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Gao R, Zhou J, Zhang J, Zhu J, Wang T, Yan C. Quantitative CT parameters combined with preoperative systemic inflammatory markers for differentiating risk subgroups of thymic epithelial tumors. BMC Cancer 2023; 23:1158. [PMID: 38012604 PMCID: PMC10683274 DOI: 10.1186/s12885-023-11332-0] [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: 01/25/2023] [Accepted: 08/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are the most common primary neoplasms of the anterior mediastinum. Different risk subgroups of TETs have different prognosis and therapeutic strategies, therefore, preoperative identification of different risk subgroups is of high clinical significance. This study aims to explore the diagnostic efficiency of quantitative computed tomography (CT) parameters combined with preoperative systemic inflammatory markers in differentiating low-risk thymic epithelial tumors (LTETs) from high-risk thymic epithelial tumors (HTETs). METHODS 74 Asian patients with TETs confirmed by biopsy or postoperative pathology between January 2013 and October 2022 were collected retrospectively and divided into two risk subgroups: LTET group (type A, AB and B1 thymomas) and HTET group (type B2, B3 thymomas and thymic carcinoma). Statistical analysis were performed between the two groups in terms of quantitative CT parameters and preoperative systemic inflammatory markers. Multivariate logistic regression analysis was used to determine the independent predictors of risk subgroups of TETs. The area under curve (AUC) and optimal cut-off values were calculated by receiver operating characteristic (ROC) curves. RESULTS 47 TETs were in LTET group, while 27 TETs were in HTET group. In addition to tumor size and CT value of the tumor on plain scan, there were statistical significance comparing in CT value of the tumor on arterial phase (CTv-AP) and venous phase (CTv-VP), and maximum enhanced CT value (CEmax) of the tumor between the two groups (for all, P < 0.05). For systemic inflammatory markers, HTET group was significantly higher than LTET group (for all, P < 0.05), including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). Multivariate logistic regression analysis showed that NLR (odds ratio [OR] = 2.511, 95% confidence interval [CI]: 1.322-4.772, P = 0.005), CTv-AP (OR = 0.939, 95%CI: 0.888-0.994, P = 0.031) and CTv-VP (OR = 0.923, 95%CI: 0.871-0.979, P = 0.008) were the independent predictors of risk subgroups of TETs. The AUC value of 0.887 for the combined model was significantly higher than NLR (0.698), CTv-AP (0.800) or CTv-VP (0.811) alone. The optimal cut-off values for NLR, CTv-AP and CTv-VP were 2.523, 63.44 Hounsfeld Unit (HU) and 88.29HU, respectively. CONCLUSIONS Quantitative CT parameters and preoperative systemic inflammatory markers can differentiate LTETs from HTETs, and the combined model has the potential to improve diagnostic efficiency and to help the patient management.
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Affiliation(s)
- Rongji Gao
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China
| | - Jian Zhou
- Department of Radiology, Taian City Central Hospital, No.29, Longtan Road, Taian, Shandong Province, 271000, China
| | - Juan Zhang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China
| | - Jianzhong Zhu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China
| | - Tiantian Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China.
| | - Chengxin Yan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China.
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Köksoy EB, Akbulut H. A late relapse thymoma and pure red cell aplasia case with an over 5 years of clinical response under everolimus. Anticancer Drugs 2023; 34:1193-1195. [PMID: 37823284 DOI: 10.1097/cad.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Although several agents showed some clinical activity in patients with recurrent thymoma, there is no standard treatment option. Here, we report a late relapse thymoma and pure red cell aplasia case, responsive to everolimus with over 5 years of clinical benefit following multiple lines of treatment. Everolimus controlled the rapidly progressive disease in our patient without significant toxicity.
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Affiliation(s)
- Elif B Köksoy
- Department of Medical Oncology, Ankara University, School of Medicine, Ankara, Turkey
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Wang Y, Zhang X, Tian D, Han S, Zhang J, Nie J, Dai L, Hu W, Chen X, Ma X, Tian G, Wu D, Zhang Z, Long J, Fang J. Second-line treatment options in advanced thymic carcinoma after failure of platinum-based chemotherapy: A multicenter retrospective study. Cancer Med 2022; 12:2303-2311. [PMID: 35924403 PMCID: PMC9939196 DOI: 10.1002/cam4.5053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Currently there is no standard therapy recommended for second-line treatment for thymic carcinoma. Our study compared multidrug chemotherapy, single-agent chemotherapy, and PD-1 inhibitors in patients diagnosed with advanced thymic carcinoma who had previous platinum-based chemotherapy at the clinic. METHODS The study included patients with thymic carcinoma who failed first-line platinum-based chemotherapy. Kaplan-Meier methods were applied in the study for estimating the progression-free survival (PFS) and overall survival (OS) curves. Pearson chi-square or Fisher's exact chi-square test was adopted to make comparisons of the objective response rate (ORR) between treatment groups. Cox regression was used for the multivariate analyses in PFS and OS. RESULTS Among the 92 patients enrolled, multidrug chemotherapy was used in 51 (55.4%) patients for second-line therapy. Thirty-six patients (35.9%) received single-agent chemotherapy, and eight patients (8.7%) underwent PD-1 inhibitors. The multidrug chemotherapy group showed better efficacy than the other two groups, with an ORR of 35.3% (p = 0.006). The median PFS of multidrug chemotherapy, single-agent chemotherapy and PD-1 inhibitors were 5.0 months, 3.0 months, and 4.0 months, respectively (p = 0.008). Patients in the multidrug chemotherapy group also showed an advantage in OS in comparison with the other two treatment groups (p = 0.045), with a median OS of 30.4 months. Multivariate analysis showed that second-line treatment was independent factor for both PFS (p = 0.035) and OS (p = 0.037). Grade 3-4 AEs were mostly detected in patients receiving multidrug chemotherapy and were primarily hematologic. Treatment-related mortality was not found in any of the groups. CONCLUSIONS Multidrug chemotherapy had a trend toward a more positive response rate and outcomes in longer survival time than single-agent chemotherapy and PD-1 inhibitors. Multidrug chemotherapy is a choice worth considering for second-line therapy in patients with thymic carcinoma if tolerable.
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Affiliation(s)
- Yang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xuanye Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Sen Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jie Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jun Nie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Ling Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Weiheng Hu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xiaoling Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xiangjuan Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Guangming Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Di Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Ziran Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jieran Long
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Jian Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic OncologyPeking University Cancer Hospital & InstituteBeijingChina
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6574354. [DOI: 10.1093/ejcts/ezac274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
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Future Perspective of Chemotherapy and Pharmacotherapy in Thymic Carcinoma. Cancers (Basel) 2021; 13:cancers13205239. [PMID: 34680386 PMCID: PMC8533972 DOI: 10.3390/cancers13205239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Thymic carcinoma is a rare cancer, and its biology remains largely unknown. Although complete surgical resection is a standard treatment for thymic carcinoma, systemic chemotherapy is frequently administered in metastatic or recurrent cases. Given the rarity, therapeutic agents are often confirmed on the basis of the results of phase II trials or retrospective studies. Platinum-based combination chemotherapy has long been employed for treating thymic carcinoma. Recently, biomarkers have been explored, and molecular profiles and major oncogenic pathways have gradually been revealed by next-generation sequencing, resulting in the development of targeted therapies. Moreover, clinical trials assessing combination therapy with immune checkpoint inhibitors are ongoing and are expected to be efficacious for treating thymic epithelial tumors. We reviewed the current role of systemic chemotherapy, including targeted therapies and immune checkpoint inhibitors, considering recent findings regarding its biology. Abstract Thymic carcinoma is a rare cancer that arises from thymic epithelial cells. Its nature and pathology differ from that of benign thymoma, presenting a poorer prognosis. If surgically resectable, surgery alone or surgery followed by chemoradiotherapy or radiotherapy is recommended by the National Comprehensive Cancer Network Guidelines. Metastatic and refractory thymic carcinomas require systemic pharmacotherapy. Combined carboplatin and paclitaxel, and cisplatin and anthracycline-based regimens have been shown a fair response rate and survival to provide a de facto standard of care when compared with other drugs employed as first-line chemotherapy. Cytotoxic agents have been pivotal for treating thymic carcinoma, as little is known regarding its tumorigenesis. In addition, genetic alterations, including driver mutations, which play an important role in treatments, have not yet been discovered. However, molecular pathways and biomarker studies assessing thymic epithelial tumors have been reported recently, resulting in the development of new agents, such as molecular targeted agents and immune checkpoint inhibitors. As treatment options are currently limited and the prognosis remains poor in metastases and recurrent thymic carcinoma, genetic alterations need to be assessed. In the present review, we focused on the current role of targeted therapies and immune checkpoint inhibitors in treating thymic carcinoma.
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Umemura S, Chen V, Chahine JJ, Kallakury B, Zhao X, Lee H, Avantaggiati ML, He Y, Wang C, Giaccone G. Arginase Pathway Markers of Immune-Microenvironment in Thymic Epithelial Tumors and Small Cell Lung Cancer. Clin Lung Cancer 2021; 23:e140-e147. [PMID: 34393062 DOI: 10.1016/j.cllc.2021.07.006] [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: 02/20/2021] [Accepted: 07/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Key regulators of antitumor immunity such as arginase-1 and the adenosine pathway may have an important role in modulating the effect of immunotherapy. Here, we investigated the expression profile of these immune-related biomarkers in thymic epithelial tumors (TETs) and small cell lung cancer (SCLC), 2 solid tumors where immune checkpoint inhibitors have activity. MATERIALS AND METHODS Immunohistochemical staining was performed using tissue microarrays of 123 TET (110 thymoma and 13 thymic carcinoma) and 125 SCLC cases. The expression profile of the following immune-related biomarkers was assessed: arginase-1, CD39, CD73, A2AR, PD-L2, and CD15. The expression profile was also correlated with clinical data. RESULTS No sample was positive for arginase-1. In the adenosine pathway, the prevalence of positive staining for CD39, CD73, and A2AR was 4.9%, 2.5%, and 69.2%, in TETs and 0%, 1.7%, and 50.8%, in SCLC. The multivariate analysis showed that CD39 expression was significantly associated with worse disease related survival (hazard ratio [HR], 10.36; 95% confidence interval [CI]: 2.01-53.47; P= .005) and a shorter time-to progression (HR, 11.35; 95% CI, 2.11-61.23; P = .005) in TETs. Other biomarkers were not associated with disease related survival or time to progression in TETs. No biomarker was associated with survival in SCLC. CONCLUSION Arginase-1 was not detectable in TETs and SCLC. Expression of markers in the adenosine pathway were present in both TETs and SCLC. CD39 expression in tumor cells may identify subsets of patients with TETs with an unfavorable prognosis.
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Affiliation(s)
- Shigeki Umemura
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Vincent Chen
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Joeffrey J Chahine
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Bhaskar Kallakury
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Xiaoliang Zhao
- Department of Oncology, Georgetown University Medical Center, Washington, DC; Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, China
| | - Hyun Lee
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | | | - Yongfeng He
- Sandra and Edward Meyer Cancer Center, Weill-Cornell Medicine, New York, NY
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, China
| | - Giuseppe Giaccone
- Department of Oncology, Georgetown University Medical Center, Washington, DC; Sandra and Edward Meyer Cancer Center, Weill-Cornell Medicine, New York, NY.
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Süveg K, Putora PM, Joerger M, Iseli T, Fischer GF, Ammann K, Glatzer M. Radiotherapy for thymic epithelial tumours: a review. Transl Lung Cancer Res 2021; 10:2088-2100. [PMID: 34012817 PMCID: PMC8107733 DOI: 10.21037/tlcr-20-458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thymic epithelial tumours (TETs) represent a rare disease, yet they are the most common tumours of the anterior mediastinum. Due to the rare occurrence of TETs, evidence on optimal treatment is limited. Surgery is the treatment of choice in the management of TETs, while the role of postoperative radiotherapy (PORT) remains unresolved. PORT remains debated for thymomas, especially in completely resected stage II tumours, for which PORT may be more likely to benefit in the presence of aggressive histology (WHO subtype B2, B3) or extensive transcapsular invasion (Masaoka-Koga stage IIB). For stage III thymoma, evidence suggests an overall survival (OS) benefit for PORT after complete resection. For incompletely resected thymomas stage II or higher PORT is recommended. Thymic carcinomas at any stage with positive resection margins should be offered PORT. Radiotherapy plays an important role in the management of unresectable locally advanced TETs. Induction therapy (chemotherapy or chemoradiation) followed by surgery may be useful for locally advanced thymic malignancies initially considered as unresectable. Chemotherapy only is offered in patients with unresectable, metastatic tumours in palliative intent, checkpoint inhibitors may be promising for refractory diseases. Due to the lack of high-level evidence and the importance of a multidisciplinary approach, TETs should be discussed within a multidisciplinary team and the final recommendation should reflect individual patient preferences.
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Affiliation(s)
- Krisztian Süveg
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Markus Joerger
- Department of Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Thomas Iseli
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Galina Farina Fischer
- Departmet of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karlheinz Ammann
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Octreotide in the treatment of malignant thymoma - Case report. Rep Pract Oncol Radiother 2020; 25:882-885. [PMID: 32982594 DOI: 10.1016/j.rpor.2020.08.012] [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: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Thymomas are the most common mediastinal tumors. Systemic therapy for patients with unresectable or recurrent thymomas is a challenging field in the current oncology research. There is some evidence that somatostatin analogs combined with corticosteroids may have a role in the treatment of advanced malignant thymoma; however, the role of these agents have not been fully evaluated. Case report A 39-year-old man with metastatic thymoma was administered long-acting depot injection form of octreotide. Octreotide scan before the treatment initiation revealed low uptake. CT control after three months of the treatment revealed marked regression of pleural metastases, while the primary tumor mass remained stable. The treatment response was lasting for 9 months. Conclusion We describe an interesting case of marked clinical and radiological response of advanced malignant thymoma to the treatment with octreotide in a heavily pre-treated patient, even though octreotide scan revealed low uptake.
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9
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Hellyer JA, Ouseph MM, Padda SK, Wakelee HA. Everolimus in the treatment of metastatic thymic epithelial tumors. Lung Cancer 2020; 149:97-102. [PMID: 33007678 DOI: 10.1016/j.lungcan.2020.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There is emerging evidence to support the use of mTOR inhibitor everolimus in patients with advanced, relapsed-refractory thymic epithelial tumors (TETs). However, patient selection and identifying predictive biomarkers of response remains a challenge. Here, we describe a single-center experience with everolimus in patients with TETs and provide detailed molecular analysis of their thymic tumors. MATERIALS AND METHODS Data on all patients with advanced TETs who were prescribed everolimus at Stanford University were retrospectively assessed. Time to treatment failure (TTF) and overall survival (OS) were calculated. STAMP, a 130-gene targeted next generation sequencing (NGS) panel, was performed on each tumor sample. RESULTS Twelve patients with thymoma (T) and three with thymic carcinoma (TC) treated with everolimus were included. Patients had been heavily pre-treated with an average of three prior lines of therapy. Three patients discontinued treatment due to adverse events. The average TTF was 14.7 months in T and 2.6 months in TC with median OS of 27.6 months in the entire cohort (NR T and 5.3 months TC). Two patients with paraneoplastic autoimmune diseases had improvement in autoimmunity on everolimus. Pathogenic mutations were observed in 4/15 (27 %) of patients and includedTP53, KEAP1 and CDKN2A. Several variants of unknown significance in key genes responsible for modulating tumor response to mTOR inhibition were also found. CONCLUSION As previously reported in a prospective trial, patients with previously treated advanced TETs appear to benefit from everolimus in this single institution cohort. Moreover, there was a manageable toxicity profile and no cases of everolimus-induced pneumonitis. A targeted NGS panel revealed several pathogenic mutations but there was no association between detectable tumor mutations and time to treatment failure in this cohort.
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Affiliation(s)
- Jessica A Hellyer
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA, USA
| | - Madhu M Ouseph
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sukhmani K Padda
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA, USA
| | - Heather A Wakelee
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA, USA.
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Okuma Y, Goto Y, Ohyanagi F, Sunami K, Nakahara Y, Kitazono S, Kudo K, Tambo Y, Kanda S, Yanagitani N, Horiike A, Horinouchi H, Fujiwara Y, Nokihara H, Yamamoto N, Nishio M, Ohe Y, Hosomi Y. Phase II trial of S-1 treatment as palliative-intent chemotherapy for previously treated advanced thymic carcinoma. Cancer Med 2020; 9:7418-7427. [PMID: 32813912 PMCID: PMC7571815 DOI: 10.1002/cam4.3385] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Thymic carcinoma (TC) is a rare cancer with minimal evidence of survival following palliative-intent chemotherapy. Sunitinib, everolimus, and pembrolizumab have been proposed as active agents based on previous phase II trials. In this phase II study, TC patients previously treated with platinum-based chemotherapy were enrolled. The patients received S-1 orally twice daily at a dose of 40-60 mg/m2 for 4 weeks, followed by 2 weeks off until the progression of the disease or the presence of unacceptable toxicities. The primary endpoint was the objective response rate (ORR), and secondary endpoints were progression-free survival (PFS), overall survival (OS), and safety. The sample size of 26 patients was planned to reject the ORR of 10% under the expectation of 30% with a power of 0.80 and a type I error of 0.05 (one-sided). Twenty-six patients were recruited between 2013 and 2016; 23 patients had squamous cell carcinoma and 10 had an ECOG performance status of 0. One patient showed complete response and seven patients showed partial responses, resulting in a 30.8% response rate (90% confidence interval [CI], 18.3-46.9) and an 80.8% disease control rate (90% CI, 65.4-90.3). The median PFS was 4.3 months (95% CI, 2.3-10.3 months) and median OS was 27.4 months (95% CI, 16.6-34.3). Adverse events of grade ≥ 3 included neutropenia (12%), skin rash (8%), elevated alanine aminotransferase, and fatigue (4%). No treatment-related death was observed. S-1 confirmed clinical activity with tolerability in patients with previously treated TC. (UMIN000010736).
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Affiliation(s)
- Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumiyoshi Ohyanagi
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Division of Pulmonary Medicine, Clinical Department of Internal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kuniko Sunami
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiro Nakahara
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Satoru Kitazono
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keita Kudo
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Thoracic Medical Oncology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Yuichi Tambo
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Respiratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Shintaro Kanda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Horiike
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Division of Medical Oncology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiroshi Nokihara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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11
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Rai M, Keogh A. A Rare Case of a High-Grade Thymic Squamous Cell Carcinoma Presenting as Cardiac Tamponade. Cureus 2020; 12:e9366. [PMID: 32850235 PMCID: PMC7445423 DOI: 10.7759/cureus.9366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Thymic tumors (for example, thymomas, thymic carcinomas, and thymic neuroendocrine tumors) are rare tumors. Thymic carcinomas are aggressive thymic epithelial neoplasms with a poor prognosis. Cardiac tamponade as a presenting complaint of malignant thymic carcinoma is rare. A 64-year-old woman presented to the emergency department with complaints of progressive exertional dyspnea and chest discomfort. On physical examination, she had diminished breath sounds at the left lung base. The chest x-ray showed a mediastinal widening, significant cardiomegaly, and pleural effusion. CT scan of the chest revealed a dominant mediastinal mass, left-sided pleural effusion, and pericardial effusion. Transthoracic echocardiogram showed 3 cm circumferential pericardial effusion, with evidence of cardiac tamponade. An emergent pericardiocentesis and thoracentesis were done. A core needle biopsy of the mediastinal mass revealed a high-grade non-keratinizing squamous cell thymic carcinoma. Immunohistochemistry staining was positive for pan-cytokeratin, high molecular weight cytokeratin, CK 5/6, E-cadherin, p63, epithelial membrane antigen (EMA), and BerEp4. The patient had repeated hospital admissions due to recurrent malignant pericardial effusion and left pleural effusion. The patient was planned for radiation and chemotherapy with oncology. In our review of literature, the primary squamous cell thymic carcinoma presenting initially as a cardiac tamponade was found to be a rare event. Early diagnosis and treatment are of utmost importance given the aggressive clinical course culminating in to poor outcome.
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Affiliation(s)
- Maitreyee Rai
- Internal Medicine, Crozer Chester Medical Center, Upland, USA
| | - Alan Keogh
- Hematology and Oncology, Crozer Chester Medical Center, Upland, USA
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12
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Abbas AES. A New Testament for the Followers of Thymic Epithelial Tumors. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:211-224. [PMID: 32438846 DOI: 10.1177/1556984520922932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abbas El-Sayed Abbas
- 12314 Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelpia, PA, USA.,Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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13
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Rouquette I, Taranchon-Clermont E, Gilhodes J, Bluthgen MV, Perallon R, Chalabreysse L, De Muret A, Hofman V, Marx A, Parrens M, Secq V, Thomas de Montpreville V, Galateau-Salle F, Brousset P, Milia J, Girard N, Besse B, Molina TJ, Mazières J. Immune biomarkers in thymic epithelial tumors: expression patterns, prognostic value and comparison of diagnostic tests for PD-L1. Biomark Res 2019; 7:28. [PMID: 31827799 PMCID: PMC6894111 DOI: 10.1186/s40364-019-0177-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background Immunotherapy is currently under investigation in B3 Thymoma (TB3) and Thymic Carcinoma (TC). PD-L1 expression has been evaluated on a limited number of patients with selected antibodies. We aimed to analyze cohort of TB3 and TC with a panel of antibodies to assess the prevalence of PD-L1 expression, its prognostic value and to set up a reproducible test. Methods We retrospectively studied 103 patients samples of FFPE histologically confirmed TB3 (n = 53) and TC (n = 50) by expert pathologists within the RYTHMIC national network. We compared PD-L1, PD1, CD8 and PD-L2 expression and performed correlation with tumor types and patients outcomes. Four PD-L1 antibodies were tested, three of them validated as companion tests in lung cancer, one tested on two automates on whole section of tumors. We evaluated the percentage and intensity of both epithelial and immune stained cells. Results TB3 epithelial cells had a higher and more diffuse expression of PD-L1 than TC regardless the antibodies tested (p < 0.0001). Three out of four antibodies targeting PD-L1 tested on the DAKO autostainer gave similar staining. Concordance between antibodies was lower for PD-L1 staining on immune cells with no significant difference between TB3 and TC except on E1L3N antibody. PD-L2 antibody stained no tumor epithelial cells. High PD-L1 expression was correlated with a better overall survival for TB3 and was not correlated with tumor staging. Conclusion Frequent PD-L1 expression, particularly in TB3, paves the way for immunotherapy in TET (Thymic Epithelial Tumor). Otherwise, we have set up three reproducible LDT (laboratory-developed test) for four PD-L1 antibodies.
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Affiliation(s)
| | | | - Julia Gilhodes
- 1IUCT-Oncopole, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | | | - Romain Perallon
- 1IUCT-Oncopole, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Lara Chalabreysse
- 3HCL, Hôpital Louis Pradel, 28 Avenue du Doyen Jean Lépine, 69500 Bron, France
| | - Anne De Muret
- Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France
| | | | - Alexander Marx
- Institut de Pathologie, Universitaetsmedizin Mannheim, Heidelberg University, D-68167 Mannheim, Germany
| | - Marie Parrens
- 7Hôpital Haut-Levêque CHU, Avenue de Magellan, 33604 Pessac, France
| | - Veronique Secq
- 8APHM Hôpital Nord, Chemin des Bourrely, 13915 Marseille, France
| | | | | | - Pierre Brousset
- 1IUCT-Oncopole, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Julie Milia
- 11Hôpital Larrey, Centre Hospitalier Universitaire de Toulouse, 24 Chemin de Pouvourville, 31059 Toulouse, France
| | - Nicolas Girard
- 12Institut du Thorax Curie Montsouris, Institut Curie, 26, Rue d'Ulm, 75005 Paris, France
| | - Benjamin Besse
- 13Gustave Roussy, 114 rue E Vaillant, 94805 Villejuif, France.,14Paris-Sud university, Orsay, France
| | - Thierry Jo Molina
- Hôpital Necker Enfants Malades, AP-HP, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France
| | - Julien Mazières
- 11Hôpital Larrey, Centre Hospitalier Universitaire de Toulouse, 24 Chemin de Pouvourville, 31059 Toulouse, France
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14
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Rajan A, Heery CR, Thomas A, Mammen AL, Perry S, O'Sullivan Coyne G, Guha U, Berman A, Szabo E, Madan RA, Ballester LY, Pittaluga S, Donahue RN, Tsai YT, Lepone LM, Chin K, Ginty F, Sood A, Hewitt SM, Schlom J, Hassan R, Gulley JL. Efficacy and tolerability of anti-programmed death-ligand 1 (PD-L1) antibody (Avelumab) treatment in advanced thymoma. J Immunother Cancer 2019; 7:269. [PMID: 31639039 PMCID: PMC6805423 DOI: 10.1186/s40425-019-0723-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022] Open
Abstract
Background Thymic epithelial tumors are PD-L1–expressing tumors of thymic epithelial origin characterized by varying degrees of lymphocytic infiltration and a predisposition towards development of paraneoplastic autoimmunity. PD-1–targeting antibodies have been evaluated, largely in patients with thymic carcinoma. We sought to evaluate the efficacy and safety of the anti-PD-L1 antibody, avelumab (MSB0010718C), in patients with relapsed, advanced thymic epithelial tumors and conduct correlative immunological studies. Methods Seven patients with thymoma and one patient with thymic carcinoma were enrolled in a phase I, dose-escalation trial of avelumab (MSB0010718C), and treated with avelumab at doses of 10 mg/kg to 20 mg/kg every 2 weeks until disease progression or development of intolerable side effects. Tissue and blood immunological analyses were conducted. Results Two of seven (29%) patients with thymoma had a confirmed Response Evaluation Criteria in Solid Tumors–defined partial response, two (29%) had an unconfirmed partial response and three patients (two thymoma; one thymic carcinoma) had stable disease (43%). Three of four responses were observed after a single dose of avelumab. All responders developed immune-related adverse events that resolved with immunosuppressive therapy. Only one of four patients without a clinical response developed immune-related adverse events. Responders had a higher absolute lymphocyte count, lower frequencies of B cells, regulatory T cells, conventional dendritic cells, and natural killer cells prior to therapy. Conclusion These results demonstrate anti-tumor activity of PD-L1 inhibition in patients with relapsed thymoma accompanied by a high frequency of immune-related adverse events. Pre-treatment immune cell subset populations differ between responders and non-responders. Trial registration ClinicalTrials.gov - NCT01772004. Date of registration – January 21, 2013. Electronic supplementary material The online version of this article (10.1186/s40425-019-0723-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Christopher R Heery
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anish Thomas
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Andrew L Mammen
- Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Susan Perry
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Geraldine O'Sullivan Coyne
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., 13N240, Bethesda, MD, 20892, USA
| | - Udayan Guha
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Arlene Berman
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Eva Szabo
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA.,Lung and Upper Aerodigestive Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., 13N240, Bethesda, MD, 20892, USA
| | - Leomar Y Ballester
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Renee N Donahue
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yo-Ting Tsai
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lauren M Lepone
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Fiona Ginty
- GE Global Research Center, Niskayuna, NY, USA
| | - Anup Sood
- GE Global Research Center, Niskayuna, NY, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Raffit Hassan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10-CRC, Room 4-5330, 10 Center Drive, Bethesda, MD, 20892, USA
| | - James L Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr., 13N240, Bethesda, MD, 20892, USA.
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15
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Hellyer JA, Gubens MA, Cunanan KM, Padda SK, Burns M, Spittler AJ, Riess JW, San Pedro-Salcedo M, Ramchandran KJ, Neal JW, Wakelee HA, Loehrer PJ. Phase II trial of single agent amrubicin in patients with previously treated advanced thymic malignancies. Lung Cancer 2019; 137:71-75. [PMID: 31557562 DOI: 10.1016/j.lungcan.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES There are limited treatment options for patients with thymic malignancies. Here we present data supporting treatment with single agent amrubicin, a third generation anthracycline and topoisomerase II inhibitor. MATERIALS AND METHODS This was a phase 2 open-label, single arm trial of amrubicin in patients with thymoma (T) or thymic carcinoma (TC), conducted at two academic institutions. Patients were included if they had received at least one prior chemotherapy regimen. The first 18 patients received amrubicin at 40 mg/m2 IV days 1-3 repeated every 3-weeks. Due to the high incidence of febrile neutropenia, dosing was subsequently amended to 35 mg/m2 for the final 15 patients. RESULTS A total of 33 patients (14 T/19 TC) were enrolled from 2011 to 2014. Median number of prior therapies was 2. Best response included 6 partial responses, 21 stable disease, and 6 progressive disease (all TC). Objective response rate was 18% (90% exact binomial CI 8.2%-32.8%; T = 4/14 (29%), TC = 2/19 (11%)). Median progression-free survival was 7.7 months (T: 8.3 months; TC: 7.3) and median overall survival was 29.7 months (T: 54.1 months; TC: 18 months). There was a high rate of febrile neutropenia (7 patients) that occurred despite a reduction in amrubicin dose and one related death. Five patients had reduction in LVEF below 50% during the course of treatment resulting in treatment discontinuation in one patient. CONCLUSION Amrubicin shows promise as a single agent in heavily pre-treated patients with thymic malignancies. Notable side effects include febrile neutropenia and the use of growth factor support is essential. Further investigation of this agent is warranted.
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Affiliation(s)
- Jessica A Hellyer
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA
| | - Matthew A Gubens
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA; University of California San Francisco, 1450 3rdSt, San Francisco, CA, USA
| | - Kristen M Cunanan
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA
| | - Sukhmani K Padda
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA
| | - Matthew Burns
- Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr. Indianapolis, IN, USA
| | - A John Spittler
- Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr. Indianapolis, IN, USA
| | - Jonathan W Riess
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA; UC Davis Comprehensive Cancer Center, 2279 45thSt, Sacramento, CA, USA
| | - Melanie San Pedro-Salcedo
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA
| | - Kavitha J Ramchandran
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA
| | - Joel W Neal
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA
| | - Heather A Wakelee
- Stanford University School of Medicine and Stanford Cancer Institute, 875 Blake Wilbur Driver, Stanford, CA, USA.
| | - Patrick J Loehrer
- Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr. Indianapolis, IN, USA
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16
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Imbimbo M, Ottaviano M, Vitali M, Fabbri A, Leuzzi G, Fiore M, Franceschini D, Pasello G, Perrino M, Schiavon M, Pruneri G, Dei Tos AP, Sangalli C, Garassino MC, Berardi R, Alessi A, Calareso G, Petrini I, Scorsetti M, Scotti V, Rosso L, Rea F, Pastorino U, Casali PG, Ramella S, Ricardi U, Abate-Daga L, Torri V, Trama A, Palmieri G, Marino M, Zucali PA. Best practices for the management of thymic epithelial tumors: A position paper by the Italian collaborative group for ThYmic MalignanciEs (TYME). Cancer Treat Rev 2018; 71:76-87. [PMID: 30366202 DOI: 10.1016/j.ctrv.2018.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/18/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022]
Abstract
Thymic epithelial tumors (TETs) are a heterogenous group of rare tumors, with a complex histopatological classification. Furthermore, the recent introduction of the first TNM staging system, that is scheduled to replace the Masaoka-Koga system, may create further difficulties in TET management, that remains challenging. Several guidelines for treatment of TETs are available and provide recommendations based mainly on non randomized trials and retrospective or limited series. Often the lack of evidence leads to formulation of indications based on expert opinions. As for other rare cancers it is crucial to create networks to coordinate the work among centres involved in treatment of these diseases in order to offer the best diagnostic and therapeutic tools. For this purpose, in 2014 a network named TYME (ThYmic MalignanciEs), was founded in Italy with the aim of improving care and research in TETs. In September 2017 a panel of multidisciplinary experts from TYME network and from other Italian centres strongly involved in TET diagnosis and treatment convened a first Italian Expert meeting together with representatives of association for patients affected by rare thoracic cancers Tu.To.R, to explore how these tumors are managed in the different centres of Italy compared to ESMO guidelines. In this paper we summarize the issues discussed during that meeting and we propose recommandations based on Masaoka Koga and the new TNM staging system.
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Affiliation(s)
- Martina Imbimbo
- Unit of Thoracic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Margaret Ottaviano
- Rare Tumors Reference Center, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Milena Vitali
- Unit of Thoracic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico di Roma, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Matteo Perrino
- Department of Medical Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | - Marco Schiavon
- Thoracic Surgery Unit Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Claudia Sangalli
- Department of Radiology and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Alessandra Alessi
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iacopo Petrini
- General Pathology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy; Humanitas University, Department of Biomedical Sciences, Rozzano (Milan), Italy
| | - Vieri Scotti
- Department of Oncology, Radiation Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Federico Rea
- Thoracic Surgery Unit Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico di Roma, Italy
| | | | | | - Valter Torri
- Laboratory of Methodology for Biomedical Research, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit-Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovannella Palmieri
- Rare Tumors Reference Center, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Roma, Italy
| | - Paolo Andrea Zucali
- Department of Medical Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
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17
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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.
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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
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18
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Saito M, Fujiwara Y, Asao T, Honda T, Shimada Y, Kanai Y, Tsuta K, Kono K, Watanabe S, Ohe Y, Kohno T. The genomic and epigenomic landscape in thymic carcinoma. Carcinogenesis 2017; 38:1084-1091. [PMID: 28968686 DOI: 10.1093/carcin/bgx094] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 09/04/2017] [Indexed: 02/06/2023] Open
Abstract
Thymic carcinoma (TC) is a rare cancer whose genomic features have been examined in only a limited number of patients of European descent. Here, we characterized both genomic and epigenomic aberrations by whole exome sequencing, RNA sequencing, methylation array and copy number analyses in TCs from Asian patients and compared them with those in TCs from USA/European patients. Samples analyzed were 10 pairs of snap-frozen surgical specimens of cancerous and non-cancerous thymic tissue. All 10 cases were Japanese patients treated at the National Cancer Center Hospital, Japan, between 1994 and 2010. Mutational signature analysis indicated that the accumulation of age-related mutations drive TC development. We identified recurrent somatic mutations in TET2, CYLD, SETD2, TP53, FBXW7, HRAS and RB1, and no mutations in GTF2I, supporting the hypothesis that TC and thymoma are distinguishable by their genetic profiles. TCs with TET2 mutations had more hypermethylated genes than those without, and hyper-methylation was associated with downregulation of gene expression. Focal genome copy number gains, associated with elevated gene expression, were observed at the KIT (which is known to drive thymic carcinogenesis) and AHNAK2 gene loci. Taken together, the results suggest that the molecular processes leading to TC depend on the accumulation of genetic and epigenetic aberrations. In addition, epigenetic dysregulation as a result of the TET2 mutation was observed in a subset of TCs.
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Affiliation(s)
- Motonobu Saito
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo 104-0045, Japan.,Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tetsuhiko Asao
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takayuki Honda
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Yoko Shimada
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Yae Kanai
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan.,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Koji Tsuta
- Department of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan.,Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Hirakata 573-1191, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shunichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
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19
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Wei Y, Gu Z, Shen Y, Fu J, Tan L, Zhang P, Han Y, Chen C, Zhang R, Li Y, Chen KN, Chen H, Liu Y, Cui Y, Wang Y, Pang L, Yu Z, Zhou X, Liu Y, Liu Y, Fang W. [Preoperative Induction Therapy for Locally Advanced Thymic Tumors: A Retrospective Analysis Using the ChART Database]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:445-52. [PMID: 27339721 PMCID: PMC6133981 DOI: 10.3779/j.issn.1009-3419.2016.07.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 探讨术前诱导治疗在胸腺瘤中的应用及其对局部进展期胸腺瘤预后的影响。 方法 收集中国胸腺肿瘤协作组(Chinese Alliance of Research for Thymomas, ChART)1994年1月1日至2012年12月31日回顾性数据库中局部进展期胸腺瘤(Masaoka-Koga分期为Ⅲ期-Ⅳa期)病例。分为诱导治疗组和直接手术组,对比分析两组的R0切除率、5年复发率及5年生存率等指标。诱导治疗组术后分期为Masaoka-Koga Ⅰ期-Ⅱ期的病例视为诱导治疗后降期。为更加精确评估诱导治疗效果,在剔除术后Ⅳ期病例的基础上,再次将诱导治疗组术后Masaoka-Koga Ⅰ期-Ⅲ期的病例与直接手术组Masaoka-Koga Ⅲ期的病例进行对比分析。 结果 ChART回顾性数据库1, 713例有效病例中,局部进展期胸腺瘤706例,仅68例(4%)作了术前诱导治疗,R0切除率为67.6%,5年复发率为44.9%,5年与10年生存率分别为49.7%和19.9%。其中17例诱导治疗后达到降期,降期亚组中胸腺瘤的比例高于胸腺癌(38.7% vs 13.9%, P=0.02);与未降期亚组相比,降期亚组获得更高的5年生存率(93.8% vs 35.6%, P=0.013)。剔除术后Ⅳ期的病例后,直接手术组和诱导治疗组R0切除率接近(76.4% vs 73.3%, P=0.63),但5年生存率差异明显(85.2% vs 68.1%, P < 0.001),对于降期亚组,5年生存率优于直接手术组(93.8% vs 85.2%, P=0.438),未降期亚组5年生存率仅35.6%,明显差于降期亚组和直接手术组(P < 0.001)。 结论 术前诱导治疗目前尚未在局部进展期胸腺瘤中广泛应用,但ChART的回顾性数据研究显示通过有效的术前诱导治疗可以使难以彻底切除的病例降期后增加R0切除的机会,从而延长生存,特别是胸腺瘤的病例。这一初步结果将有助于未来的研究。
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Affiliation(s)
- Yucheng Wei
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yi Shen
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Liejie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Zhang
- Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Renquan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yin Li
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China
| | - Hezhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China
| | - Youbing Cui
- Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liewen Pang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China
| | - Xinming Zhou
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Yangchun Liu
- Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yuan Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Maury JM, Girard N, Tabutin M, Grima R, Chalabreysse L, Pavlakovic I, Sayag-Beaujard A, Leroux C, Souquet PJ, Glehen O, Tronc F. Intra-Thoracic Chemo-Hyperthermia for pleural recurrence of thymoma. Lung Cancer 2017. [PMID: 28625619 DOI: 10.1016/j.lungcan.2017.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pleural recurrences are a hallmark of thymomas, and represent a challenge for multidisciplinary management. The purpose of this study was to assess the feasibility and the results in terms of morbidity, mortality and survival rates, of Intra-Thoracic Chemo-Hyperthermia (ITCH) for the treatment of pleural recurrences of thymomas. METHODS Retrospective analysis of 19 consecutives patients between 1997 and 2015 treated by surgical cytoreduction (pleurectomy) followed by ITCH with 25mg/m2 of mitomycin, and 50mg/m2 of Cisplatin. RESULTS There were 8 men and 11 women with a median age of 44 years. ITCH was combined with pleurectomy alone in 4 (22%) patients, pleurectomy and wedge resections in 14 (74%) patients; 1 (5%) patient had a pleuropneumonectomy. There were no perioperative deaths, and 5 patients (26%) presented with postoperative complication, including 3 (16%) cases related to chemotherapy (one case of reversible grade 2 bone marrow aplasia, and 2 cases of reversible, acute kidney failure). The median length of stay in intensive care unit and hospital were 1day and 10days, respectively. After a median follow-up period of 39 months (range 10-127 months), median disease-free survival was 42 months. Five patients (26%) died during follow-up. CONCLUSIONS Our data indicate that ITCH is a feasible option for selected patients with pleural recurrence of thymomas. ITCH clearly provides long local control, without major safety issues, and prolonged survival may be achieved in selected patients. This therapeutic option should be discussed at a multidisciplinary tumor board.
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Affiliation(s)
- Jean Michel Maury
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France
| | - Nicolas Girard
- Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France; Department of Respiratory Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France.
| | - Mayeul Tabutin
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Department of Surgery, Centre Léon-Berard, Cancer Research Center of Lyon 28, F-69008 Lyon, France
| | - Renaud Grima
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Lara Chalabreysse
- Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France; Department of Pathology, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Isabelle Pavlakovic
- Department of Anesthesiology and Reanimation, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Annie Sayag-Beaujard
- Department of Anesthesiology and Reanimation, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Caroline Leroux
- Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France
| | - Pierre-Jean Souquet
- Department of Respiratory Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, F-69495 Pierre Benite, France
| | - Olivier Glehen
- Departement of General Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, F-69495 Pierre Benite, France
| | - François Tronc
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France
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Zhan P, Chen X, Wu XY, Hou ZB, Qian Q, Zhang Y, Zou J, Zhang YQ, Wan MY, Wang JD, Yu LK, Xie HY. Mutation analysis of the EGFR gene and its downstream signaling pathway in thymic carcinoma patients from a Chinese Han population. CLINICAL RESPIRATORY JOURNAL 2016; 12:601-607. [PMID: 27731926 DOI: 10.1111/crj.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/24/2016] [Accepted: 09/28/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION For thymic carcinoma (TC), which is a rare epithelial neoplasm of the thymus gland, median survival with current treatments is only 2 years. OBJECTIVES Mutations in the epidermal growth factor receptor (EGFR) gene or its downstream effectors may cause constitutive activation that leads to cell proliferation and metastases. Thus, molecular profiling is essential for selecting TC patients who may respond to anti-EGFR therapies. METHODS Genomic DNA was extracted from 61 histological samples of TCs. Real-time polymerase chain reaction (PCR) and direct sequencing were used to assess the mutations in the EGFR downstream pathway. RESULTS Gene mutations were identified in seven patients (11.5%). In particular, the identified mutations included four mutations in the KRAS gene, one mutation in the BRAF gene, one mutation in the PIK3CA gene, and only one mutation in the EGFR gene itself. Gene mutations in the EGFR downstream pathway were associated with shorter survival time and were observed to be an independent prognostic factor for TC patients. CONCLUSION Mutations in the EGFR downstream pathway are not rare in TCs. These data offer interesting possibilities for the future management of TCs, particularly in the era of new targeted therapies.
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Affiliation(s)
- Ping Zhan
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Xiao Chen
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao-Yuan Wu
- Central Laboratory, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Zhi-Bo Hou
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Qian Qian
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Yu Zhang
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Jue Zou
- Department of Pathology, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Yuan-Qing Zhang
- Department of Pathology, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Ming-Yue Wan
- Department of Pathology, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Jian-Dong Wang
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Li-Ke Yu
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Hai-Yan Xie
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
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Remon J, Lindsay C, Bluthgen M, Besse B. Thymic malignancies: Moving forward with new systemic treatments. Cancer Treat Rev 2016; 46:27-34. [DOI: 10.1016/j.ctrv.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 11/29/2022]
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Wei Y, Gu Z, Shen Y, Fu J, Tan L, Zhang P, Han Y, Chen C, Zhang R, Li Y, Chen K, Chen H, Liu Y, Cui Y, Wang Y, Pang L, Yu Z, Zhou X, Liu Y, Liu Y, Fang W. Preoperative induction therapy for locally advanced thymic tumors: a retrospective analysis using the ChART database. J Thorac Dis 2016; 8:665-72. [PMID: 27114833 DOI: 10.21037/jtd.2016.03.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To evaluate the role of preoperative induction therapy on prognosis of locally advanced thymic malignancies. METHODS Between 1994 and 2012, patients received preoperative induction therapies (IT group) in the Chinese Alliance for Research in Thymomas (ChART) database, were compared with those having surgery directly after preoperative evaluation (DS group). All tumors receiving induction therapies were locally advanced (clinically stage III-IV) before treatment and those turned out to be in pathological stage I and II were considered downstaged by induction. Clinical pathological characteristics were retrospectively analyzed. To more accurately study the effect of induction therapies, stage IV patients were then excluded. Only stage I-III tumors in the IT group and stage III cases in the DS group were selected for further comparison in a subgroup analysis. RESULTS Only 68 (4%) out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals (OS) of 49.7% and 19.9%. Seventeen patients (25%) were downstaged after induction. Significantly more thymomas were downstaged than thymic carcinomas (38.7% vs. 13.9%, P=0.02). Tumors downstaged after induction had significantly higher 5-year OS than those not downstaged (93.8% vs. 35.6%, P=0.013). For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group (P=0.000), although R0 resection were similar (76.4% vs. 73.3%, P=0.63). However, 5-year OS in tumors downstaged after induction (93.8%) was similar to those in the DS group (85.2%, P=0.438), both significantly higher than those not downstaged after induction (35.6%, P=0.000). CONCLUSIONS Preoperative neoadjuvant therapy have been used only occasionally in locally advanced thymic malignances. Effective induction therapy leading to tumor downstaging may be beneficial for potentially unresectable diseases, especially in patients with thymomas. These findings would be helpful to related studies in the future.
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Affiliation(s)
- Yucheng Wei
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Zhitao Gu
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yi Shen
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Jianhua Fu
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Liejie Tan
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Peng Zhang
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yongtao Han
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Chun Chen
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Renquan Zhang
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yin Li
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Keneng Chen
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Hezhong Chen
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yongyu Liu
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Youbing Cui
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yun Wang
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Liewen Pang
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Zhentao Yu
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Xinming Zhou
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yangchun Liu
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yuan Liu
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Wentao Fang
- 1 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
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Okuma Y, Hosomi Y, Miyamoto S, Shibuya M, Okamura T, Hishima T. Correlation between S-1 treatment outcome and expression of biomarkers for refractory thymic carcinoma. BMC Cancer 2016; 16:156. [PMID: 26915359 PMCID: PMC4766615 DOI: 10.1186/s12885-016-2159-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/10/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Thymic carcinoma is a rare cancer with minimal evidence of a survival benefit following chemotherapy. An oral fluoropyrimidine of S-1, however, is the recommended active cytotoxic chemotherapy agent for refractory thymic carcinoma based on a case series, whereas sunitinib or everolimus are recommended as molecular-targeted agents based on Phase II trials. We retrospectively investigated the efficacy of S-1 for refractory thymic carcinoma and performed a biomarker analysis. METHODS We assessed the clinicopathological variables of 14 consecutive patients who underwent S-1 for refractory thymic carcinoma and correlated the clinical outcomes with potential biomarkers using paraffin-embedded cancer tissues of eight patients in the cohort. RESULTS A total of 178 thymic malignancies were identified, of whom 14 patients included 12 cases of squamous cell carcinoma, one lymphoepithelioma-like carcinoma, and one undifferentiated carcinoma. Six patients exhibited a partial response (42.9 %: 95 % confidence interval [CI], 21.4-67.4) and the disease control rate was 85.7 % (60.0-96.0 %). After a median follow-up of 24.2 months, the median progression-free survival was 8.1 months (range, 2.6-12.2 months), and median overall survival was 30.0 months (range, 6.2-41.9 months). No significant correlation between biomarker expression and response was noted. However, thymidine synthase (TS)/dihydropyrimidine dehydrogenase and TS/orotate phosphoribosyltransferase were observed. CONCLUSIONS S-1 for refractory thymic carcinoma offered clinical activity and achieved an 85 % disease control rate. Although the biomarkers did not correlate with clinical outcome, the study results showed efficacy of S-1 as a cytotoxic chemotherapy for refractory thymic carcinoma, which warrants future investigation.
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Affiliation(s)
- Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
- Division of Oncology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato, Tokyo, Japan.
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
| | - Shingo Miyamoto
- Department of Clinical Oncology, Japan Red Cross Medical Center, Shibuya, Tokyo, Japan.
| | - Masahiko Shibuya
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
| | - Tatsuru Okamura
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan.
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Gemcitabine in patients previously treated with platinum-containing chemotherapy for refractory thymic carcinoma: radiographic assessment using the RECIST criteria and the ITMIG recommendations. Int J Clin Oncol 2015; 21:531-8. [PMID: 26646221 DOI: 10.1007/s10147-015-0926-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The key drugs for chemotherapy of thymic carcinoma are gradually being revealed in phase II and conventional retrospective studies. Gemcitabine is regarded as one of these key drugs according to the findings of clinical trials in which it was combined with capecitabine. However, the activity of single-agent gemcitabine concerning refractory thymic carcinoma remains unclear. PATIENTS AND METHODS We conducted a retrospective review of the medical records of refractory thymic carcinoma patients previously treated with platinum-containing chemotherapy between 1980 and 2014. RESULTS Of all 11 patients in this study, the objective response rate regarding gemcitabine was 36.4 % [95 % confidence interval (CI) 15.2-64.6] using the RECIST criteria and the response criteria proposed by the ITMIG. The median progression-free survival time was 4.3 months (95 % CI 0.7-11.0). The survival time from the start of gemcitabine treatment was 28.5 months (95 % CI 5.5-47.8), and from the start of first-line chemotherapy was 46.5 months (95 % CI 7.3-47.8). CONCLUSIONS Gemcitabine achieved a moderate response and has the potential to be used as a key drug for thymic carcinoma. Some patients treated with gemcitabine demonstrated prolonged cancer control even in later lines of chemotherapy.
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Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v40-55. [PMID: 26314779 DOI: 10.1093/annonc/mdv277] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- N Girard
- Department of Respiratory Medicine, Expert Centre for Thymic Malignancies, Reference Centre for Orphan Pulmonary Diseases, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - E Ruffini
- Department of Thoracic Surgery, University of Torino, Turin, Italy
| | - A Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Faivre-Finn
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - S Peters
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Serpico D, Trama A, Haspinger ER, Agustoni F, Botta L, Berardi R, Palmieri G, Zucali P, Gallucci R, Broggini M, Gatta G, Pastorino U, Pelosi G, de Braud F, Garassino MC. Available evidence and new biological perspectives on medical treatment of advanced thymic epithelial tumors. Ann Oncol 2014; 26:838-847. [PMID: 25411417 DOI: 10.1093/annonc/mdu527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/27/2014] [Indexed: 12/14/2022] Open
Abstract
Thymic epithelial tumors (TETs) are rare primary mediastinal tumors arising from thymic epithelium. Their rarity and complexity hinder investigations of their causes and therapy development. Here, we summarize the existing knowledge regarding medical treatment of these tumors, and thoroughly review the known genetic aberrations associated with TETs and the present status of potential biological treatments. Epidermal growth factor receptor (EGFR), stem-cell factor receptor, insulin-like growth factor-1 receptor (IGF1R), and vascular endothelial growth factors (VEGF-A, VEGF-B, and VEGF-2) are overexpressed in TETs. EGFR overexpression in TETs is associated with higher stage, and IGF1R overexpression has poor prognostic value. Data indicate that anti-IGF1R monoclonal antibodies, and inhibitors of angiogenesis, somatostatin receptors, histone deacetylase, mammalian target of rapamycin, and cyclin-dependent kinases may be active against TETs. Continued investigations in this field could lead to advancement of targeted and biological therapies for TETs.
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Affiliation(s)
- D Serpico
- Thoracic Oncology Unit, Department of Medical Oncology
| | - A Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - E R Haspinger
- Thoracic Oncology Unit, Department of Medical Oncology
| | - F Agustoni
- Thoracic Oncology Unit, Department of Medical Oncology
| | - L Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Berardi
- Department of Medical Oncology, Universita Politecnica delle Marche, Ancona
| | - G Palmieri
- Department of Molecular and Clinical Endocrinology and Oncology, 'Federico II', University, Naples
| | - P Zucali
- Department of Oncology and Hematology, Humanitas Cancer Center, Rozzano
| | - R Gallucci
- Thoracic Oncology Unit, Department of Medical Oncology
| | - M Broggini
- Laboratory of Molecular Pharmacology, IRCCS 'Mario Negri', Milan
| | - G Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | - F de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M C Garassino
- Thoracic Oncology Unit, Department of Medical Oncology.
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Response to cytotoxic chemotherapy in patients previously treated with palliative-intent chemotherapy for advanced thymic carcinoma. Clin Lung Cancer 2014; 16:221-7. [PMID: 25468802 DOI: 10.1016/j.cllc.2014.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinical efficacy of second- and later-line chemotherapy for patients with thymic carcinoma previously treated with chemotherapy remains uncertain; limited data are available about this carcinoma because of its rarity. The aim of this study was to investigate effective chemotherapy for patients with thymic carcinoma previously treated with chemotherapy using a retrospective analysis of responses and times to event. PATIENTS AND METHODS We conducted a retrospective review of the medical records of 23 advanced thymic carcinoma patients previously treated with palliative-intent chemotherapy between 1980 and 2014 in our institution. Clinical demographic characteristics, agents, response, and time to treatment failure for each treatment line and overall survival were reviewed. Factors expected to be associated with survival rates were analyzed. Differences in survival were assessed using Kaplan-Meier analysis and univariate and multivariate Cox proportional hazards regression analyses. RESULTS The study included 13 men (56.5%) and 10 women (43.5%). The median age at diagnosis was 58.5 years. The most common histological subtypes were squamous cell carcinoma (16 patients [69.6%]), followed by neuroendocrine carcinoma (4 patients [17.4%]). The objective response rates of first-, second-, third-, and fourth-line chemotherapy were 60.9%, 39.1%, 23.1%, and 25.0%, respectively. The median survival time was 18.8 months (95% confidence interval, 7.5-40.9 months). Uni- and multivariate analyses of all assessed variables failed to identify any statistically significant indicators of overall survival. CONCLUSION Patients with thymic carcinoma previously treated with palliative-intent chemotherapy might respond to second- or later-lines of cytotoxic chemotherapy.
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[Retrospective analysis of 50 thymic epithelial tumors in Rennes university hospital]. Rev Mal Respir 2014; 31:591-600. [PMID: 25239580 DOI: 10.1016/j.rmr.2013.09.015] [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: 05/23/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Thymic epithelial tumors (TET), including thymomas and thymic carcinomas, are rare and characterized by very different evolutionary patterns depending on histology and invasion stage. The therapeutic management is not well defined but is a subject of increasing interest. The descriptive and analytic objectives of this retrospective monocentric study were to analyze the clinical characteristics of patients with TET, and to assess the management of these tumors in our centre. METHODS Adult patients with TET managed in the Rennes university hospital in the period 2000-2011 were selected via the pathology department. Their clinical and pathological features and survival were analyzed retrospectively. RESULTS Fifty TET were retrieved (46 thymomas and 4 thymic carcinomas). Their clinical and histological features and their invasion stages were concordant with published studies. Their diagnostic and therapeutic managements were also in accordance with current guidelines. In univariate analysis, myasthenia and surgery were associated with better survival rates. CONCLUSION Management of TET in Rennes university hospital is in accordance with guidelines.
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31
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Thymoma patients treated in a phase I clinic at MD Anderson Cancer Center: responses to mTOR inhibitors and molecular analyses. Oncotarget 2014; 4:890-8. [PMID: 23765114 PMCID: PMC3757246 DOI: 10.18632/oncotarget.1015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Thymomas and thymic carcinoma are rare tumors with no approved therapies. Our purpose was to analyze the molecular features and outcomes of patients referred to the Clinical Center for Targeted Therapy (Phase I Clinic). METHODS We retrospectively reviewed the medical records of consecutive referred patients with advanced/metastatic thymoma or thymic carcinoma RESULTS Twenty-one patients were identified (median age 52 years; 10 women; median number of prior systemic therapies = 2). Six of 10 patients (60%) treated with mTOR inhibitor combination regimens achieved stable disease (SD) ≥12 months or a partial response (PR). For patients treated on mTOR inhibitor regimens (N = 10), median time to treatment failure (TTF) was 11.6 months versus 2.3 months on last conventional regimen prior to referral (p=0.024). Molecular analyses (performed by next generation sequencing in seven patients and single polymerase chain reaction (PCR)-based assays in an additional six patients) showed diverse actionable mutations: PIK3CA (1 of 12 tested; 8%); EGFR (1 of 13; 8%); RET (1 of 7; 14%); and AKT1 (1 of 7; 14%). Of two patients with PIK3CA or AKT1 mutations, one was treated with an mTOR inhibitor-based regimen and achieved 26% regression with a TTF of 17 months. CONCLUSION Patients with advanced/metastatic thymoma or thymic carcinoma demonstrated prolonged TTF on mTOR inhibitor-based therapy as compared to prior conventional treatment. Heterogeneity in actionable molecular aberrations was observed, suggesting that multi-assay molecular profiling and individualizing treatment merits investigation.
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32
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Leduc C, Besse B. Tumeurs épithéliales thymiques : aspects diagnostiques et thérapeutiques. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fonseca AL, Ozgediz DE, Christison-Lagay ER, Detterbeck FC, Caty MG. Pediatric thymomas: report of two cases and comprehensive review of the literature. Pediatr Surg Int 2014; 30:275-86. [PMID: 24322668 DOI: 10.1007/s00383-013-3438-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Thymomas are rare pediatric malignancies with indolent behavior. There are fewer than 50 reported cases and no comprehensive review. We sought to evaluate our recent experience with pediatric thymomas, and comprehensively review the extant literature. METHODS A systematic search of the PubMed database was performed using keywords: "thymoma", "pediatric", "juvenile", "childhood", and "child". Additional studies were identified by a manual search of the reference list. RESULTS We report two patients with thymomas. We identified 22 case reports or series that described 48 patients; 62 % were male, 15 % presented with myasthenia gravis. Fifty percent were Masaoka Stage I, 15 % were Stage II, 13 % were Stage III, and 23 % were Stage IV. Four patients with early stage (I or II) disease were treated with adjuvant therapies in addition to surgical excision, while five patients with late stage (III or IV) disease treated with surgical excision alone. Of studies reporting at least 2-year follow-up, survival was 71 %. CONCLUSION Pediatric thymomas are rare tumors with a slight male predominance. Wide variations were observed in the treatment of thymomas across all stages. Our review indicates a need for large database and multi-institutional studies to clearly elucidate clinical course, prognostic factors and outcome.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Pediatric Surgery, Yale School of Medicine, FMB 107, 333 Cedar Street, New Haven, CT, 06511, USA,
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Huang B, Belharazem D, Li L, Kneitz S, Schnabel PA, Rieker RJ, Körner D, Nix W, Schalke B, Müller-Hermelink HK, Ott G, Rosenwald A, Ströbel P, Marx A. Anti-Apoptotic Signature in Thymic Squamous Cell Carcinomas - Functional Relevance of Anti-Apoptotic BIRC3 Expression in the Thymic Carcinoma Cell Line 1889c. Front Oncol 2013; 3:316. [PMID: 24427739 PMCID: PMC3876280 DOI: 10.3389/fonc.2013.00316] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 12/24/2022] Open
Abstract
The molecular pathogenesis of thymomas and thymic carcinomas (TCs) is poorly understood and results of adjuvant therapy are unsatisfactory in case of metastatic disease and tumor recurrence. For these clinical settings, novel therapeutic strategies are urgently needed. Recently, limited sequencing efforts revealed that a broad spectrum of genes that play key roles in various common cancers are rarely affected in thymomas and TCs, suggesting that other oncogenic principles might be important. This made us re-analyze historic expression data obtained in a spectrum of thymomas and thymic squamous cell carcinomas (TSCCs) with a custom-made cDNA microarray. By cluster analysis, different anti-apoptotic signatures were detected in type B3 thymoma and TSCC, including overexpression of BIRC3 in TSCCs. This was confirmed by qRT-PCR in the original and an independent validation set of tumors. In contrast to several other cancer cell lines, the BIRC3-positive TSCC cell line, 1889c showed spontaneous apoptosis after BIRC3 knock-down. Targeting apoptosis genes is worth testing as therapeutic principle in TSCC.
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Affiliation(s)
- Bei Huang
- Pathologisches Institut der Universität Würzburg , Würzburg , Germany
| | - Djeda Belharazem
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany
| | - Li Li
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany ; Pathologisches Institut der Universitätsmedizin Göttingen , Göttingen , Germany
| | - Susanne Kneitz
- Pathologisches Institut der Universität Würzburg , Würzburg , Germany
| | | | - Ralf J Rieker
- Pathologisches Institut, Universität Heidelberg , Heidelberg , Germany
| | - Daniel Körner
- Abteilung Thoraxchirurgie, Thoraxklinik Rohrbach, Universität Heidelberg , Heidelberg , Germany
| | - Wilfred Nix
- Neurologische Universitätsklinik Mainz , Mainz , Germany
| | - Berthold Schalke
- Neurologische Universitätsklink Regensburg , Regensburg , Germany
| | | | - German Ott
- Pathologisches Institut, Robert-Bosch-Krankenhaus , Stuttgart , Germany
| | - Andreas Rosenwald
- Pathologisches Institut der Universität Würzburg , Würzburg , Germany
| | - Philipp Ströbel
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany ; Pathologisches Institut der Universitätsmedizin Göttingen , Göttingen , Germany
| | - Alexander Marx
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany
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Berardi R, De Lisa M, Pagliaretta S, Onofri A, Morgese F, Savini A, Ballatore Z, Caramanti M, Santoni M, Mazzanti P, Cascinu S. Thymic neoplasms: an update on the use of chemotherapy and new targeted therapies. A literature review. Cancer Treat Rev 2013; 40:495-506. [PMID: 24355362 DOI: 10.1016/j.ctrv.2013.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/10/2013] [Accepted: 11/12/2013] [Indexed: 12/14/2022]
Abstract
Thymic malignancies represent a wide range of clinical, histological and molecular entities, with probably considerable heterogeneity even among tumors of the same histotype. Systemic chemotherapy with cisplatin-based regimens continues to represent the standard of care in metastatic or inoperable refractory/recurrent diseases and ADOC regimen (including cisplatin, doxorubicin, vincristine and cyclophosphamide) demonstrated the longer overall response rate and median survival in the first line setting, although no randomized trial is available; and there is still a lack of standard treatment after first-line failure. To date research efforts are focused on translational studies on molecular pathways involved in thymic tumors carcinogenesis, aimed to better understand and predict the efficacy of chemotherapy and targeted therapy. Recent molecular characterization includes identification of a number of oncogenes, tumor suppressor genes, chromosomal aberrations, angiogenic factors, and tumor invasion factors involved in cellular survival and proliferation and in tumor growth. The use of biologic drugs is currently not recommended in a routine practice because there are limited data on their therapeutic role in thymic epitelial tumors. Because of the lack of data from adequate-sized, prospective trials are required for validation and the enrolment of patients with advanced disease into available clinical trials has to be encouraged.
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Affiliation(s)
- Rossana Berardi
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy.
| | - Mariagrazia De Lisa
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Azzurra Onofri
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesca Morgese
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Agnese Savini
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Zelmira Ballatore
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Miriam Caramanti
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Paola Mazzanti
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Stefano Cascinu
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
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Rashid OM, Cassano AD, Takabe K. Thymic neoplasm: a rare disease with a complex clinical presentation. J Thorac Dis 2013; 5:173-83. [PMID: 23585946 DOI: 10.3978/j.issn.2072-1439.2013.01.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/31/2013] [Indexed: 01/08/2023]
Abstract
Thymic neoplasms constitute a broad category of rare lesions with a wide spectrum of pathologic characteristics and clinical presentations which therefore require a high index of suspicion to diagnose. The natural history of the disease is seldom predictable, anywhere from an indolent to an aggressively malignant course. Although the classification and staging of these lesions are complex and controversial, complete radical surgical resection remains the gold standard of therapy. Radiation and chemotherapy are important elements of the multimodality approach to treating these patients and it is important for thoracic surgeons to work closely with their colleagues in other disciplines in the management of and future research endeavors in thymic neoplasm. In this review, we discuss the evaluation of the patient with an anterior mediastinal mass, the classification and staging of thymic neoplasms, the role of surgery, radiation and chemotherapy in treating this disease, as well as future directions in research for novel targeted therapies.
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Affiliation(s)
- Omar M Rashid
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia, USA
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