Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
9
|
Li G, Chang H, Wang Z, He D, Qu L, Shao Q, Wang Q. Effect of open versus video-assisted thoracoscopy on perioperative outcomes and survival for cases of thymic carcinomas and thymic neuroendocrine tumors. World J Surg Oncol 2023; 21:329. [PMID: 37845701 PMCID: PMC10578011 DOI: 10.1186/s12957-023-03210-7] [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: 02/09/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The oncology-related indices between open and video-assisted thoracoscopic surgery (VATS) procedures for thymic carcinomas (TCs) and thymic neuroendocrine tumors (TNETs) remain unclear. METHODS Propensity score matching (PSM) and multivariate Cox proportional risk models were used to evaluate the perioperative outcomes and survival rates of patients undergoing open and VATS for TCs and TNETs at the Second Affiliated Hospital of Air Force Military Medical University Hospital, between 2009 and 2018. RESULTS Of the total 126 cases of TCs and TNETs, VATS treatment was used in 39 (30.9%). Advanced age and Masaoka-Koga staging were found to be independent prognostic factors for both TCs and TNETs, through a multifactorial Cox regression analysis. There was no significant difference in survival between the VATS and open groups before and after PSM; however, the VATS group had better perioperative-related indicators. There were no significant differences between the groups in terms of mortality at 30 days, mortality at 90 days, R0 resection rate, and 5-year survival rate (67.5% vs. 58.5% [P = 0.260] in the VATS group compared to the open group, in a PSM analysis of the 27 VATS and 27 open groups). Compared to the open group, the VATS group had a shorter length of hospital stay (13 days vs. 16 days, P = 0.015), a shorter level I care (0 days vs. 1 day, P = 0.016), and less intraoperative bleeding (50 mL vs. 300 mL, P < 0.001). CONCLUSIONS In this single-center retrospective study of TCs and TNETs, survival rates were comparable between the VATS group and the open group, and the VATS group showed improved perioperative-related parameters.
Collapse
Affiliation(s)
- Gaiyan Li
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Hao Chang
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | | | - Dongjie He
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lin Qu
- Department of Thoracic Surgery, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiuju Shao
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiming Wang
- Department of Radiotherapy Oncology, Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China.
| |
Collapse
|
10
|
Zhang Y, Lin D, Aramini B, Yang F, Chen X, Wang X, Wu L, Huang W, Fan J. Thymoma and Thymic Carcinoma: Surgical Resection and Multidisciplinary Treatment. Cancers (Basel) 2023; 15:cancers15071953. [PMID: 37046614 PMCID: PMC10093507 DOI: 10.3390/cancers15071953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Thymoma and thymic carcinoma are the most common tumors of the anterior mediastinum and a relatively rare type of thoracic cancer. The prerequisite for surgery is clinical staging and operative evaluation, both of which are based on medical imaging. The best strategy for treating a thymic epithelial tumor is surgical resection of the organ and surrounding tissue. Thymectomy modalities vary, including open surgery and minimally invasive surgery, and surgeons have used various innovations to better meet the needs of the procedure; therefore, it is critical to select the appropriate procedure based on the patient's characteristics. Evaluation of resectability is the first step of surgical resection for thymic tumors without distant metastasis. The decision regarding unresectability should be made carefully. During subsequent chemotherapy or chemoradiotherapy, reevaluation of whether an area is resectable or not remains essential. Despite numerous technological advances in the surgical treatment of thymic tumors, several contentious issues remain, including the selection of surgical approaches for difficult cases, the selection of video-assisted thoracoscopic approaches, the evaluation of resectability, minimally invasive surgery for locally advanced thymic tumors, lymphadenectomy in thymic tumors, neoadjuvant therapy for thymic tumors, debulking surgery, and salvage surgery. In solving these problems, the surgeon's judgment, surgical experience, and surgical skills are especially important.
Collapse
Affiliation(s)
- Yue Zhang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dong Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences-DIMEC of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 47121 Forlì, Italy
| | - Fu Yang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xi Chen
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xing Wang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
11
|
Xu C, Zhang Y, Wang W, Wang Q, Li Z, Song Z, Wang J, Yu J, Liu J, Zhang S, Cai X, Wu M, Zhan P, Liu H, Lv T, Miao L, Min L, Li J, Liu B, Yuan J, Jiang Z, Lin G, Chen X, Pu X, Rao C, Lv D, Yu Z, Li X, Tang C, Zhou C, Zhang J, Guo H, Chu Q, Meng R, Liu X, Wu J, Hu X, Fang M, Zhou J, Zhu Z, Chen X, Pan W, Pang F, Zhou Y, Jian Q, Wang K, Wang L, Zhu Y, Yang G, Lin X, Cai J, Liang L, Feng H, Wang L, Du Y, Yao W, Shi X, Niu X, Yuan D, Yao Y, Huang J, Zhang Y, Sun P, Wang H, Ye M, Wang D, Wang Z, Hao Y, Wang Z, Wan B, Lv D, Yu G, Li A, Kang J, Zhang J, Zhang C, Chen H, Shi L, Ye L, Wang G, Wang Y, Gao F, Zhou W, Hu C, Wei J, Li B, Li Z, Li Y, Liu Z, Yang N, Wu L, Wang Q, Huang W, Hong Z, Wang G, Fang M, Fang Y, Zhu X, Du K, Ji J, Shen Y, Zhang Y, Ma S, Song Y, Lu Y, Liu A, Fang W, Zhong W. Chinese expert consensus on the diagnosis and treatment of thymic epithelial tumors. Thorac Cancer 2023; 14:1102-1117. [PMID: 36924056 PMCID: PMC10125784 DOI: 10.1111/1759-7714.14847] [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: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
Thymic epithelial tumors (TETs) are a relatively rare type of thoracic tumor, accounting for less than 1% of all tumors. The incidence of TETs is about 3.93/10000 in China, slightly higher than that of European and American countries. For resectable TETs, complete surgical resection is recommended. Radiotherapy or chemotherapy may be used as postoperative adjuvant treatment. Treatment for advanced, unresectable TETs consist mainly of radiotherapy and chemotherapy, but there is a lack of standard first- and second-line treatment regimens. Recently, targeted therapies and immune checkpoint inhibitors have shown promising outcomes in TETs. Based on the currently available clinical evidences and the opinions of the national experts, the Thymic Oncology Group of Yangtze River Delta Lung Cancer Cooperation Group (East China LUng caNcer Group, ECLUNG; Youth Committee) established this Chinese expert consensus on the clinical diagnosis and treatment of TETs, covering the epidemiology, diagnosis, treatment, prognosis and follow-up of TETs.
Collapse
Affiliation(s)
- Chunwei Xu
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, People's Republic of China.,Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China.,Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yongchang Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Wenxian Wang
- Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Qian Wang
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, People's Republic of China
| | - Ziming Li
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhengbo Song
- Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Jiandong Wang
- Department of Pathology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Jinpu Yu
- Department of Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Jingjing Liu
- Department of Thoracic Cancer, Jilin Cancer Hospital, Jilin, People's Republic of China
| | - Shirong Zhang
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiuyu Cai
- Department of VIP Inpatient, Sun Yet-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ming Wu
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Cancer Center, Zhejiang University, Hangzhou, People's Republic of China
| | - Ping Zhan
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Hongbing Liu
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Liyun Miao
- Department of Respiratory Medicine, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Lingfeng Min
- Department of Respiratory Medicine, Clinical Medical School of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, People's Republic of China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Baogang Liu
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhansheng Jiang
- Derpartment of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Gen Lin
- Department of Medical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xiaohui Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xingxiang Pu
- Department of Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Chuangzhou Rao
- Department of Radiotherapy and Chemotherapy, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Dongqing Lv
- Department of Pulmonary Medicine, Taizhou Hospital of Wenzhou Medical University, Taizhou, People's Republic of China
| | - Zongyang Yu
- Department of Respiratory Medicine, the 900th Hospital of the Joint Logistics Team (the Former Fuzhou General Hospital), Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiaoyan Li
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuanhao Tang
- Department of Medical Oncology, Peking University International Hospital, Beijing, People's Republic of China
| | - Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University(The First Affiliated Hospital of Guangzhou Medical University), Guangzhou, People's Republic of China
| | - Junping Zhang
- Department of Thoracic Oncology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Hui Guo
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rui Meng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xuewen Liu
- Department of Oncology, the Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jingxun Wu
- Department of Medical Oncology, the First Affiliated Hospital of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Xiao Hu
- Zhejiang Key Laboratory of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Min Fang
- Zhejiang Key Laboratory of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Jin Zhou
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, People's Republic of China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiaofeng Chen
- Department of Oncology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China
| | - Weiwei Pan
- Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, People's Republic of China
| | - Fei Pang
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Yuxiang Zhou
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Qijie Jian
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Kai Wang
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Liping Wang
- Department of Oncology, Baotou Cancer Hospital, Baotou, People's Republic of China
| | - Youcai Zhu
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Guocai Yang
- Department of Thoracic Surgery, Zhoushan Hospital, Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University(The First Affiliated Hospital of Guangzhou Medical University), Guangzhou, People's Republic of China
| | - Jing Cai
- Department of Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Lijun Liang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Cancer Center, Zhejiang University, Hangzhou, People's Republic of China
| | - Huijing Feng
- Department of Thoracic Oncology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Lin Wang
- Department of Pathology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Yingying Du
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xuefei Shi
- Department of Respiratory Medicine, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, People's Republic of China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Dongmei Yuan
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yanwen Yao
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Jianhui Huang
- Department of Oncology, Lishui Municipal Central Hospital, Lishui, People's Republic of China
| | - Yinbin Zhang
- Department of Oncology, the Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Pingli Sun
- Department of Pathology, The Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Hong Wang
- Senior Department of Oncology, The 5th Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Mingxiang Ye
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Dong Wang
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Zhaofeng Wang
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yue Hao
- Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Zhen Wang
- Department of Radiation Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Bing Wan
- Department of Respiratory Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Donglai Lv
- Department of Clinical Oncology, The 901 Hospital of Joint Logistics Support Force of People Liberation Army, Hefei, People's Republic of China
| | - Genhua Yu
- Department of Radiation Oncology, Zhebei Mingzhou Hospital, Huzhou, People's Republic of China
| | - Anna Li
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Jin Kang
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Jiatao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Huafei Chen
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Lin Shi
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Leiguang Ye
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Gaoming Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yina Wang
- Department of Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Feng Gao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wei Zhou
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Chunxiu Hu
- Department of Cancer Radiotherapy and Chemotherapy, Zhejiang Queue Hospital, Quzhou, People's Republic of China
| | - Jianguo Wei
- Department of Pahtology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, People's Republic of China
| | - Bihui Li
- Department of Oncology, The Second Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Zhefeng Liu
- Senior Department of Oncology, The 5th Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Nong Yang
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Lin Wu
- Department of Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Qiming Wang
- Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Wenbin Huang
- Department of Pathology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China
| | - Zhuan Hong
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Guansong Wang
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Meiyu Fang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Xixu Zhu
- Department of Radiation Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Kaiqi Du
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Jiansong Ji
- Department of Radiology, Lishui Municipal Central Hospital, Lishui, People's Republic of China
| | - Yi Shen
- Department of Thoracic Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yiping Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Shenglin Ma
- Department of Oncology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou Cancer Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yong Song
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yuanzhi Lu
- Department of Clinical Pathology, The First Affiliated Hospital Of Jinan University, Guangzhou, People's Republic of China
| | - Anwen Liu
- Department of Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| |
Collapse
|
12
|
Efficacy and safety of treatments for advanced thymic carcinoma after failure of first-line platinum-based chemotherapy: A systematic literature review and meta-analysis. Lung Cancer 2023; 176:132-139. [PMID: 36638588 DOI: 10.1016/j.lungcan.2023.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
Thymic carcinoma (TC) is a rare cancer and patients failing initial chemotherapy (relapse/refractory) face limited therapeutic options given no approved options or consensus standard of care. This study aimed to identify and summarize clinical outcomes of all regimens evaluated in clinical trials of relapsed or refractory patients. Interventional trials enrolling advanced TC patients who failed first-line chemotherapy and reported outcomes in this group were eligible for inclusion in our systemic literature review (SLR). Between-study heterogeneity was assessed to determine the feasibility of pooling specific studies and treatments. Objective response rate (ORR), overall survival (OS), progression-free survival (PFS), and duration of response (DOR) endpoints were of interest for meta-analysis. Nineteen trials were identified in the SLR. Three trials with one or two TC patients were removed from our assessment to reduce publication bias. Response rates among studies with at least ten TC patients varied from 9 % to 38 %. Pooled ORRs in patients receiving S-1 (46 patients), sunitinib (46 patients), or pembrolizumab (66 patients) were 28 %, 24 %, and 21 %, respectively. Prolonged duration of response with pembrolizumab was observed with a pooled median of 23.8 months (95 % confidence interval [CI]: 12, not reached). Median PFS of five months or greater was reported in patients treated with sunitinib, lenvatinib, pembrolizumab, capecitabine + gemcitabine, everolimus, or S-1. Median OS of 20 months or greater was reported in trials evaluating S-1 or pembrolizumab; this endpoint was not reached in trials evaluating lenvatinib, regorafenib, or sunitinib. Generalizability of treatment effects is challenging in the research of rare diseases and meta-analysis of clinical outcomes may help to increase precision and relevance of results to the larger TC population. Our study found limited treatment options upon relapse, demonstrating a need for further investigations into novel therapeutics and well-powered clinical trials to better inform on optimal treatments.
Collapse
|
13
|
Nishii Y, Furuhashi K, Ito K, Sakaguchi T, Suzuki Y, Fujiwara K, Yasuma T, Kobayashi T, D’Alessandro-Gabazza CN, Gabazza EC, Taguchi O, Hataji O. Good Response of Advanced Thymic Carcinoma with Low PD-L1 Expression to Chemotherapy plus Pembrolizumab as First-Line Therapy and to Pembrolizumab as Maintenance Therapy: A Case Report. Pharmaceuticals (Basel) 2022; 15:ph15070889. [PMID: 35890187 PMCID: PMC9319623 DOI: 10.3390/ph15070889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
Thymic carcinoma is a rare malignant tumor with a poor prognosis. No standard treatment is currently available. The present case was a 64-year-old male smoker with no symptoms referred to our hospital because of abnormal chest radiological findings. The CT study showed a tumor between the anterior mediastinum and the right lung upper lobe, multiple nodular shadows along the right pleura, and pleural effusion. A CT-guided needle biopsy revealed squamous cell carcinoma. However, the differential diagnosis between thymic carcinoma and primary lung cancer was difficult. Treatment with carboplatin, nanoparticle albumin-bound paclitaxel, and pembrolizumab was initiated. The CT scan showed tumor shrinkage and good clinical response after four treatment cycles. Therapy was switched to maintenance therapy with pembrolizumab alone. Imaging studies showed further tumor shrinkage after twelve cycles of maintenance therapy with pembrolizumab. Sixteen cycles of maintenance therapy were continued without performance status deterioration. An abnormal radiological finding was detected after a twelve-month exacerbation-free period. The diagnosis was thymic carcinoma. Treatment with lenvatinib was initiated, and tumor-size reduction was observed. This is the first report of a case showing a successful maintenance therapy with pembrolizumab after effective first-line therapy with a combination of carboplatin-based chemotherapy plus pembrolizumab in advanced thymic carcinoma.
Collapse
Affiliation(s)
- Yoichi Nishii
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Kazuki Furuhashi
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Tadashi Sakaguchi
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Yuta Suzuki
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Kentaro Fujiwara
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Taro Yasuma
- Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (T.Y.); (C.N.D.-G.)
| | - Tetsu Kobayashi
- Department of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Tsu 514-8507, Japan;
| | - Corina N. D’Alessandro-Gabazza
- Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (T.Y.); (C.N.D.-G.)
| | - Esteban C. Gabazza
- Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (T.Y.); (C.N.D.-G.)
- Correspondence:
| | - Osamu Taguchi
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka 515-0073, Japan; (Y.N.); (K.F.); (K.I.); (T.S.); (Y.S.); (K.F.); (O.T.); (O.H.)
| |
Collapse
|
14
|
Tsai YH, Lin KH, Huang TW. Rare solitary splenic metastasis from a thymic carcinoma detected on fluorodeoxyglucose-positron emission tomography: A case report. World J Clin Cases 2022; 10:5072-5076. [PMID: 35801052 PMCID: PMC9198860 DOI: 10.12998/wjcc.v10.i15.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thymic carcinoma is a rare, aggressive tumor arising from the thymus. In less than 7% of patients with thymic carcinoma, extrathoracic metastases occur in the extrathoracic lymph nodes, liver, and bone. Isolated splenic metastasis can occur but is very uncommon. To date, only 2 cases of splenic metastases from thymic carcinoma have been reported.
CASE SUMMARY A 45-year-old man presented with chronic cough, dyspnea, persistent hoarseness and unintentional weight loss 17 kgs in 6 mo. Neck magnetic resonance imaging revealed a large, lobulated, soft-tissue mass measuring 5.4 cm × 6.6 cm × 3.8 cm which involved the left superior mediastinum and supraclavicular fossa. Chest computed tomography (CT) revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery, right and left carotid arteries, and left subclavian artery in the mediastinum. A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey. The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum, over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa. CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis. The patient was diagnosed of thymic carcinoma, cT2N2M1b, stage IVb.
CONCLUSION A fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging. Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.
Collapse
Affiliation(s)
- Yueh-Hsun Tsai
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Kuan-Hsun Lin
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| |
Collapse
|
15
|
Roden AC, Ahmad U, Cardillo G, Girard N, Jain D, Marom EM, Marx A, Moreira AL, Nicholson AG, Rajan A, Shepherd AF, Simone CB, Strange CD, Szolkowska M, Truong MT, Rimner A. Thymic Carcinomas-A Concise Multidisciplinary Update on Recent Developments From the Thymic Carcinoma Working Group of the International Thymic Malignancy Interest Group. J Thorac Oncol 2022; 17:637-650. [PMID: 35227908 PMCID: PMC11080660 DOI: 10.1016/j.jtho.2022.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Thymic carcinomas are rare malignancies that in general arise in the prevascular (anterior) mediastinum. These tumors are usually invasive, often present at advanced stages, and typically behave aggressively. Studies are hampered by the paucity of these tumors, the large variety of carcinoma subtypes, and the lack of unique morphologic and immunophenotypic features. Despite these challenges, advances in diagnostic imaging, surgical approaches, systemic therapies, and radiation therapy techniques have been made. The WHO classification of thymic epithelial tumors has been updated in 2021, and the eighth tumor nodal metastasis staging by the American Joint Committee on Cancer/Union for International Cancer Control included thymic carcinomas in 2017. Molecular alterations that provide more insight into the pathogenesis of these tumors and that potentially permit use of novel targeted therapies are increasingly being identified. New approaches to radiation therapy, chemotherapy, and immunotherapy are under evaluation. International societies, including the International Thymic Malignancy Interest Group, European Society of Thoracic Surgeons, and Japanese, Chinese, and Korean thymic associations, have been critical in organizing and conducting multi-institutional clinical studies. Herein, we review contemporary multidisciplinary perspectives in diagnosis and management of thymic carcinoma.
Collapse
Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Usman Ahmad
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Nicolas Girard
- Institut Curie, Institut du thorax Curie Montsouris, Paris, France; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Paris Saclay Campus, Versailles, France
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Edith M Marom
- Radiology Department, The Chaim Sheba Medical Center Affiliated With Tel Aviv University, Tel Aviv, Israel
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Annemarie F Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center and New York Proton Center, New York, New York
| | - Chad D Strange
- Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Texas
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Mylene T Truong
- Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Texas
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
16
|
Combined clinical and specific positron emission tomography/computed tomography-based radiomic features and machine-learning model in prediction of thymoma risk groups. Nucl Med Commun 2022; 43:529-539. [PMID: 35234213 DOI: 10.1097/mnm.0000000000001547] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this single-center study, we aimed to propose a machine-learning model and assess its ability with clinical data to classify low- and high-risk thymoma on fluorine-18 (18F) fluorodeoxyglucose (FDG) (18F-FDG) PET/computed tomography (CT) images. METHODS Twenty-seven patients (14 male, 13 female; mean age: 49.6 ± 10.2 years) who underwent PET/CT to evaluate the suspected anterior mediastinal mass and histopathologically diagnosed with thymoma were included. On 18F-FDG PET/CT images, the anterior mediastinal tumor was segmented. Standardized uptake value (SUV)max, SUVmean, SUVpeak, MTV and total lesion glycolysis of primary mediastinal lesions were calculated. For texture analysis first, second, and higher-order texture features were calculated. Clinical information includes gender, age, myasthenia gravis status; serum levels of lactate dehydrogenase (LDH), alkaline phosphatase, C-reactive protein, hemoglobin, white blood cell, lymphocyte and platelet counts were included in the analysis. RESULTS Histopathologic examination was consistent with low risk and high-risk thymoma in 15 cases and 12 cases, respectively. The age and myasthenic syndrome were statistically significant in both groups (P = 0.039 and P = 0.05, respectively). The serum LDH level was also statistically significant in both groups (450.86 ± 487.07 vs. 204.82 ± 59.04; P < 0.001). The highest AUC has been achieved with MLP Classifier (ANN) machine learning method, with a range of 0.830 then the other learning classifiers. Three features were identified to differentiate low- and high-risk thymoma for the machine learning, namely; myasthenia gravis, LDH, SHAPE_Sphericity [only for 3D ROI (nz>1)]. CONCLUSIONS This small dataset study has proposed a machine-learning model by MLP Classifier (ANN) analysis on 18F-FDG PET/CT images, which can predict low risk and high-risk thymoma. This study also demonstrated that the combination of clinical data and specific PET/CT-based radiomic features with image variables can predict thymoma risk groups. However, these results should be supported by studies with larger dataset.
Collapse
|
17
|
Trends in incidence and survival of patients with thymic epithelial tumor in a high-incidence Asian country: Analysis of the Korean Central Cancer Registry 1999-2017. J Thorac Oncol 2022; 17:827-837. [DOI: 10.1016/j.jtho.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022]
|
18
|
Mimori T, Shukuya T, Ko R, Okuma Y, Koizumi T, Imai H, Takiguchi Y, Miyauchi E, Kagamu H, Sugiyama T, Azuma K, Namba Y, Yamasaki M, Tanaka H, Takashima Y, Soda S, Ishimoto O, Koyama N, Kobayashi K, Takahashi K. Clinical Significance of Tumor Markers for Advanced Thymic Carcinoma: A Retrospective Analysis from the NEJ023 Study. Cancers (Basel) 2022; 14:cancers14020331. [PMID: 35053494 PMCID: PMC8773938 DOI: 10.3390/cancers14020331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Advanced thymic carcinoma (ATC) is rare. Owing to its rarity, there is limited information on the prognostic factors, and the optimal serum tumor markers are also unknown. We conducted a multi-institutional retrospective study of patients with ATC. In this study, we collected data on patient characteristics, progression-free survival (PFS), overall survival (OS), and tumor marker values, and investigated the relationship between tumor marker values and PFS/OS. We found that the neuron-specific enolase (NSE) level may be a useful prognostic tumor marker for ATC, regardless of histology. The findings of the analysis limited to squamous cell carcinoma suggested that the NSE and squamous cell carcinoma antigen levels may be useful prognostic factors. Abstract The optimal tumor marker for predicting the prognosis of advanced thymic carcinoma (ATC) remains unclear. We conducted a multi-institutional retrospective study of patients with ATC. A total of 286 patients were treated with chemotherapy. Clinicopathological information, including serum tumor markers, was evaluated to determine the overall survival (OS) and progression-free survival (PFS). The carcinoembryonic antigen, cytokeratin-19 fragment, squamous cell carcinoma (SCC) antigen, progastrin-releasing peptide, neuron-specific enolase (NSE), and alpha-fetoprotein levels were evaluated. In the Kaplan–Meier analysis, the OS was significantly shorter in the patients with elevated NSE levels than in those with normal NSE levels (median, 20.3 vs. 36.8 months; log-rank test p = 0.029; hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.05–2.31 (Cox proportional hazard model)); a similar tendency regarding the PFS was observed (median, 6.4 vs. 11.0 months; log-rank test p = 0.001; HR, 2.04; 95% CI, 1.31–3.18). No significant differences in the OS and PFS were observed among the other tumor markers. In both univariate and multivariate analyses of the patients with SCC only, the NSE level was associated with the OS and PFS. Thus, the NSE level may be a prognostic tumor marker for thymic carcinoma, regardless of histology.
Collapse
Affiliation(s)
- Tomoyasu Mimori
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (T.M.); (K.T.)
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (T.M.); (K.T.)
- Correspondence: (T.S.); (R.K.)
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
- Correspondence: (T.S.); (R.K.)
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo 113-8677, Japan;
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 105-0045, Japan
| | - Tomonobu Koizumi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan;
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota 373-8550, Japan;
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (H.K.); (K.K.)
| | - Yuichi Takiguchi
- Department of Medical Oncology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan;
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai 980-8574, Japan;
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (H.K.); (K.K.)
| | - Tomohide Sugiyama
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya 320-0834, Japan;
| | - Keisuke Azuma
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima 960-1295, Japan;
| | - Yukiko Namba
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan;
| | - Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross & Atomic-Bomb Survivors Hospital, Hiroshima 730-8619, Japan;
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8563, Japan;
| | - Yuta Takashima
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan;
| | - Sayo Soda
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Osamu Ishimoto
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai 980-0873, Japan;
- Department of Pulmonary Medicine, Okino Medical Clinic, Miyagi 984-0831, Japan
| | - Nobuyuki Koyama
- Division of Pulmonary Medicine, Clinical Department of Internal Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan;
- Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, Saitama 350-8550, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (H.K.); (K.K.)
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (T.M.); (K.T.)
| |
Collapse
|
19
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6544688. [DOI: 10.1093/ejcts/ezac159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
|
20
|
Li Y, Jiang A, Zhao Y, Shi C, Ma Y, Fu X, Liang X, Tian T, Ruan Z, Yao Y. A novel risk classifier for predicting the overall survival of patients with thymic epithelial tumors based on the eighth edition of the TNM staging system: A population-based study. Front Endocrinol (Lausanne) 2022; 13:1050364. [PMID: 36561557 PMCID: PMC9763871 DOI: 10.3389/fendo.2022.1050364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Thymic epithelial tumors (TETs) are rare tumors that originated from thymic epithelial cells, with limited studies investigating their prognostic factors. This study aimed to investigate the prognostic factors of TETs and develop a new risk classifier to predict their overall survival (OS). METHODS This retrospective study consisted of 1224 TETs patients registered in the Surveillance, Epidemiology, and End Results (SEER) database, and 75 patients from the First Affiliated Hospital of Xi'an Jiaotong University. The univariate and multivariate Cox regression analyses were adopted to select the best prognostic variables. A nomogram was developed to predict the OS of these patients. The discriminative and calibrated abilities of the nomogram were assessed using the receiver operating characteristics curve (ROC) and calibration curve. Decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI) were adopted to assess its net clinical benefit and reclassification ability. RESULTS The multivariate analysis revealed that age, sex, histologic type, TNM staging, tumor grade, surgery, radiation, and tumor size were independent prognostic factors of TETs, and a nomogram was developed to predict the OS of these patients based on these variables. The time-dependent ROC curves displayed that the nomogram yielded excellent performance in predicting the 12-, 36- and 60-month OS of these patients. Calibration curves presented satisfying consistencies between the actual and predicted OS. DCA illustrated that the nomogram will bring significant net clinical benefits to these patients compared to the classic TNM staging system. The estimated NRI and IDI showed that the nomogram could significantly increase the predictive ability of 12-, 36- and 60-month OS compared to the classic TNM staging system. Consistent findings were discovered in the internal and external validation cohorts. CONCLUSION The constructed nomogram is a reliable risk classifier to achieve personalized survival probability prediction of TETs, and could bring significant net clinical benefits to these patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yu Yao
- *Correspondence: Yu Yao, ; Zhiping Ruan,
| |
Collapse
|
21
|
Sphingomonas and Phenylobacterium as Major Microbiota in Thymic Epithelial Tumors. J Pers Med 2021; 11:jpm11111092. [PMID: 34834444 PMCID: PMC8623653 DOI: 10.3390/jpm11111092] [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: 08/19/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022] Open
Abstract
The microbiota has been reported to be closely associated with carcinogenesis and cancer progression. However, its involvement in the pathology of thymoma remains unknown. In this study, we aimed to identify thymoma-specific microbiota using resected thymoma samples. Nineteen thymoma tissue samples were analyzed through polymerase chain reaction amplification and 16S rRNA gene sequencing. The subjects were grouped according to histology, driver mutation status in the GTF2I gene, PD-L1 status, and smoking habits. To identify the taxa composition of each sample, the operational taxonomic units (OTUs) were classified on the effective tags with 97% identity. The Shannon Index of the 97% identity OTUs was calculated to evaluate the alpha diversity. The linear discriminant analysis effect size (LEfSe) method was used to compare the relative abundances of all the bacterial taxa. We identified 107 OTUs in the tumor tissues, which were classified into 26 genera. Sphingomonas and Phenylobacterium were identified as abundant genera in almost all the samples. No significant difference was determined in the alpha diversity within these groups; however, type A thymoma tended to exhibit a higher bacterial diversity than type B thymoma. Through the LEfSe analysis, we identified the following differentially abundant taxa: Bacilli, Firmicutes, and Lactobacillales in type A thymoma; Proteobacteria in type B thymoma; Gammaproteobacteria in tumors harboring the GTF2I mutation; and Alphaproteobacteria in tumors without the GTF2I mutation. In conclusion, Sphingomonas and Phenylobacterium were identified as dominant genera in thymic epithelial tumors. These genera appear to comprise the thymoma-specific microbiota.
Collapse
|
22
|
Huang YY, Wu LL, Liu X, Liang SH, Ma GW. Nomogram predict relapse-free survival of patients with thymic epithelial tumors after surgery. BMC Cancer 2021; 21:847. [PMID: 34294070 PMCID: PMC8299634 DOI: 10.1186/s12885-021-08585-y] [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: 04/12/2021] [Accepted: 07/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Hematological indicators and clinical characteristics play an important role in the evaluation of the progression and prognosis of thymic epithelial tumors. Therefore, we aimed to combine these potential indicators to establish a prognostic nomogram to determine the relapse-free survival (RFS) of patients with thymic epithelial tumors undergoing thymectomy. Methods This retrospective study was conducted on 156 patients who underwent thymectomy between May 2004 and August 2015. Cox regression analysis were performed to determine the potential indicators related to prognosis and combine these indicators to create a nomogram for visual prediction. The prognostic predictive ability of the nomogram was evaluated using the consistency index (C-index), receiver operating characteristic (ROC) curve, and risk stratification. Decision curve analysis was used to evaluate the net benefits of the model. Results Preoperative albumin levels, neutrophil-to-lymphocyte ratio (NLR), T stage, and WHO histologic types were included in the nomogram. In the training cohort, the nomogram showed well prognostic ability (C index: 0.902). Calibration curves for the relapse-free survival (RFS) were in good agreement with the standard lines in training and validation cohorts. Conclusions Combining clinical and hematologic factors, the nomogram performed well in predicting the prognosis and the relapse-free survival of this patient population. And it has potential to identify high-risk patients at an early stage. This is a relatively novel approach for the prediction of RFS in this patient population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08585-y.
Collapse
Affiliation(s)
- Yang-Yu Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Xuan Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shen-Hua Liang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-Wei Ma
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| |
Collapse
|
23
|
Chen K, Bai L, Ji L, Wu L, Li G. Bioinformatics analysis of the key potential ceRNA biomarkers in human thymic epithelial tumors. Medicine (Baltimore) 2021; 100:e26271. [PMID: 34128858 PMCID: PMC8213305 DOI: 10.1097/md.0000000000026271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/23/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs), originating from the thymic epithelial cells, are the most common primary neoplasms of the anterior mediastinum. Emerging evidence demonstrated that the competing endogenous RNAs (ceRNAs) exerted a crucial effect on tumor development. Hence, it is urgent to understand the regulatory mechanism of ceRNAs in TETs and its impact on tumor prognosis. METHODS TETs datasets were harvested from the UCSC Xena as the training cohort, followed by differentially expressed mRNAs (DEmRNAs), lncRNAs (DElncRNAs), and miRNAs (DEmiRNAs) at different pathologic type (A, AB, B, and TC) identified via DESeq2 package. clusterProfiler package was utilized to carry out gene ontology and Kyoto encyclopedia of genes and genomes functional analysis on the DEmRNAs. Subsequently, the lncRNA-miRNA-mRNA regulatory network was constructed to screen the key DEmRNAs. After the key DEmRNAs were verified in the external cohort from Gene Expression Omnibus database, their associated-ceRNAs modules were used to perform the K-M and Cox regression analysis to build a prognostic significance for TETs. Lastly, the feasibility of the prognostic significance was validated by receiver operating characteristic (ROC) curves and the area under the curve. RESULTS Finally, a total of 463 DEmRNAs, 87 DElncRNAs, and 20 DEmiRNAs were obtained from the intersection of differentially expressed genes in different pathological types of TETs. Functional enrichment analysis showed that the DEmRNAs were closely related to cell proliferation and tumor development. After lncRNA-miRNA-mRNA network construction and external cohort validation, a total of 4 DEmRNAs DOCK11, MCAM, MYO10, and WASF3 were identified and their associated-ceRNA modules were significantly associated with prognosis, which contained 3 lncRNAs (lncRNA LINC00665, lncRNA NR2F1-AS1, and lncRNA RP11-285A1.1), 4 mRNAs (DOCK11, MCAM, MYO10, and WASF3), and 4 miRNAs (hsa-mir-143, hsa-mir-141, hsa-mir-140, and hsa-mir-3199). Meanwhile, ROC curves verified the accuracy of prediction ability of the screened ceRNA modules for prognosis of TETs. CONCLUSION Our study revealed that ceRNAs modules might exert a crucial role in the progression of TETs. The mRNA associated-ceRNA modules could effectively predict the prognosis of TETs, which might be the potential prognostic and therapeutic markers for TETs patients.
Collapse
Affiliation(s)
- Kegong Chen
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University
| | - Long Bai
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University
- Department of Chest Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Lin Ji
- Department of Orthopedics, The First Hospital of Harbin, Harbin Institute of Technology
| | - Libo Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Guanghua Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| |
Collapse
|
24
|
Wang H, Xu X, Luo L, Wang C, Jiang Z, Lin Y. Mutational landscape of thymic epithelial tumors in a Chinese population: insights into potential clinical implications. Gland Surg 2021; 10:1410-1417. [PMID: 33968692 PMCID: PMC8102230 DOI: 10.21037/gs-21-157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are a heterogeneous group of rare malignancies which may be devastating, difficult to treat, and for which treatment options are limited. Herein, we investigated the comprehensive genomic alterations of TETs in a Chinese population for providing clinical management, especially targeted therapy. METHODS Comprehensive genomic profiling (CGP) was performed with DNA targeted sequencing of cancer-associated genes (CSYS) from a cohort of 40 Chinese TET patients. TMB was measured by an in-house algorithm. MSI status was inferred based on the MANTIS (Microsatellite Analysis for Normal-Tumor InStability) score. The expression status of PD-L1 was estimated by immunohistochemistry. RESULTS The mutational profiling of thymomas (Ts) and thymic neuroendocrine tumors (TNETs) showed scattered mutation distributions with no recurrently mutated genes. In contrast, thymic carcinomas (TCs) did show highly recurrent mutations including CDKN2A, CYLD, CDKN2B, and TP53. Among them, CDKN2A and CDKN2B mutations were the top potentially actionable alterations in TCs. PD-L1 expression was mainly present in Ts and TCs, and was predominant in males and smokers. CONCLUSIONS Our study provided a comprehensive genetic alteration view on the largest Chinese cohort of TETs to date. The results identified different genomic mutational profiles of Ts, TCs, and TNETs, and analyzed potential druggable biomarkers with clinical implications in Chinese TET patients, which provided the evidence for precision medicine of rare TET patients.
Collapse
Affiliation(s)
- Hongbiao Wang
- Medical Oncology Session No.1, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Xiaohua Xu
- Cardiothoracic surgery department, The Second Affiliated Hospital of Shantou University Medical College, Guangzhou, China
| | - Lan Luo
- Department of Oncology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Chunbing Wang
- Medical Oncology Department, Cancer Hospital Chinese Academy of Medical Science, Shenzhen, China
| | - Zeyong Jiang
- Department of Thoracic Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yingcheng Lin
- Medical Oncology Session No.1, Cancer Hospital of Shantou University Medical College, Shantou, China
| |
Collapse
|
25
|
Xu C, Sun J, Zhang W, Yuan Z, Wang J. The safety and efficacy of Cyberknife® for thymic malignancy. Cancer Radiother 2021; 25:119-125. [PMID: 33676829 DOI: 10.1016/j.canrad.2020.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of Cyberknife® (CK) for the treatment of primary or recurring thymic tumours. MATERIALS AND METHODS We retrospectively reviewed 12 patients (16 tumour lesions) with primary or recurring thymic tumours who were treated with CK between March 2008 and October 2017. Their data was stored in prospectively collected database. Kaplan-Meier method was used to calculate survival curves. RESULTS Five patients (41.7%), who had inoperable disease or refused surgery, were treated with CK initially, and 7 patients (58.3%) were treated with CK when they had recurrence diseases. The disease sites treated with CK were primary tumour site (5), regional lymph nodes (4), tumour bed (3), chest wall (2), pleura (1), and bone (1). The median target volume was 43.8 cm3 (range, 13.1-302.5cm3) for the 16 tumour lesions. The median follow-up time was 69.3 months (range, 9.7-124.8 months). The median survival time was 48.2 months, and the 5-year and 10-year OS rates were 68.2% and 45.5%, respectively. A high response rate for the tumour lesions irradiated with CK was obtained. Only one patient (8%) experienced in-field recurrence, and the 5-year local recurrence free survival was 90.9%. A case indicated that CK may induce the abscopal effect, which provides the potential to combine CK and immunotherapy. No severe radiation related toxicities were observed, and no treatment related death occurred. CONCLUSION CK treatment resulted in good outcomes, particularly local control, with minimal side effects, in highly selected patients with primary and recurring thymic tumours. More studies with larger sample are needed.
Collapse
Affiliation(s)
- C Xu
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - J Sun
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - W Zhang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Z Yuan
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - J Wang
- Department of radiation oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| |
Collapse
|
26
|
Salgueiro FR, Cunha P, Miranda D, Pereira T, Pontes F, Monteiro J, Caetano A. Clear Cell Carcinoma of the Thymus: An Improbable Enemy. Eur J Case Rep Intern Med 2021; 8:002224. [PMID: 33768067 DOI: 10.12890/2021_002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Thymic clear cell carcinoma is the most uncommon subtype of thymic carcinoma, with 20 cases reported worldwide. Case description We present the case of a 61-year-old female with dyspnoea and chest pain for 2 days. Computed tomography (CT) angiography showed pulmonary thromboembolism and the existence of mediastinal and bilateral hilar lymphadenopathy, the largest infracarinal with an inferior axis of 25 mm, and also, micronodules on the left pulmonary parenchyma. The patient was admitted for aetiological assessment and underwent anticoagulant therapy. After a month, she had an ischaemic stroke, the sequelae of which proved to be fatal. The autopsy showed a mass in the superior-anterior mediastinum, with dimensions of 11×8×6 cm, corresponding to a thymus signet ring cell primary carcinoma. The immunohistochemistry study revealed that this mass was positive for AE1/AE3, CK5/6 and CK7. Conclusion The clinical, morphological and immunophenotypic diversity of this tumour makes its diagnosis a difficult multidisciplinary challenge, which requires a high level of clinical knowledge and accurate imaging and histological investigation. LEARNING POINTS Thymic clear cell carcinoma is a very rare entity with an aggressive and nonspecific clinical behaviour.There are no defined diagnostic criteria, although diagnosis could be established with histologic/cytology analysis.There are no clear guidelines for treatment, which can include highly invasive surgery and chemotherapy or radiation therapy.
Collapse
Affiliation(s)
- Fábio Rêgo Salgueiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Paulo Cunha
- Internal Medicine Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Diana Miranda
- Internal Medicine Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Tatiana Pereira
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Filipa Pontes
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Joana Monteiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Ana Caetano
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| |
Collapse
|
27
|
Knetki-Wróblewska M, Kowalski DM, Olszyna-Serementa M, Krzakowski M, Szołkowska M. Thymic epithelial tumors: Do we know all the prognostic factors? Thorac Cancer 2021; 12:339-348. [PMID: 33386778 PMCID: PMC7862797 DOI: 10.1111/1759-7714.13750] [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: 07/23/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors constitute a morphologically and clinically diverse group of rare neoplasm of the anterior mediastinum. METHODS Here, we present an analysis of 188 patients diagnosed with primary thymic tumors between 1995 and 2015. The prognostic value of selected clinical and morphological factors was assessed in relation to overall survival and recurrence-free survival. RESULTS The risk of recurrence increased significantly in thymic carcinoma diagnosis (P = 0.0036), co-occurrence of other diseases, and weight loss (P = 0.0012 and 0.0348, respectively). Multivariate analysis showed that the most important independent risk factor for disease recurrence was clinical stage IV (P = 0.0036). A total of 63 patients (33.5%) died. In the univariate analysis, the following factors were considered as independent prognostic factors for overall survival: clinical stage (P < 0.0001), histological type (P < 0.0001), lymph node involvement (P < 0.001), WHO performance status 2 (P < 0.0001), anemia (Hb <9.5 g/dL; P = 0.0002), leucocytosis (>12.5 G/L; P = 0.0011), LDH level (>185 U/L; P < 0.0001), concomitant diseases (P = 0.0012) and weight loss (P < 0.0001).The strongest independent risk factor for death was stage IV disease (P < 0.001). CONCLUSIONS The results confirmed a fairly good prognosis for patients with thymic epithelial tumors. Clinical stage was the most important prognostic factor, but, some additional clinical factors may also have prognostic value.
Collapse
Affiliation(s)
- Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Chest Tumours, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Chest Tumours, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marta Olszyna-Serementa
- Department of Lung Cancer and Chest Tumours, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Chest Tumours, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Małgorzata Szołkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| |
Collapse
|
28
|
Rioja P, Ruiz R, Galvez-Nino M, Lozano S, Valdiviezo N, Olivera M, Cabero O, Guillen ME, De La Guerra A, Amorin E, Barrionuevo C, Mas L. Epidemiology of thymic epithelial tumors: 22-years experience from a single-institution. Thorac Cancer 2020; 12:420-425. [PMID: 33356008 PMCID: PMC7882391 DOI: 10.1111/1759-7714.13760] [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: 09/29/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background To assess the correlation of WHO histological classification and Masaoka–Koga staging system of thymic epithelial tumors (TETs) with prognosis. Methods We retrospectively analyzed 83 patients with TETs in the Instituto Nacional de Enfermedades Neoplasicas between 1996 to 2018. We analyzed the clinical stages, histological types and treatment modalities and attempted to determine the impact on overall survival. The data was retrieved from clinical files and reviewed by a pathologist who reclassificated according to the 2004 WHO classification system. The staging was performed with the Masaoka–Koga staging system. Survival curves were constructed with Kaplan‐Meir method. Results There was a total of 83 patients with a median age of 55 years old included in the study. The histological type corresponded to thymoma (T) in 63.8% (n = 53) and to thymic carcinoma (TC) in 36.1%. T were type A, AB, B1, B2 and B3 in 14.4%, 18%, 12%, 3.6%, 7.4% of cases, respectively. The proportion of advanced disease (Masaoka stage III–IV) was high (65%). With a median follow‐up of 88.4 months, median overall survival (OS) was 81.6 months for T and 12.3 months for TC (P = 0.01). Univariate analysis showed that sex, histological type, clinical stage and surgery (P = 0.01) were significant independent prognostic factors. On multivariate analysis, histology type and Masaoka–Koga staging had an effect on survival. Conclusions The results indicates a clear association between the WHO histological classification and Masaoka–Koga staging system with survival. We found a higher proportion of TETs with advanced disease at diagnosis. Further research are required and collaboration is important to foster knowledge focused on classification and treatment. Key points Significant findings of the study The WHO histological classification, the Masaoka–Koga system and surgery treatment were associated with overall survival. What this study adds To determine prognosis factors in TETs.
Collapse
Affiliation(s)
| | - Rossana Ruiz
- National Institute of Neoplastic Diseases, Lima, Peru.,Peruvian Group of Clinical Studies in Oncology, Lima, Peru
| | | | - Sophia Lozano
- National Institute of Neoplastic Diseases, Lima, Peru
| | | | | | | | | | | | - Edgar Amorin
- National Institute of Neoplastic Diseases, Lima, Peru
| | | | - Luis Mas
- National Institute of Neoplastic Diseases, Lima, Peru.,Peruvian Group of Clinical Studies in Oncology, Lima, Peru
| |
Collapse
|
29
|
Tahara I, Oishi N, Mochizuki K, Oyama T, Miyata K, Miyauchi A, Hirokawa M, Katoh R, Kondo T. Identification of Recurrent TERT Promoter Mutations in Intrathyroid Thymic Carcinomas. Endocr Pathol 2020; 31:274-282. [PMID: 32594366 DOI: 10.1007/s12022-020-09635-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intrathyroid thymic carcinoma (ITTC) is a rare malignant neoplasm considered to be a eutopic thymic carcinoma (TC) arising ectopically in the thyroid. Histopathologically, ITTC resembles squamous cell carcinoma of the thymus with positive TC markers such as CD5 and c-KIT. Despite these similar histological findings, ITTC is clinically less aggressive than TC. In this study, we compared clinical, histological, and genetic characteristics of ITTCs and TCs. We collected 9 ITTCs and 8 TCs with their clinicopathological profiles. Immunohistochemistry for CD5, p63, CD117/c-KIT, Ki-67, p53, TTF-1, thyroglobulin, PAX8, EGFR, and PD-L1/CD274 plus in situ hybridization for EBER was performed. We further investigated mutation status of KIT, EGFR, BRAF, and TERT promoter using Sanger sequencing. In our study, ITTCs affected significantly younger patients than TCs. After a mean follow-up of 86 months, all patients with ITTC were alive, while two patients with TC had died. Immunohistochemistry showed ITTCs and TCs had a similar immunophenotype except for EGFR and p53. Genetic analysis did not identify KIT or BRAF mutations in any ITTCs or TCs. EGFR mutations were positive in 11% (1/9) of ITTCs and 25% (2/8) of TCs. Notably, TERT promoter C228T mutation was identified in 22% (2/9) of ITTCs but none of the TCs. There were no significant differences in age, tumor size, or sex between TERT-mutated and TERT-wild-type ITTCs. Collectively, ITTC and TC have similar histopathologic and immunophenotypic features but different clinical outcomes. Recurrent TERT promoter mutation may be a key event related to cancer progression in ITTCs and warrants further investigation.
Collapse
Affiliation(s)
- Ippei Tahara
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Toshio Oyama
- Department of Pathology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kazuyuki Miyata
- Department of Pathology, Kofu Municipal Hospital, Kofu, Yamanashi, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
| | | | - Ryohei Katoh
- Department of Pathology, Ito hospital, Tokyo, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan.
| |
Collapse
|
30
|
Primary Driver Mutations in GTF2I Specific to the Development of Thymomas. Cancers (Basel) 2020; 12:cancers12082032. [PMID: 32722121 PMCID: PMC7466068 DOI: 10.3390/cancers12082032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Thymomas are rare mediastinal tumors that are difficult to treat and pose a major public health concern. Identifying mutations in target genes is vital for the development of novel therapeutic strategies. Type A thymomas possess a missense mutation in GTF2I (chromosome 7 c.74146970T>A) with high frequency. However, the molecular pathways underlying the tumorigenesis of other thymomas remain to be elucidated. We aimed to detect this missense mutation in GTF2I in other thymoma subtypes (types B). This study involved 22 patients who underwent surgery for thymomas between January 2014 and August 2019. We isolated tumor cells from formalin-fixed paraffin-embedded tissues from the primary lesions using laser-capture microdissection. Subsequently, we performed targeted sequencing to detect mutant GTF2I coupled with molecular barcoding. We used PyClone analysis to determine the fraction of tumor cells harboring mutant GTF2I. We detected the missense mutation (chromosome 7 c.74146970T>A) in GTF2I in 14 thymomas among the 22 samples (64%). This mutation was harbored in many type B thymomas as well as type A and AB thymomas. The allele fraction for the tumors containing the mutations was variable, primarily owing to the coexistence of normal lymphocytes in the tumors, especially in type B thymomas. PyClone analysis revealed a high cellular prevalence of mutant GTF2I in tumor cells. Mutant GTF2I was not detected in other carcinomas (lung, gastric, colorectal, or hepatocellular carcinoma) or lymphomas. In conclusion, the majority of thymomas harbor mutations in GTF2I that can be potentially used as a novel therapeutic target in patients with thymomas.
Collapse
|
31
|
Liu M, Wang C, Gao L, Lv C, Fu X. Clinical significance of age at diagnosis among patients with thymic epithelial tumors: a population-based study. Aging (Albany NY) 2020; 12:4815-4821. [PMID: 32224505 PMCID: PMC7138550 DOI: 10.18632/aging.102897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
Background: To investigate the clinicopathologic characteristics and survival outcomes of patients with thymic epithelial tumors (TET) according to age at diagnosis. Results: A total of 4431 patients were analyzed. Gender, race, tumor histology and surgery were similar between different age groups. The 0-18 group was associated with a higher risk of distant metastasis. Compared to patients aged above 80, the hazard ratios (HR) for patients aged 0-18, 19-30, 31-40, 41-50, 51-60, 61-70, 71-80 were 1.079, 0.739, 0.614, 0.621, 0.633, 0.673, 0.861, respectively. From the subgroup analysis for the adult patients who were above 19 years old, we found that the 19-70 group had significant better cancer specific survival (CSS) and overall survival (OS) than the above 70 group. Conclusions: Age is a strong independent prognostic factor for survival in TET. Pediatric TET has a higher risk of distant metastasis and an inferior CSS. For the adults who were above 19, patients older than 70-year-old were associated with a shorter CSS. Methods: Information of 4431 TET patients was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic features, clinicopathologic characteristics and survival outcomes were compared between patients diagnosed at different age groups (0-18, 19-30, 31-40, 41-50, 51-60, 61-70, 71-80, above 80).
Collapse
Affiliation(s)
- Mina Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lanting Gao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Changxing Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| |
Collapse
|
32
|
Ye C, Bao M, Li H, Liu X, Jiang G, Wang W. Surgery in Masaoka stage IV thymic carcinoma: a propensity-matched study based on the SEER database. J Thorac Dis 2020; 12:659-671. [PMID: 32274131 PMCID: PMC7138999 DOI: 10.21037/jtd.2019.12.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thymic carcinoma is a type of rare and highly malignant tumor. Limited information was available on prognostic factors of late-stage thymic carcinoma. The aim of this study was to identify factors that impact prognosis and to define the relationship between survival and surgical intervention in patients with Masaoka stage IV thymic carcinoma. METHODS From 1973 to 2015, a total of 311 consecutive patients were enrolled in this study with pathologic confirmed Masaoka stage IV thymic carcinoma from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier analyses, Cox-regression analyses and propensity score matching (PSM) were performed to evaluate prognosis. RESULTS In the multivariate analysis, larger tumor size, distant metastasis and positive lymph node status were associated with poorer outcome. After PSM, no receipt of surgery was the prognostic factor indicating poorer survival [hazard ratio (HR) 1.985, 95% confidence interval (CI) 1.007-3.913, P=0.048 for overall survival (OS); HR 1.649, 95% CI: 1.009-2.697, P=0.046 for disease-specific survival (DSS)]. Subgroup analysis indicated that significantly improved survival with surgery was observed in patients who were <60 years (HR 0.48, 95% CI: 0.32-0.72), female (HR 0.37, 95% CI: 0.23-0.60), Caucasian (HR 0.56, 95% CI: 0.40-0.77), with larger tumor size (≥7.0 cm, HR 0.42, 95% CI: 0.25-0.69), with (HR 0.60, 95% CI: 0.39-0.90) or without distant metastasis (HR 0.46, 95% CI: 0.26-0.83), and node-positive (HR 0.56, 95% CI: 0.38-0.82). CONCLUSIONS Surgical treatment could be beneficial in patients with Masaoka stage IV thymic carcinoma. This SEER based analysis revealed the role of surgical resection and the favorable effect of surgery in specific thymic carcinoma subgroups.
Collapse
Affiliation(s)
- Cong Ye
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Minwei Bao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Huiting Li
- Department of Respiratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiaogang Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Weixi Wang
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| |
Collapse
|
33
|
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.
Collapse
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.
| |
Collapse
|
34
|
Chen YY, Huang SY, Huang CH, Su HL, Chen YH, Chiu TJ. Efficacy and safety of uracil-tegafur in patients with recurrent or metastatic thymic carcinoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_11_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
35
|
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.
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
Novellis P, Veronesi G, Raffeeq Z, Alloisio M. Thymoma surgery: extreme surgical indications. J Thorac Dis 2019; 11:2695-2699. [PMID: 31463095 DOI: 10.21037/jtd.2019.06.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pierluigi Novellis
- Thoracic Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giulia Veronesi
- Thoracic Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Zaheer Raffeeq
- Biomedical Science Department, Humanitas University, Rozzano, Milan, Italy
| | - Marco Alloisio
- Thoracic Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Biomedical Science Department, Humanitas University, Rozzano, Milan, Italy
| |
Collapse
|
38
|
Yang X, Yu L, Li F, Yu T, Zhang Y, Liu H. Successful treatment of thymic carcinoma with dermatomyositis and interstitial pneumonia: A case report. Thorac Cancer 2019; 10:2031-2034. [PMID: 31456295 PMCID: PMC6775021 DOI: 10.1111/1759-7714.13168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022] Open
Abstract
Here, we report a rare case of thymic carcinoma (TC) associated with dermatomyositis (DM) and interstitial pneumonia (IP) in a 68-year-old man. The patient presented with the characteristic features of a skin rash with Gottron's papules and increased serum levels of muscle-associated enzymes. Computed tomography (CT) showed the presence of an anterior mediastinal soft tissue mass with IP, which was diagnosed as TC by CT-guided tumor biopsy. The patients DM and IP disappeared completely after radical resection of the tumor. After a 20-month follow-up period, the patient was in good clinical condition without disease recidivism.
Collapse
Affiliation(s)
- Xingguo Yang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fei Li
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yunfeng Zhang
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Honggang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
39
|
Abstract
OBJECTIVES For patients with unresectable or metastatic thymic epithelial neoplasms, few therapy options are available and outcomes are poor. This case series demonstrates that the combination of capecitabine and celecoxib may be a promising therapeutic option for these patients. MATERIALS AND METHODS The current report describes the outcomes of 5 patients with thymic neoplasms treated on a drug-drug interaction study of capecitabine and celecoxib in patients with advanced solid malignancies (NCT01705106) conducted at the University of Chicago, plus a sixth patient treated with the same regimen outside of the protocol. RESULTS Six patients with thymic neoplasms were treated with capecitabine 1000 mg/m twice daily and celecoxib 200 mg twice daily, day 1 to day 14 on a 21-day cycle. This included 3 patients with thymic carcinoma, 1 with thymic neuroendocrine tumor, and 2 with thymomas. Objective response rates were noted in 3 of 6 patients. Two of the 3 thymic carcinoma patients had complete responses, and the third had a partial response. Best response for the other patients included stable disease for both thymoma patients and progressive disease for the thymic neuroendocrine patient. Other than grade 3 palmar-plantar erythrodysesthesia, which developed in 4 of 6 patients and required dose reductions, the regimen was well tolerated. CONCLUSIONS This case series suggests that capecitabine plus celecoxib may be an effective and well-tolerated treatment option for patients with thymic carcinoma. Further studies should be carried out to establish the efficacy of capecitabine plus celecoxib in thymic carcinoma, and to determine whether monotherapy with capecitabine would be similarly effective.
Collapse
|
40
|
Cheufou DH, Valdivia D, Puhlvers S, Fels B, Weinreich G, Taube C, Theegarten D, Stuschke M, Schuler M, Hegedus B, Stamatis G, Aigner C. Lymph Node Involvement and the Surgical Treatment of Thymic Epithelial and Neuroendocrine Carcinoma. Ann Thorac Surg 2019; 107:1632-1638. [DOI: 10.1016/j.athoracsur.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023]
|
41
|
Song Q, Zhang LL, Qi Y, Xing KL, Wu XH. Effect of clinicopathologic features on survival of patients with thymic carcinomas and thymic neuroendocrine tumors: A population-based analysis. Curr Probl Cancer 2019; 43:411-420. [PMID: 30952367 DOI: 10.1016/j.currproblcancer.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 02/01/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Thymic carcinomas (TCs) and thymic neuroendocrine tumors (TNETs) are aggressive cancers with poor survival outcome and limited investigation. This study is to investigate clinicopathologic features on TC and TNET patients' prognosis of a large cohort. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database were used to identify a total of 362 TC and TNET patients with documented clinicopathologic features we investigated. The characteristics and overall survival of the TC and TNET patients were studied. RESULTS Two hundred and forty TC and 122 TNET patients were identified. For the entire cohort of TC and TNET, histologic type (P < 0.001), tumor size (P = 0.015), Masaoka-Koga stage (P = 0.008), regional node positive (P = 0.004), surgery of primary site (P < 0.001), lymph node surgery (P = 0.013), and chemotherapy (P = 0.001) were considered as significant clinicopathologic features that could affect prognosis of TC and TNET patients in univariate analysis. More importantly, histologic type (P < 0.001), regional nodes positive (P = 0.03) and surgery of primary site (P < 0.001) were able to independently predict overall survival of those patients. In addition, for the cohort of TC, we found that regional nodes positive (P = 0.034) and surgery of primary site (P = 0.001) could be independent predictors of TC patients' survival. CONCLUSION Regional nodes detection is essential for TC and TNET patients. Surgery of primary site is the preferred primary treatment for those patients.
Collapse
Affiliation(s)
- Qian Song
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan-Lin Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Qi
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kai-Lin Xing
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiang-Hua Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| |
Collapse
|
42
|
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.
Collapse
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.
| |
Collapse
|
43
|
Wang Y, Xu L, Du T, Gao Y, Wu Z, Luo D. A Nomogram Predicting Recurrence and Guiding Adjuvant Radiation for Thymic Carcinoma After Resection. Ann Thorac Surg 2018. [PMID: 29530769 DOI: 10.1016/j.athoracsur.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Resection is an effective treatment for thymic carcinoma. We aimed to develop a nomogram for postoperative prediction of recurrence-free survival for patients with thymic carcinoma and guide adjuvant radiotherapy. METHODS A total of 198 patients who underwent surgery were divided into training cohort (n = 152) and validation cohort (n = 46). Clinicopathologic features and independent factors for postoperative recurrence were analyzed. A predictive nomogram was developed based on the prognostic factors. Discrimination and predictive accuracy of the model were measured using the concordance index (C-index), calibration curves, and validation study. RESULTS The overall 1-, 3-, and 5-year recurrence rate of 198 patients was 7.6%, 27.9%, and 39.9%, respectively. Independent predictors of recurrence-free survival on multivariate analysis were incorporated into the nomogram. Calibration curves for the probability of 1-, 3-, and 5-year recurrence-free survival fitted well. The C-index of the nomogram for predicting recurrence-free survival was 0.862 (95% confidence interval: 0.804 to 0.919). Internal validation supported the results optimally. Adjuvant radiotherapy was effective for patients with a total score greater than 208. CONCLUSIONS Our nomogram for predicting recurrence-free survival had good performance. Adjuvant radiotherapy should be recommended for patients with a total score greater than 208.
Collapse
Affiliation(s)
- Yang Wang
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Liangliang Xu
- Second Department of Thoracic Surgery, Chest Hospital of Xinjiang, Urumqi, China
| | - Tongxin Du
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Yunfei Gao
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Zhenhua Wu
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Dongbo Luo
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China.
| |
Collapse
|
44
|
Banna GL, Sheel A, Sheel V, Bille A, Routledge T, Fernando S, Nair A, Lal R. Treatment and prognostic factors of patients with thymic epithelial tumors at first recurrence or progression. Future Oncol 2017; 13:2429-2439. [PMID: 29121777 DOI: 10.2217/fon-2017-0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM The treatment of patients with recurrent or progressive thymic epithelial tumors remains uncertain due to limited data in this rare disease. MATERIALS & METHODS A retrospective 10-year monoinstitutional analysis was conducted on 25 patients with first recurrence or disease progression following primary treatment. RESULTS Twenty patients had thymoma, five thymic carcinomas. Ten patients (40%) received surgery, four (40%) following chemotherapy; 17 (68%) had chemotherapy, with a combination regimen in 16 of them (94%). Surgery had a significant effect both on overall survival and progression-free survival-2 by univariate analysis (p = 0.04), combination chemotherapy only on progression-free survival-2 (p = 0.03). CONCLUSION Combination chemotherapy and surgery at first recurrence/progression of thymic epithelial tumors were associated with improved survival. DISCUSSION Although several limitations may have affected this retrospective study on a relatively small number of patients with this rare entity of recurrent thymic malignancies, we suggest the use of combination chemotherapy and surgery at their first recurrence may have contributed to the high overall and progression-free survival observed with adequate follow-up and deserve further investigations in broader retrospective and comparative studies.
Collapse
Affiliation(s)
- Giuseppe L Banna
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK.,Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - Ankur Sheel
- University of Massachusetts School of Medicine, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Varun Sheel
- University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Andrea Bille
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Tom Routledge
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | | | - Arjun Nair
- University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Rohit Lal
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| |
Collapse
|
45
|
Gomez JMD, Syed G, Co MLF, Bayoumi M, Abrams R. A rare highly aggressive tumour: lymphoepithelioma-like thymic carcinoma. BMJ Case Rep 2017; 2017:bcr-2017-221478. [PMID: 28942409 PMCID: PMC5747802 DOI: 10.1136/bcr-2017-221478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 11/04/2022] Open
Abstract
Lymphoepithelioma-likethymic carcinoma is a rare neoplasm that presents with compressive symptoms or as an incidental radiological finding of an anterior mediastinal mass. It is an aggressive carcinoma with a high rate of invasion, metastasis and recurrence. Its diagnosis usually carries a poor prognosis largely due to propensity for late diagnosis. To date, guidance for treatment remains limited. This is a case of lymphoepithelioma-like thymic carcinoma in a young male adult who presented initially with back pain. Despite prompt initiation of chemotherapy with cisplatin, doxorubicin and cyclophosphamide, he had a complicated hospital course leading to demise within 2 months of diagnosis.
Collapse
Affiliation(s)
| | - Gulrana Syed
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Mohamed Bayoumi
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard Abrams
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
46
|
Arbour KC, Naidoo J, Steele KE, Ni A, Moreira AL, Rekhtman N, Robbins PB, Karakunnel J, Rimner A, Huang J, Riely GJ, Hellmann MD. Expression of PD-L1 and other immunotherapeutic targets in thymic epithelial tumors. PLoS One 2017; 12:e0182665. [PMID: 28771603 PMCID: PMC5542609 DOI: 10.1371/journal.pone.0182665] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/13/2017] [Indexed: 01/05/2023] Open
Abstract
Introduction The thymus is a critical organ for the development of the adaptive immune system and thymic epithelial tumors (TETs; thymomas and thymic carcinomas) are often associated with auto-immune paraneoplastic conditions. However, the immunobiology of TETs is not well described. An evaluation of the tumor microenvironment, with particular focus on expression of immunotherapeutic targets, may facilitate and prioritize development of immunotherapy strategies for patients with TETs. Methods Tumor tissues from 23 patients with WHO Type B2/B3 thymoma (n = 12) and thymic carcinoma (n = 11) were identified and clinical outcomes were annotated. The expression of membranous PD-L1 on tumor cells, CD3+ and CD8+ tumor infiltrating lymphocytes (TILs), co-stimulatory (CD137, GITR, ICOS), and co-inhibitory immune checkpoint molecules (PD-1, CTLA-4, TIM-3) were assessed semi-quantitatively using immunohistochemistry. Results PD-L1 positivity (≥ 25% of tumor membrane expression) was frequent in TETs (15/23, 65%), more common in thymomas compared to thymic carcinomas (p<0.01), and was associated with longer overall survival (p = 0.02). TIM-3 and GITR were expressed in all TETs, including 18/23 and 12/23 with at least moderate/high expression, respectively. Moderate/high CD137 expression correlated with CD8+ (p = 0.01) and moderate/high GITR expression co-associated with PD-1 (p = 0.043). Conclusions TETs are characterized by frequent PD-L1 expression and PD-L1 is associated with improved survival, suggesting PD-L1 signaling may be biologically important in TETs. Robust expression of markers of immune activation and immunotherapeutic target molecules in TETs emphasizes the potential for development of anti-PD-1/PD-L1 therapies.
Collapse
Affiliation(s)
- Kathryn C. Arbour
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Jarushka Naidoo
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Keith E. Steele
- MedImmune LLC, Gaithersburg, Maryland, United States of America
| | - Ai Ni
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Andre L. Moreira
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Paul B. Robbins
- MedImmune LLC, Gaithersburg, Maryland, United States of America
| | | | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Gregory J. Riely
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Matthew D. Hellmann
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| |
Collapse
|
47
|
Carillo C, Diso D, Mantovani S, Pecoraro Y, De Giacomo T, Ciccone AM, Poggi C, Longo F, Cassese R, Tombolini V, Rendina EA, Venuta F, Anile M. Multimodality treatment of stage II thymic tumours. J Thorac Dis 2017; 9:2369-2374. [PMID: 28932541 DOI: 10.21037/jtd.2017.06.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Complete resection for stage II thymic tumors can be easily accomplished even if the capsula and adjacent mediastinal tissue are macroscopically involved; however, also at this stage, recurrence may occur, particularly for B2, B3 and thymic carcinoma. The criteria for the administration of adjuvant therapy remain controversial and it is unclear whether patients at this stage may benefit from it. We reviewed a series of patients at this stage receiving adjuvant chemo-radiotherapy (chemo-RT) based on histology. METHODS Eighty-eight consecutive patients with stage II thymic tumors were reviewed; 59 patients (67%) with B thymoma or thymic carcinoma received adjuvant treatment with mediastinal irradiation (40-55 Gy), chemotherapy (CH) (PAC regimen) or a combination of both. RESULTS Complete resection was achieved in all patients. Fifty-four patients (61%) received post-operative chemo-RT, 2 (2%) patients received adjuvant CH only and 3 (3%) post-operative RT only; they all had B2, B3 histology or thymic carcinoma. The median follow up was 107±83 months. 5-year and 10-year survival were 96%±2% and 83.4%±5%. Recurrence was observed in 5 patients (5.7%). Disease-free 5 and 10-year survival was 94%±2% and 92%±3% respectively. Five patients (5.7%) had recurrence. CONCLUSIONS The administration of adjuvant chemo-RT to patients with stage II type B thymoma and thymic carcinoma contributes to reduce the recurrence rate and to increase long-term survival.
Collapse
Affiliation(s)
- Carolina Carillo
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Sara Mantovani
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Ylenia Pecoraro
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Tiziano De Giacomo
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | | | - Camilla Poggi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy
| | - Flavia Longo
- Department of Medical Oncology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Cassese
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Federico Venuta
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| |
Collapse
|
48
|
Yang Y, Fan XW, Wang HB, Xu Y, Li DD, Wu KL. Stage IVb thymic carcinoma: patients with lymph node metastases have better prognoses than those with hematogenous metastases. BMC Cancer 2017; 17:217. [PMID: 28347273 PMCID: PMC5368898 DOI: 10.1186/s12885-017-3228-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/23/2017] [Indexed: 12/21/2022] Open
Abstract
Background This study aimed to analyze the pattern of lymphogenous and hematogenous metastases in patients with stage IVb thymic carcinomas and identify prognostic factors for their survivals. Methods Between September 1978 and October 2014, 68 patients with pathologically confirmed stage IVb thymic carcinomas were treated at Fudan University Shanghai Cancer Center. Forty-three patients had lymph node involvement without distant metastases, and the remaining 25 patients had hematogenous metastases. Clinical-pathological characteristics, including age, sex, histologic subtype, tumor size, metastasis, treatment modalities, such as surgical resection, radiotherapy, and chemotherapy, and clinical outcomes, such as overall survival (OS) and progression free survival (PFS), were analyzed. Results The median follow-up time was 22 months (range, 1–126 months). The median OS of all patients with stage IVb thymic carcinomas was 30 months, and the 5-year overall survival rate was 25.1%. The median PFS was 11 months, and the 5-year PFS was 17.9%. Stage IVb patients with lymph node involvement had a better survival than those with distant metastasis (40 vs. 20 months, p = 0.002). Patients with myasthenia gravis had a worse prognosis (p = 0.033). Multivariate analysis identified metastatic status as an independent prognostic factor for OS in patients with stage IVb thymic carcinomas. Conclusions Patients with lymph node involvement had a better survival than those with distant metastases. Much work remains to investigate the prognosis of patients with stage IVb thymic carcinomas and to explore different treatment strategies for patients with lymph node involvement and distant metastases.
Collapse
Affiliation(s)
- Yu Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xing-Wen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hong-Bing Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yin Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Dou-Dou Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Kai-Liang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
49
|
Mohiuddin IH, Furqan M, Clamon G, Keech J, Anderson C, Smith MC, Buatti JM, Allen BG. A Single-Institution Analysis of Thymic Carcinoma Treated with Multi-Modality Therapy. ANNALS OF RADIATION THERAPY AND ONCOLOGY 2017; 1:1011. [PMID: 30148284 PMCID: PMC6103631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Review of our experience in treating thymic carcinoma patients using a combination of surgery, chemotherapy and radiation therapy. METHODS An institutional review of thymic carcinoma patients treated between 2007 and 2014 was performed analyzing clinical characteristics, treatment intent, surgical margin status, and radiation treatment dose. Survival curves were generated using the Kaplan-Meier method. RESULTS Nine individuals were treated for newly diagnosed thymic carcinoma. Three patients had unresectable disease at presentation; two of these were treated with definitive chemoradiation therapy while another received neoadjuvant chemotherapy. Seven subjects underwent surgical resection (one after neoadjuvant chemotherapy) with pathological staging ranging from IIa - IVb disease. Patients were planned for adjuvant radiotherapy followed by chemotherapy; however, one developed liver metastases prior to initiating radiotherapy and was therefore treated with palliative chemotherapy alone. A second patient was non-compliant with radiation treatments and was considered as treated with palliative chemotherapy alone. Of the seven patients who completed definitive treatment, median time to progression and overall survival has yet to be reached. Only one of these patients developed progressive disease 10 months after completing treatment and eventually succumbed to disease 41 months after completing definitive therapy. With a median follow up of 30 months, two year overall survival is 67% for all patients. CONCLUSION Resection with an emphasis on best possible oncologic margins, followed by radiation and chemotherapy remains an effective treatment strategy for advanced stage thymic carcinoma. In patients who present with unresectable tumors, neoadjuvant chemotherapy or definitive chemoradiation therapy may also be considered as viable treatment strategies.
Collapse
Affiliation(s)
| | - Muhammad Furqan
- Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, USA
| | - Gerald Clamon
- Department of Internal Medicine, Division of Hematology and Oncology, University of Iowa, USA
| | - John Keech
- Department of Surgery, Division of Thoracic Surgery, University of Iowa, USA
| | | | - Mark C Smith
- Department of Radiation Oncology, University of Iowa, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, USA
| | - Bryan G Allen
- Department of Radiation Oncology, University of Iowa, USA,Correspondence: Bryan G Allen, Department of Radiation Oncology, Division of Free Radical Radiation Biology, University of Iowa, Iowa City, 52242, USA, Tel: (319)-335- 8019; Fax: (319)-335-8039;
| |
Collapse
|
50
|
Xu JP, Hao XZ, Zhang XR, Yang S, Shi YK. Efficacy and safety of the combination of paclitaxel and platinum in advanced thymic carcinoma. Thorac Cancer 2015; 7:222-5. [PMID: 27042225 PMCID: PMC4773309 DOI: 10.1111/1759-7714.12320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/01/2015] [Indexed: 12/12/2022] Open
Abstract
This study aimed to assess the efficacy and safety of a combination of paclitaxel and cisplatin/carboplatin for the treatment of advanced thymic carcinoma. Thirty‐seven patients (23 men and 14 women, median age 47 years, performance status score ≤2) with pathologically or cytologically diagnosed advanced thymic carcinoma were recruited. Patients received 175 mg/m2 paclitaxel on day 1 and 75 mg/m2 cisplatin or 300 mg/m2 carboplatin on day 2 of a 21 day cycle for at least two cycles to evaluate efficacy and adverse events. No complete response (CR) was observed; 11 patients had a partial response (PR), 16 patients had no change (NC), and 10 had progressive disease, resulting in an overall response rate of 29.7%, a stable rate of 43.2%, and a disease control rate (CR + PR + NC) of 72.9%. Grade I/II and III/IV neutropenia were observed in 21 (56.7%) and 13 (35.1%) patients, respectively. Four (10.8%) patients developed grade I/II thrombocytopenia. Grade I/II and III/IV nausea and vomiting were observed in 19 (51.2%) and five (13.5%) patients, respectively. Grade I/II liver dysfunction was observed in seven (18.9%) patients. Two patients with grade III liver dysfunction recovered after hepatoprotective treatment. The combination of paclitaxel and platinum was effective and well tolerated in patients with advanced thymic carcinoma.
Collapse
Affiliation(s)
- Jian-Ping Xu
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Xue-Zhi Hao
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Xiang-Ru Zhang
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Sheng Yang
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Yuan-Kai Shi
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| |
Collapse
|