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Suzuki T, Hishida T, Suzuki S, Okubo Y, Masai K, Kaseda K, Asakura K, Emoto K, Asamura H. Clinicopathological predictors of postoperative long-term myasthenic status in resected thymoma with myasthenia gravis. Surg Today 2024; 54:787-794. [PMID: 38416144 DOI: 10.1007/s00595-024-02806-0] [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: 08/24/2023] [Accepted: 11/22/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE Surgical patients with thymoma and myasthenia gravis (MG) must have their MG status and oncological outcomes critically monitored. We aimed to identify clinicopathological predictors of the postoperative MG status. METHODS We conducted a retrospective review of 40 consecutive surgical patients with MG-related thymomas between 2002 and 2020. The quantitative myasthenia gravis score (QMGS) and Myasthenia Gravis Foundation of America post-intervention status (MGFA-PIS) were used to evaluate postoperative MG status. RESULTS All patients underwent extended total thymectomy. The most common WHO type was type B2 (32%), while 65% of patients had type B1-B3 and 35% had type A-AB thymomas. Eleven patients (28%) achieved controlled MG status in MGFA-PIS 6 months after surgery. This controlled status was observed more frequently in type A-AB than in B1-B3 (57% vs. 12%, p = 0.007). In a multivariate analysis, WHO type (A-AB or B1-B3) was an independent predictor of worsening episodes of MG based on the QMGS (Type B1-B3, hazard ratio: 3.23, 95% confidence interval: 1.12-9.25). At the last follow-up, 23 patients (58%) achieved controlled MG status. The 5-year overall survival rate of all patients was 93.7%. CONCLUSION The WHO type of thymoma is an informative predictor of postoperative MG status in patients with MG-related thymoma.
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Affiliation(s)
- Takahiro Suzuki
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yu Okubo
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kyohei Masai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Katsura Emoto
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Liu HY, Liu YF, Chang YC, Chiu HC, Yeh JH. Tumor size combined with staging systems for thymoma recurrence prediction: A 28-year experience. Surg Open Sci 2023; 16:157-161. [PMID: 38026826 PMCID: PMC10656211 DOI: 10.1016/j.sopen.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background We evaluated a new thymoma prognosis prediction model by combining current staging systems with tumor size. Methods The clinical records of thymoma patients in a single center between January 1993 and December 2021 were collected, and data on tumor size and stage and recurrence-free survival (RFS) was obtained. The prediction model was designed by combining staging with tumor size. Results During 28 years, 219 thymoma patients were enrolled. Twenty-seven patients had a median RFS of 8.2 years. Further, 153 patients were categorized into limited stage and 66 patients into advanced stage. The RFS was statistically different between these two groups (P = 0.022). The largest area under the curve (AUC) of receiver operating characteristic (ROC) was the dividing group as 5 cm (AUC: 0.804). Conclusions Combining tumor staging and size improves thymoma recurrence prediction. Patients with advanced stage and tumor size >5 cm may show a poor prognosis.
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Affiliation(s)
- Hao-Yun Liu
- Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Ya-Fang Liu
- Department of Research, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yi-Chen Chang
- Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hou-Chang Chiu
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Jiann-Horng Yeh
- Deputy Superintendent, Education and Research, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
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Al Shammari A, Saad A, Saif LT, Othman SA, Ghosheh MJ, Khdeir GM, Alashgar O, Abu-Rayya MA, Ahmed MH, AlKattan K, Saleh W. Clinicodemographic characteristics and prognostic role of myasthenia gravis in thymoma: Experience from a Saudi population. Ann Thorac Med 2023; 18:211-216. [PMID: 38058787 PMCID: PMC10697300 DOI: 10.4103/atm.atm_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/10/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES The objectives of the study were to determine the clinicodemographic characteristics and the prognostic role of myasthenia gravis (MG) in thymoma. METHODS The records of patients who underwent surgical resection of thymoma at King Faisal Specialist Hospital and Research Center in the past 23 years were reviewed. Seventy thymoma patients were finally included and were then categorized based on MG status into the MG group (39 patients) and the non-MG group (31 patients). Collected data included patients' demographic characteristics, tumor characteristics, and postoperative clinical outcomes. All analyses were conducted using SPSS. The comparison between both groups was tested using the Student t-test and Chi-square test for continuous and categorical variables, respectively. A P = 0.05 or less indicated statistical significance. RESULTS Patients' age ranged from 11 to 76 years, and female predominance was observed (55.7%). Compared to the non-MG group, no difference in patients' gender was observed (P = 0.058); however, MG patients had a younger age (39.30 vs. 48.77, P = 0.0095). No difference was noted between both groups based on the World Health Organization classification (P = 0.398), but MG patients tended to present with less-advanced tumors based on the TNM classification (P = 0.039) and lower stage based on the MASAOKA staging system (P = 0.017). No significant change in tumor size (P = 0.077), resectability (P = 0.507), and adjuvant therapy (P = 0.075) were observed. MG was not significantly associated with postoperative complications, morbidity, or mortality. However, it exhibited a prognostic protective role in terms of lower recurrence (2.56% vs. 35.48%, P = 0.0001) and longer survival duration (18.62 vs. 10.21 years, P < 0.001) as compared to non-MG patients. CONCLUSIONS MG occurrence in thymoma patients is more likely to occur at a younger age, higher TNM classification, and advanced MASAOKA stage. Although no significant association was noted between MG and complications and mortality, MG exhibited a protective role in thymoma by providing a lower recurrence rate and longer survival duration.
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Affiliation(s)
- Abdullah Al Shammari
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Aida Saad
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Lama Tareq Saif
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Safy A. Othman
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammad J. Ghosheh
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ghadir M. Khdeir
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omniyah Alashgar
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Khaled AlKattan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Thoracic Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Waleed Saleh
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Chen L, Li Y, Dong X, Tanzhu G, Chu X, Deng F, Li X, Zhang J, Long B, Jing D, Niu L, Peng H, Yang H, Zhou R. The Value of Postoperative Radiotherapy in Thymoma Patients with Myasthenia Gravis. Radiother Oncol 2023; 183:109644. [PMID: 36990391 DOI: 10.1016/j.radonc.2023.109644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Surgery is the first-line treatment for patients with thymoma associated with myasthenia gravis (MG); however, the value of radiotherapy among these patients remains debatable. Herein, we examined the impact of postoperative radiotherapy (PORT) on the efficacy and prognosis of patients with thymoma and MG. METHODS This retrospective cohort study included 126 patients with thymoma and MG who were enrolled in the Xiangya Hospital clinical database between 2011 and 2021. Demographic and clinical data were collected including sex, age, histologic subtype, Masaoka-Koga staging, primary tumor, lymph node, metastasis (TNM) staging, and therapeutic modalities. To evaluate short-term MG symptom improvement following PORT, we examined changes in the quantitative myasthenia gravis (QMG) scores within 3 months post-treatment. Minimal manifestation status (MMS) was the main endpoint for assessing long-term improvement in MG symptoms. Overall survival (OS) and disease-free survival (DFS) were primary endpoints to determine the impact of PORT on prognosis. RESULTS Effects of PORT on MG symptoms: QMG scores significantly differed between the non-PORT and PORT groups (χ2= 6.300, p = 0.012). The median time to achieve MMS was significantly shorter in the PORT group than that in the non-PORT group (2.0 years vs. 4.4 years; p = 0.031). Multivariate analysis revealed that radiotherapy was associated with a reduced time to achieve MMS (hazard ratio [HR] 1.971, 95% confidence interval [CI]:1.102-3.525, p = 0.022). Effects of PORT on DFS and OS: The 10-year OS rate of the entire cohort was 90.5%, whereas OS rates for the PORT and non-PORT groups were 94.4 and 85.1%, respectively. The 5-year DFS rates for the whole cohort, PORT group, and non-PORT group were 89.7, 95.8, and 81.5%, respectively. PORT was associated with improved DFS (HR 0.139, 95% CI: 0.037-0.533, p = 0.004). In the high-risk histologic subgroup (type B2, B3), patients who received PORT had better OS (p = 0.015) and DFS (p = 0.0053) than those who did not receive PORT. PORT was associated with improved DFS (HR 0.232, 95% CI: 0.069-0.782, p = 0.018) in Masaoka-Koga stages II, III, and IV disease. CONCLUSIONS Overall, our findings indicate that PORT positively impacts thymoma patients with MG, particularly those with a higher histologic subtype and Masaoka-Koga staging.
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Li Y, Tang Z, Zhu X, Tian H. Nomogram based on TNM stage to predict the prognosis of thymic epithelial tumors (TETs) patients undergoing extended thymectomy. Front Surg 2023; 10:1136166. [PMID: 36936648 PMCID: PMC10020510 DOI: 10.3389/fsurg.2023.1136166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Background Thymomas and thymic carcinoma are thymic epithelial tumors (TETs) of the anterior mediastinum. On the basis of The AJCC 8th Edition of TNM classification, no prognostic prediction model has been established for TETs patients undergoing surgical resection. In this study, based on data from Qilu Hospital of Shandong University, we identified prognostic factors and developed a nomogram to predict the prognosis for TETs patients undergoing extended thymectomy. Methods Patients with TETs who underwent thymectomy between 2010 and 2020 were consecutively enrolled. An analysis of multivariate Cox regression and stepwise regression using the Akaike information criterion (AIC) was conducted to identify prognostic factors, and a nomogram for TETs was derived from the results of these analyses. The model was validated internally with the Kaplan-Meier curves, ROC curves and calibration curves. Results There were 350 patients with TETs enrolled in the study, and they were divided into a training group (245,0.7) and a validation group (105,0.3). Age, histological type, tumor size, myasthenia gravis, and TNM stage were independent prognostic factors for CSS. The Kaplan-Meier curves showed a significant difference between high nomorisk group and low nomorisk group. A nomogram for CSS was formulated based on the independent prognostic factors and exhibited good discriminative ability as a means of predicting cause-specific mortality, as evidenced by the area under the ROC curves (AUCs) of 3-year, 5-year, and 10-year being 0.946, 0.949, and 0.937, respectively. The calibration curves further revealed excellent consistency between the predicted and actual mortality when using this nomogram. Conclusion There are several prognostic factors for TETs. Based on TNM stage and other prognostic factors, the nomogram accurately predicted the 3-, 5-, and 10-year mortality rates of patients with TETs in this study. The nomogram could be used to stratify risk and optimize therapy for individual patients.
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Miura K, Doi T, Tanaka Y, Hokka D, Jimbo N, Itoh T, Maniwa Y. Effect of myasthenia gravis on the surgical outcomes of patients with thymoma. Asian Cardiovasc Thorac Ann 2022; 30:924-930. [PMID: 35898168 DOI: 10.1177/02184923221116679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myasthenia gravis (MG) is the most common paraneoplastic syndrome in thymoma. However, the association between MG and postoperative outcomes is controversial. Therefore, we examined the effect of MG on the surgical outcomes of patients with thymoma. METHODS This study enrolled 145 consecutive patients with thymoma who underwent surgical resection at our institution between January 2000 and December 2020. The patients were classified into thymoma with MG (MG group) and without MG (non-MG group). Data about characteristics of patients, surgical outcomes, and prognostic factors were compared between the two groups. RESULTS Of 145 patients, 47 (32%) presented with MG and 98 (68%) did not. There was no significant difference in terms of the incidence of postoperative complications, overall survival (OS), and recurrence-free survival (RFS) between the two groups. The deaths were not caused by thymoma. Among the patients aged >60 years, the MG group had a lower survival rate than the non-MG group. In the univariate analysis, age ≥60 years was a poor prognostic factor for OS, whereas in the multivariate analysis, Masaoka stage III and IV classifications were poor prognostic factors for RFS. CONCLUSION The incidence of postoperative complications did not differ between patients with thymoma and without MG. In the MG group, age ≥60 years was a poor prognostic factor for OS. The postoperative follow-up of patients aged ≥60 years with thymoma with MG should focus on not only recurrence but also progression of diseases other than thymoma.
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Affiliation(s)
- Kenji Miura
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Naoe Jimbo
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Fang W, Filosso PL, Roden AC, Gu Z, Liu Y, Agzarian J, Shen RK, Ruffini E. Clinicopathological features and current treatment outcomes of neuroendocrine thymic tumours. Eur J Cardiothorac Surg 2021; 59:1004-1013. [PMID: 33367634 DOI: 10.1093/ejcts/ezaa453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Neuroendocrine thymic tumours (NETTs) are a distinct subgroup of rare malignancies. An international, multicentre retrospective analysis was used to study the clinicopathological features, current pattern of diagnosis, treatment and outcomes of patients with NETT. METHODS One hundred and forty-six NETT treated from 1989 to 2016 at 21 centres in China, Europe and North America were retrospectively collected and reclassified according to the World Health Organization histological type and International Thymic Malignancy Interest Group (ITMIG)/International Association for Studies in Lung Cancer (IASLC)/Union for International Cancer Control (UICC) staging. Clinicopathological features, diagnostic and therapeutic approaches and outcomes were investigated. Results in the earlier and latter halves of the study period were also compared. RESULTS The pretreatment work-up relied exclusively on computed tomography in 85.6% (125/146) of cases. Most patients had advanced disease, with 32.2% (47/146) having lymph node involvement. Higher-grade histological type was associated with more advanced disease (P < 0.05). Induction therapies and surgical procedures were used more often in the latter half of the study. However, the complete resection rate remained unchanged, being 71.5% (98/137) in the whole group. Complete resection was associated with significantly longer 5-year overall survival (77.2% vs 51.2%; P < 0.001) than incomplete or no resection. Significant survival differences were seen with the T, N and M categories of ITMIG/IASLC/UICC staging. Poorly differentiated carcinoma, ITMIG/IASLC/UICC stage IIIa or above and incomplete or no resection were independent risk factors for worse survival. No survival difference was noted between the earlier and the latter halves of the study (58.2% vs 71.9%; P = 0.299). CONCLUSIONS Current management similar to that for thymomas is unsatisfactory in providing disease control or long-term survival for patients with NETT. Specific diagnostic tools and novel therapeutic agents are needed to improve management outcomes of this disease.
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Affiliation(s)
- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, San Giovanni Battista Hospital, University of Torino, Torino, Italy
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Liu
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - John Agzarian
- Department of Thoracic Surgery, McMaster University Hospital, Hamilton, ON, Canada
| | - Robert K Shen
- Division of General Thoracic Surgery, Mayo Clinic Rochester, MN, USA
| | - Enrico Ruffini
- Department of Thoracic Surgery, San Giovanni Battista Hospital, University of Torino, Torino, Italy
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Tian W, Li X, Sun Y, Wang J, Jiang G, Tong H. Myasthenia gravis affects overall survival in patients with thymoma: an analysis of multicentre database using propensity score matching. Interact Cardiovasc Thorac Surg 2021; 33:250-257. [PMID: 34151968 DOI: 10.1093/icvts/ivab074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES About one-third of patients with thymoma have myasthenia gravis (MG). It remains controversial whether MG affects the prognosis of patients with thymoma. The aim of this study was to evaluate the effect of MG on the prognosis of patients with thymoma in a multicentre database. METHODS Patients with thymoma who underwent thymectomy were identified from 2 prospectively collected databases in 2 medical centres from 2010 to 2018. Kaplan-Meier curves and the log-rank test were used to assess overall survival and recurrence-free survival, and a Cox proportional hazards model was used to determine significant contributors to survival. Propensity score matching was performed to eliminate selection bias. RESULTS A total of 514 patients with thymoma were included in this study, of whom 320 patients were MG-free and 194 had MG. Patients with MG were younger (median age 50 vs 54 years, P = 0.001) and had smaller tumours (4.4 ± 2.0 vs 4.9 ± 2.3 cm, P = 0.020). Pathological analysis showed that type B tumours especially B2-B3 (B2 + B3 + mix B tumours, 55.2%) are more common in patients with MG, while type AB (37.2%) was the most common in patients without MG. A larger proportion of Masaoka III-IV stage tumour (25.7% vs 11.0%, P < 0.001) was seen in patients with thymoma and MG. Multivariable Cox regression analysis demonstrated that MG (hazard ratio [HR] = 3.729, 95% confidence interval [CI]: 1.398-9.947, P = 0.009), incomplete resection (HR = 5.441, 95% CI: 1.500-19.731, P = 0.010) and Masaoka stage III + IV (HR = 3.390, 95% CI: 1.196-9.612, P = 0.022) were negative prognostic factors of overall survival. Meanwhile, MG (HR =3.489, 95% CI: 1.403-8.680, P = 0.007) and Masaoka stage III + IV (HR = 6.582, 95% CI: 2.575-16.828, P < 0.001) were negative prognostic factors of recurrence-free survival. Propensity-matched analysis compared 148 patient pairs. K-M survival analysis demonstrated that MG was associated with worse overall survival and recurrence-free survival in propensity score-matched patients (log-rank, P = 0.034 and 0.017, respectively). CONCLUSIONS Thymoma patients with MG have smaller tumours and a higher percentage of late-stage tumours, which are mainly of WHO B types, especially B2-B3 types. In addition, MG is significantly associated with worse overall survival and recurrence-free survival in thymoma.
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Affiliation(s)
- Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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Hishida T, Asamura H, Yoshida K, Tsuboi M, Yokoi K, Toyooka S, Matsumura A, Tagawa T, Okumura M. Clinical features and prognostic impact of coexisting autoimmune disease other than myasthenia gravis in resected thymomas: analysis of a Japanese multi-institutional retrospective database. Eur J Cardiothorac Surg 2021; 59:641-649. [PMID: 33188679 DOI: 10.1093/ejcts/ezaa362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The purpose of this study was to clarify the prevalence, clinical features and survival of patients with thymoma and non-myasthenia gravis autoimmune disease (NMAD) using a nationwide cohort. METHODS The Japanese Association for Research on the Thymus nationwide database, which includes data from 32 institutions, was examined to clarify the prevalence and characteristics of NMAD associated with thymomas and elucidate the prognostic impact of NMAD for thymoma patients. RESULTS Among the 2423 patients with thymomas who were surgically treated between 1991 and 2010, 114 (4.7%) were identified with NMAD. The most frequently observed NMAD was pure red cell aplasia (PRCA) in 44 (1.8%), followed by hypogammaglobulinaemia (0.5%) and rheumatic arthritis (0.5%). Twenty-eight percent of patients with NMAD had concomitant myasthenia gravis. The presence of NMAD was not an independent prognostic factor for overall survival (OS) irrespective of the type of NMAD [PRCA+: hazard ratio (HR) 1.99, 95% confidence interval 0.74-4.47; PRCA- NMAD: HR 1.28, 0.30-3.56]; however, there were more cases with advanced age and disease of the thymoma amongst PRCA+ patients and these showed a worse OS than patients with PRCA- NMAD (P < 0.001), who had an OS similar to those without NMAD (P = 0.489). The 10-year OS rates in PRCA+, PRCA- NMAD and NMAD- groups were 45.5%, 97.4% and 89.5%, respectively. The main causes of death in PRCA+ patients were the progression of thymoma and other diseases including pneumonia. CONCLUSIONS Although the presence of NMAD itself did not significantly affect survival after surgery for thymoma, the type of NMAD was associated with different clinical features and prognosis. The NMAD+ thymomas should be separately categorized according to the presence or absence of PRCA.
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Affiliation(s)
- Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Yoshida
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Centre Hospital East, Chiba, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akihide Matsumura
- Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Centre, Osaka, Japan
| | - Tetsuzo Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, National Hospital Organization Osaka Toneyama Medical Centre, Osaka, Japan
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Blum TG, Misch D, Kollmeier J, Thiel S, Bauer TT. Autoimmune disorders and paraneoplastic syndromes in thymoma. J Thorac Dis 2020; 12:7571-7590. [PMID: 33447448 PMCID: PMC7797875 DOI: 10.21037/jtd-2019-thym-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Thymomas are counted among the rare tumour entities which are associated with autoimmune disorders (AIDs) and paraneoplastic syndromes (PNS) far more often than other malignancies. Through its complex immunological function in the context of the selection and maturation of T cells, the thymus is at the same time highly susceptible to disruptive factors caused by the development and growth of thymic tumours. These T cells, which are thought to develop to competent immune cells in the thymus, can instead adopt autoreactive behaviour due to the uncontrolled interplay of thymomas and become the trigger for AID or PNS affecting numerous organs and tissues within the human body. While myasthenia gravis is the most prevalent PNS in thymoma, numerous others have been described, be they related to neurological, cardiovascular, gastrointestinal, haematological, dermatological, endocrine or systemic disorders. This review article sheds light on the pathophysiology, epidemiology, specific clinical features and therapeutic options of the various forms as well as courses and outcomes of AID/PNS in association with thymomas. Whenever suitable and backed by the limited available evidence, the perspectives from both the thymoma and the affected organ/tissue will be highlighted. Specific issues addressed are the prognostic significance of thymectomy on myasthenia gravis and other thymoma-associated AID/PND and further the impact and safety of immunotherapies on AID and PND relating to thymomas.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Daniel Misch
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Jens Kollmeier
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Sebastian Thiel
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
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11
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Zhai Y, Wei Y, Hui Z, Gao Y, Luo Y, Zhou Z, Feng Q, Li Y. Myasthenia Gravis Is Not an Independent Prognostic Factor of Thymoma: Results of a Propensity Score Matching Trial of 470 Patients. Front Oncol 2020; 10:583489. [PMID: 33330060 PMCID: PMC7729010 DOI: 10.3389/fonc.2020.583489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022] Open
Abstract
Objective The association between the prognosis of thymoma and MG remains controversial. Differences in clinical characteristics and treatments between patients with and without MG may affect the findings of those studies. We designed this propensity score matching trial to investigate whether MG is an independent prognostic predictor in thymoma. Methods Patients with pathologically diagnosed thymoma and MG were enrolled in the MG group. Moreover, the propensity score matching method was used to select patients who were diagnosed with thymoma without MG from the database of two participating centers. Matched factors included sex, age, Masaoka stage, pathological subtypes, and treatments. Matched patients were enrolled in the non-MG group. Chi-squared test was used to compare the characteristics of the two groups. Overall survival, local-regional relapse-free survival, distant metastasis-free survival, progression-free survival, and cancer-specific survival were calculated from the diagnosis of thymoma using the Kaplan–Meier method. Results Between April 1992 and October 2018, 235 patients each were enrolled in the MG and non-MG groups (1:1 ratio). The median ages of patients in the MG and non-MG groups were 46 years old. The World Health Organization pathological subtypes were well balanced between the two groups (B2 + B3: MG vs. non-MG group, 63.0 vs. 63.4%, p = 0.924). Most patients in both groups had Masaoka stages I–III (MG vs. non-MG group, 90.2 vs. 91.5%, p = 0.631). R0 resections were performed in 86.8 and 90.2% of the MG and non-MG groups, respectively (p = 0.247). The median follow-up time of the two groups was 70.00 months (MG vs. non-MG group, 73.63 months vs. 68.00 months). Five-year overall survivals were 92.5 and 90.3%, 8-year overall survivals were 84.2 and 84.2%, and 10-year overall survivals were 80.2 and 81.4% (p = 0.632) in the MG and non-MG groups, respectively. No differences were found in the progression-free survival, distant metastasis-free survival, and local-regional relapse-free survival between the two groups. Conclusion MG is not an independent or direct prognostic factor of thymoma, although it might be helpful in diagnosis thymoma at an early stage, leading indirectly to better prognosis.
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Affiliation(s)
- Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong Wei
- Department of Radiation Oncology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China.,Graduate School, Hebei North University, Zhangjiakou, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuemin Li
- Department of Radiation Oncology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
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12
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Dharanikota A, Arjunan R, Chowdappa R, Althaf S. Survival Outcomes in Patients with Thymoma after Thymectomy in an Indian Scenario. Indian J Surg Oncol 2020; 11:785-790. [PMID: 33299290 DOI: 10.1007/s13193-020-01258-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022] Open
Abstract
Thymomas are relatively slow growing with late presentation. Because of rarity and underreporting in India, there is an unmet need for evaluating the patient characteristics and assessing the factors affecting survival for standardizing the ideal modality of treatment in Indian population. A retrospective analysis of 96 patients with thymoma was done between 1998 and 2018. Patient characteristics, histopathological characteristics, operative outcomes, local recurrences, and survival outcomes were recorded. Survival analysis was done using Kaplan-Meier method, and statistical data were analyzed using SPSS version 25 (IBM). The incidence of thymoma was relatively high in 6th decade with no sex predilection. Common presenting symptoms were cough and dyspnea. Myasthenia gravis was noted in 30.2%, which resolved after thymectomy in 65.5% of patients. Most patients presented with Masaoka stages I and II, and predominant WHO histological types were B1 and AB. Complete resection was done in 69.8% cases, and local recurrence was noted in 15.6%. Median sternotomy was the most frequently used approach for thymectomy. The 5-year overall survival was 76%, with an excellent 5-year survival of 95% and 86% in stages I and II patients. Masaoka stage, WHO histologic type, completeness of surgery, and local recurrence did affect the survival significantly. Masaoka stages III and IV, histological type B3, incomplete resection during surgery, and presence of local recurrence did independently predict a worse overall survival.
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Affiliation(s)
- Anvesh Dharanikota
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
| | - Ramachandra Chowdappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
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13
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Tian W, Sun Y, Wu Q, Jiao P, Ma C, Yu H, Huang C, Tong H. Surgical outcomes of 215 patients with thymic epithelial tumors: A single-center experience. Thorac Cancer 2020; 11:1840-1847. [PMID: 32384230 PMCID: PMC7327686 DOI: 10.1111/1759-7714.13464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives To evaluate the oncological prognosis and neurological outcomes for patients with thymic epithelial tumors (TETs) after thymectomy. Methods Consecutive patients with TETs who underwent thymectomy at Beijing Hospital from January 2011 to December 2018 were retrospectively enrolled into the study. Clinical, pathological, and perioperative data was collected. Patients were followed‐up by telephone interview and outpatient records. Statistical analyses were performed using SPSS version 19.0. Results A total of 215 patients (115 men and 100 women) were included in this study of which 133 patients (61.9%) had TETs associated with myasthenia gravis (MG), and 82 patients (38.1%) had thymic tumors without MG. A total of 194 (90.2%) patients were successfully followed‐up. The median follow‐up period was 42 months. The five‐year overall survival (OS) rate was 88.6%. MG was the first cause of death for patients with MG (6/10). Prognosis in MG patients was similar to those without MG. Multivariate Cox regression analysis demonstrated that TNM stage III + IV was an independent risk factor for OS. Incomplete resection and younger age were risk factors for tumor recurrence. For patients with MG, the cumulative complete stable remission (CSR) rate increased with the postoperative follow‐up period, and the five‐year CSR rate was 44.7%. Univariate Cox analysis indicated that age, preoperative MG duration and preoperative medication might correlate with CSR. Multivariate Cox analysis only indicated older age as a negative factor of achieving CSR. Conclusions MG had little influence on OS and tumor recurrence of thymic tumors. The new TNM staging system was an independent prognostic factor. Incomplete resection and younger age were risk factors for tumor recurrence. Older age was a negative factor of achieving CSR for thymoma patients with MG after extended thymectomy. Key points
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Affiliation(s)
- Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanbo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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14
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Tian W, Li X, Tong H, Weng W, Yang F, Jiang G, Wang J. Surgical effect and prognostic factors of myasthenia gravis with thymomas. Thorac Cancer 2020; 11:1288-1296. [PMID: 32189468 PMCID: PMC7180567 DOI: 10.1111/1759-7714.13396] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background To evaluate the surgical effect and prognostic factors of extended thymectomy for myasthenia gravis (MG) patients with thymomas. Methods Patients with MG with thymomas who underwent extended thymectomy at Peking University People's Hospital and Beijing Hospital between January 2010 and December 2018 were retrospectively enrolled. Patients were followed up by telephone or outpatient record review . Statistical analyses were performed using SPSS version 19.0. Results A total of 194 patients were included in this study. According to the Osserman classification, there were 56 type I, 52 type IIa, 67 type IIb, 14 type III, and five type IV. Video‐assisted thoracoscopic surgery (VATS) thymectomies were performed in 137 patients, and transthymectomies in 57 patients. The average operation time was 136.6 ± 46.5 minutes, average blood loss was 129.3 ± 287.4 mL, and average postoperative stay was 8.3 ± 7.4 days. A total of 170 patients (87.6%) were successfully followed up. The median follow‐up period was 45 months, and the five‐year overall survival (OS) rate was 81.9%. Cox regression analysis demonstrated that age, Masaoka stage, and recurrence were prognostic factors of OS. Tumor recurrence tended to occur in patients with Masaoka stage III + IV, and age was a protective factor. A total of 20 patients experienced postoperative myasthenic crisis (POMC). Univariate analysis indicated that presence of bulbar symptoms, surgical procedure, and blood loss were risk factors for POMC, but multivariate analysis only indicated the presence of bulbar symptoms as an independent risk factor. A total of 162 patients were evaluated for post intervention MG status. A total of 55 patients achieved complete stable remission; the overall effective rate was 84.5%. Older patients and those with B‐type thymomas had a lower probability of achieving complete stable remission. Efficacy was similar in patients who underwent VATS or the transsternal procedure. Conclusions Age, Masaoka stage, and recurrence were prognostic factors of OS. Presence of bulbar symptoms was an independent risk factor for POMC. Age and World Health Organization classification influence the postoperative effect of MG. Key points Significant findings of the study Age, Masaoka stage, and recurrence were prognostic factors of OS for MG with thymomas. The presence of bulbar symptoms was an independent risk factor for POMC. Age and World Health Organization classification may influence the postoperative effect of MG. What this study adds Our study had a relatively large sample size of MG patients with thymomas only. We emphasize the analysis of the postoperative effect of MG and overall survival for these patients, which is a complement to previous studies.
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Affiliation(s)
- Wenxin Tian
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenhan Weng
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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15
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Prognostic factors after treatment for iterative thymoma recurrences: A multicentric experience. Lung Cancer 2019; 138:27-34. [DOI: 10.1016/j.lungcan.2019.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/14/2019] [Accepted: 09/28/2019] [Indexed: 11/23/2022]
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16
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Cacho-Díaz B, Salmerón-Moreno K, Lorenzana-Mendoza NA, Texcocano J, Arrieta O. Myasthenia gravis as a prognostic marker in patients with thymoma. J Thorac Dis 2018; 10:2842-2848. [PMID: 29997948 DOI: 10.21037/jtd.2018.04.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Thymoma is the most common mediastinal tumor, representing <1% of all cancers. It is usually associated with paraneoplastic disorders, mainly myasthenia gravis (MG). The aim of the present study was to describe patients with thymoma and the differences between those with MG and those without it. Methods A retrospective 10-year database of the patients with thymoma treated at a single cancer referral hospital (National Institute of Cancer, Mexico City), was analyzed. Results Sixty-four files from patients with thymoma were analyzed, 18 of them had MG. The symptoms that occurred most frequently in patients with MG were ptosis, diplopia, appendicular weakness, dysphonia and dysphagia. The most frequent Myasthenia Gravis Foundation of America (MGFA) stage was IIIb followed by stage I. Almost all the patients with MG had positive Acetylcholine Receptor antibodies (P<0.001), with not specified antibodies in four patients. The median overall survival showed a trend to be higher among the patients with MG, but there were no significant differences. Conclusions In patients with thymoma MG manifests with different clinical and autoimmune traits, but not survival differences. A larger multi-centric study should be encouraged to evaluate the prognostic implications of having MG in patients with thymoma.
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Affiliation(s)
| | | | | | - Julia Texcocano
- Neuroscience Unit, Instituto Nacional de Cancerología, México City, México
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
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17
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Mou H, Liao Q, Hou X, Chen T, Zhu Y. Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988-2013). Int J Radiat Biol 2018; 94:495-502. [PMID: 29553917 DOI: 10.1080/09553002.2018.1454618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The surgery with adjuvant radiation for the treatment of thymoma is still debated. The aim of this study was to examine the efficacy of postoperative radiotherapy (PORT) in a population-based registry of patients with thymoma. MATERIALS AND METHODS We conducted a retrospective analysis of the Surveillance, Epidemiology, and End Results database to compare the outcomes of patients with thymoma who received surgery with or without PORT. RESULTS Among the 2234 patients of this study, the surgery with PORT group had a longer mean overall survival (OS) and cancer-specific survival (CSS) than did the surgery without PORT group (OS: 172.3 vs. 155.3 months, p = .005; CSS: 247.3 vs. 241.8 months, p = .04). PORT significantly improved OS and CSS of patients with stage III/IV disease, but decreased CSS for those with stage I/IIA disease. Although the surgery with PORT group had a higher rate of secondary cancers, the between-group difference in the disease-free interval was not significant. CONCLUSIONS PORT provides a significant benefit for patients with thymoma, particularly those with advanced disease. However, it also increases the risk of a second malignancy. We suggest that treatment guidelines should adopt a more positive stance on the use of PORT.
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Affiliation(s)
- Haibo Mou
- a Department of Oncology , Zhejiang University International Hospital (Shulan Hospital) , Hangzhou , China
| | - Qin Liao
- a Department of Oncology , Zhejiang University International Hospital (Shulan Hospital) , Hangzhou , China
| | - Xuehua Hou
- a Department of Oncology , Zhejiang University International Hospital (Shulan Hospital) , Hangzhou , China
| | - Te Chen
- a Department of Oncology , Zhejiang University International Hospital (Shulan Hospital) , Hangzhou , China
| | - Yuping Zhu
- a Department of Oncology , Zhejiang University International Hospital (Shulan Hospital) , Hangzhou , China
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18
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Padda SK, Yao X, Antonicelli A, Riess JW, Shang Y, Shrager JB, Korst R, Detterbeck F, Huang J, Burt BM, Wakelee HA, Badve SS. Paraneoplastic Syndromes and Thymic Malignancies: An Examination of the International Thymic Malignancy Interest Group Retrospective Database. J Thorac Oncol 2018; 13:436-446. [PMID: 29191778 PMCID: PMC5983900 DOI: 10.1016/j.jtho.2017.11.118] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) are associated with paraneoplastic/autoimmune (PN/AI) syndromes. Myasthenia gravis is the most common PN/AI syndrome associated with TETs. METHODS The International Thymic Malignancy Interest Group retrospective database was examined to determine (1) baseline and treatment characteristics associated with PN/AI syndromes and (2) the prognostic role of PN/AI syndromes for patients with TETs. The competing risks model was used to estimate cumulative incidence of recurrence (CIR) and the Kaplan-Meier method was used to calculate overall survival (OS). A Cox proportional hazards model was used for multivariate analysis. RESULTS A total of 6670 patients with known PN/AI syndrome status from 1951 to 2012 were identified. PN/AI syndromes were associated with younger age, female sex, thymoma histologic type, earlier stage, and an increased rate of total thymectomy and complete resection status. There was a statistically significant lower CIR in the group with a PN/AI syndrome than in the group without a PN/AI syndrome (10-year CIR 17.3% versus 21.2%, respectively [p = 0.0003]). The OS was improved in the group with a PN/AI syndrome compared to the group without a PN/AI syndrome (median OS 21.6 years versus 17.0 years, respectively [hazard ratio = 0.63, 95% confidence interval: 0.54-0.74, p < 0.0001]). However, in the multivariate model for recurrence-free survival and OS, PN/AI syndrome was not an independent prognostic factor. DISCUSSION Previously, there have been mixed data regarding the prognostic role of PN/AI syndromes for patients with TETs. Here, using the largest data set in the world for TETs, PN/AI syndromes were associated with favorable features (i.e., earlier stage and complete resection status) but were not an independent prognostic factor for patients with TETs.
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Affiliation(s)
- Sukhmani K Padda
- Department of Medicine, Division of Oncology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, California.
| | - Xiaopan Yao
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Alberto Antonicelli
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan W Riess
- Department of Medicine, Division of Oncology, University of California Davis Cancer Center, Sacramento, California
| | - Yue Shang
- The MathWorks, Natick, Massachusetts
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, California
| | - Robert Korst
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, New York; Valley/Mount Sinai Comprehensive Cancer Care, Paramus, New Jersey
| | - Frank Detterbeck
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - James Huang
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bryan M Burt
- Department of Surgery, Division of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, California
| | - Sunil S Badve
- Department of Pathology, Indiana University, Indianapolis, Indiana
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19
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The effect of myasthenia gravis as a prognostic factor in thymoma treatment. North Clin Istanb 2017; 3:194-200. [PMID: 28275751 PMCID: PMC5336624 DOI: 10.14744/nci.2016.60352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE: Thymoma is a standard epithelial tumor. Though it is rare, it constitutes 50% of anterior mediastinal masses. Variety of immunological diseases may accompany thymoma; however, myasthenia gravis (MG) is the most frequently associated paraneoplastic syndrome. Most effective treatment for thymoma is complete surgical resection. In this study, impact of MG on prognosis of thymoma cases was examined. METHODS: Records of 61 patients who underwent surgery with diagnosis of thymoma between January 2003 and September 2016 were retrospectively reviewed. All cases were analyzed for data related to age, gender, complaint, localization of lesion, surgical procedure, histopathological diagnosis, stage, MG, and long-term follow-up results. RESULTS: Total of 58 cases were included in the study. Of those, 37 patients were male and 21 were female. Mean age was 48 years. While 24 cases of thymoma were accompanied by MG, 34 cases were not. Duration of follow-up ranged from 1 month to 155 months. CONCLUSION: It was found that in group with MG, 5-year survival rate was 87.5% while it was 82.4% in group without MG. Despite longer duration of survival in group of thymoma associated with MG, there was no significant statistical difference between groups (p=0.311).
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20
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Marino M, Salvitti T, Pescarmona E, Palmieri G. Thymic epithelial tumors in a worldwide perspective: lessons from observational studies. J Thorac Dis 2016; 8:1851-5. [PMID: 27621842 PMCID: PMC4999657 DOI: 10.21037/jtd.2016.06.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/17/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Tommaso Salvitti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovannella Palmieri
- Rare Tumors Reference Center, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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21
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Toker A, Ozkan B. Editorial on "Postoperative survival for patients with thymoma complicating myasthenia gravis-preliminary retrospective results of the ChART database". J Thorac Dis 2016; 8:1048-9. [PMID: 27293815 DOI: 10.21037/jtd.2016.04.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alper Toker
- Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Berker Ozkan
- Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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