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Chiappetta M, Lococo F, Sassorossi C, Moser B, Schil PV, Podobed A, Liberman M, Opitz I, Zisis C, Menghesha H, Furak J, Mendogni P, Ruffini E, Guerrera F, Venuta F, Voltolini L, Londero F, Casiraghi M, Bravio I, Voulaz E, Barmin V, Trancho FH, Billè A, Cafarotti S, Campanella A, Santoro G, Novoa NM, Margaritora S. Tumour dimension is a prognostic factor in thymic epithelial tumours: An update analysis from the ESTS thymic database: Tumour dimension in thymic tumours. Lung Cancer 2025; 203:108535. [PMID: 40220716 DOI: 10.1016/j.lungcan.2025.108535] [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: 01/14/2025] [Revised: 03/28/2025] [Accepted: 04/07/2025] [Indexed: 04/14/2025]
Abstract
OBJECTIVE The 9thTNM proposal for thymic epithelial tumours (TETs) introduced size as category in stage I, confirming tumour infiltration type as descriptor for the other stages. Aim of this study is to evaluate the role of tumour size in TETs considering different possible cut-offs also among different subgroups. MATERIAL AND METHODS Clinical and pathological data of patients from ESTS thymic database who underwent surgery for TETs from1/2000 to 12/2022 were reviewed and analysed. Patients clinical data, tumour characteristics, size and organs infiltration were collected and correlated to overall survival (OS), Disease free Survival (DFS) and Cancer specific Survival (CSS) using Kaplan Meier curves. The log-rank test was used to assess differences between subgroups. A multivariable model was built using Cox-regression analysis including clinical relevant variables resulting significant at univariable (p-value < 0.05). RESULTS The final analysis was conducted on 2146 patients. Most patients presented tumours size >5 cm(59 %)and without surrounding structures infiltrations (51.3 %). During FUP, a recurrence occurred in 235 (11%) patients, 199 (9.3%) died, 38 due to tumour progression. Multivariable confirmed as independent negative prognostic factors age (p < 0.001), carcinoma/NETT histology (p < 0.001),TETs size >5 cm (p < 0.001, HR 2.16; 95 %CI 1.32-3.50), and infiltration (p = 0.04) for OS; advanced TNM STAGE 9th edition (p < 0.001) and carcinoma/NETT (p = 0.001) for DFS; infiltration presence (p < 0.001) and carcinoma/NETT (p < 0.001) for CSS. Significant differences in OS, DFS and CSS were present considering size cut-off 5 cm (p < 0.001, p < 0.001 and p = 0.001, respectively), while using 3 cm cut-off only DFS (p < 0.001) and CSS (p = 0.001) resulted statistically significant. Significant differences in OS, DFS and CSS were present considering surrounding organ infiltration in TETs ≤ 5 cm (p = 0.004, p < 0.001 and p = 0.001) and in TETs > 5 cm (p = 0.024, p < 0.001 and p < 0.001). CONCLUSIONS Tumour size resulted a significant prognosticator in TETs, and its associations with infiltration permits to identify different prognostic groups.
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Affiliation(s)
- Marco Chiappetta
- UOC di Chirurgia Toracica Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy.
| | - Filippo Lococo
- UOC di Chirurgia Toracica Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carolina Sassorossi
- UOC di Chirurgia Toracica Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Bernhard Moser
- Head ESTS Thymic Working Group-Thoracic Surgery-Medical University of Vienna-Waehringer Guertel, Vienna, Austria
| | | | | | - Moishe Liberman
- Division of Thoracic Surgery, University of Montreal, Canada
| | - Isabelle Opitz
- Thoraxchirurgin und Leitende Ärztin am USZ Zurich, Zurich, Switzerland
| | - Charalambros Zisis
- Department of Thoracic Surgery, Chest disease Hospital "Sotiria" Athens, Greece
| | - Hruy Menghesha
- Medical University of Essen, Ruhrlandklinik, Dept. of Thoracic Surgery, Essen, Germany
| | - Jozsef Furak
- University of Szeged, Department of Surgery, Szeged, Hungary
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant - Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ruffini
- UOC Di Chirurgia Toracica, Ospedale le Molinette, Torino, Italy
| | | | - Federico Venuta
- University of Rome La Sapienza,Department of Thoracic Surgery, Rome, Italy
| | - Luca Voltolini
- AOU Careggi, SOD Chirurgia Toracica, Firenze, Firenze, Italy
| | - Francesco Londero
- Thoracic Surgery Unit - Cardiothoracic Department.Azienda Sanitaria Universitaria Friuli Centrale - Presidio Ospedaliero S Maria della Misericordia, Udine, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, European Institute of Oncology-IEO IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ivan Bravio
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Portugal
| | | | - Vitaly Barmin
- P.A. Herzen Moscow Oncology Research Institute, Moscow, Russia
| | | | - Andrea Billè
- Department of Clinical Oncology, Guys Cancer Centre, London, United Kingdom
| | | | - Annalisa Campanella
- General Surgery Unit, Fondazione Policlinico Universitario A.Gemelli-IRCCS, Roma, Italy
| | - Gloria Santoro
- General Surgery Unit, Fondazione Policlinico Universitario A.Gemelli-IRCCS, Roma, Italy
| | - Nuria Maria Novoa
- Thoracic Surgery and Lung Transplantation Department,Hospital Universitario Puerta de Hierro-Majadahonda, Spain
| | - Stefano Margaritora
- UOC di Chirurgia Toracica Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Pavese V, Carfì FM, Capelletto E, Tabbò F, Leo F, Passiglia F, Righi L, Novello S, Merlini A, Bironzo P. Therapeutic management of patients with advanced thymic malignancies: A review for clinicians. Lung Cancer 2025; 204:108554. [PMID: 40334289 DOI: 10.1016/j.lungcan.2025.108554] [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: 08/30/2024] [Revised: 03/21/2025] [Accepted: 04/21/2025] [Indexed: 05/09/2025]
Abstract
Thymic epithelial tumors (TETs) are a heterogeneous group of rare tumors that arise from thymic epithelial cells in the anterior mediastinum. They can be divided into three different histological subtypes: thymomas, thymic carcinomas (TC), and neuroendocrine carcinomas (TNET). TCs and TNETs are rarer but more aggressive entities with frequent distant metastasis. Thymomas occur in 90 % of cases in a localized/locally advanced stage, on the other hand about 70 % of TCs are locally advanced at the time of diagnosis. Surgery plays a primary role in the management of patients in whom complete resection is feasible. The benefit of post-operative radiotherapy (PORT) is still controversial, since it could be related to stage, histotype, and preoperative chemotherapy. If the tumor is unresectable at diagnosis, radiotherapy or concurrent chemoradiotherapy is the most commonly used approach. Cisplatin and anthracycline-based regimens are standard of care in patients with unresectable or metastatic thymomas, but, at the same time, regimens with carboplatin and paclitaxel are the most widely used especially in patients with contraindications to cisplatin/anthracyclines, due to better tolerance. Recently, the anti-VEGFR antibody Ramucirumab has shown promising activity in combination with carboplatin plus paclitaxel in previously untreated advanced TCs. Several clinical trials with chemotherapy combination, target therapy and immunotherapy are still ongoing to define the best therapeutic strategy in this disease, also for the second line treatment, for which in daily practice there is currently no standard of care for patients who went into progression to the first line.
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Affiliation(s)
- Valeria Pavese
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Cardinal Massaia Hospital, Corso Dante 202, Asti, Italy
| | - Federica Maria Carfì
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy
| | - Enrica Capelletto
- Division of Medical Oncology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy
| | - Fabrizio Tabbò
- Division of Medical Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Francesco Leo
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Division of Thoracic Surgery, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Division of Medical Oncology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy
| | - Luisella Righi
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Division of Pathology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Division of Medical Oncology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Division of Medical Oncology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Torino - AOU San Luigi Gonzaga, Regione Gonzole 10, Orbassano, Italy; Division of Medical Oncology, San Luigi Gonzaga University Hospital, Regione Gonzole 10, Orbassano, Italy.
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3
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Sarihan S, Metin AT, Bayram AS, Melek H. Thymic tumors: radiotherapy experience for single institute. Strahlenther Onkol 2025:10.1007/s00066-025-02395-y. [PMID: 40266316 DOI: 10.1007/s00066-025-02395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 03/16/2025] [Indexed: 04/24/2025]
Abstract
PURPOSE The aim is to evaluate treatment outcomes and prognostic factors in patients with thymic epithelial tumor (TET) treated with radiotherapy (RT). METHODS Sixty-four patients were treated between 2000 and 2023. The median age was 52 years (20-83), and 81% of underwent R0 resection. The stage (s) distribution for I, II, III, and IV were 5%, 61%, 26%, and 8% by Masaoka-Koga and 63%, 11%, 17%, and 9% by TNM, respectively. WHO types A/AB/B/C and thymic neuroendocrine tumors were seen in 5%, 22%, 64%, 6%, and 3% of patients, respectively. The median RT dose was 5040 cGy (1620-6596). Survival was calculated from the beginning of RT. RESULTS The median follow-up was 70 months (1.5-268). The median time to recurrence was 30 months (6.5-106), seen in 23% of patients. Mean overall (OS), progression-free survival (PFS) and 5‑year local control were 141, 138 months, and 82.4%, respectively. In univariate analysis, the presence of organ invasion and TNM stage were significant as new prognostic factors for survival (p < 0.05). In multivariate analysis, the high-risk group (B2/B3/C) and another surgical center (p < 0.05) for OS, and KPS ≤ 80, thymic carcinoma, and Masaoka-Koga sIII-IV (p < 0.05) for PFS were identified as unfavorable prognostic factors. CONCLUSION Recurrence in TET can occur over a longer period. In this study, 5‑year local control of 82.4% was achieved. The prognostic importance of KPS, histology, Masaoka-Koga stage, risk group, and surgical center was demonstrated. Advances in the diagnosis, staging, and treatment of TET will enable more personalized treatment.
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Affiliation(s)
- Sureyya Sarihan
- Faculty of Medicine, Department of Radiation Oncology, Bursa Uludag University, 16059, Bursa, Turkey.
| | - Aybuke Tugce Metin
- Faculty of Medicine, Department of Radiation Oncology, Bursa Uludag University, 16059, Bursa, Turkey
| | - Ahmet Sami Bayram
- Faculty of Medicine, Department of Thoracic Surgery, Bursa Uludag University, 16059, Bursa, Turkey
| | - Huseyin Melek
- Faculty of Medicine, Department of Thoracic Surgery, Bursa Uludag University, 16059, Bursa, Turkey
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Wang X, Huang P, Wang Z, Liu Y, Fan B, Dong W. Radiomics in thymic epithelial tumors: a scoping review of current status and advances. BMC Cancer 2025; 25:493. [PMID: 40098112 PMCID: PMC11916611 DOI: 10.1186/s12885-025-13909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 03/11/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND This scoping review aims to evaluate the current status and recent advances in the use of radiomics for the diagnosis, risk stratification, and staging of thymic epithelial tumors (TETs). The review also explores radiomics' potential in predicting the risk of myasthenia gravis (MG), an associated autoimmune condition in TETs patients. METHODS A comprehensive literature search was conducted using PubMed and Web of Science to identify studies published since 2012 on the application of radiomics in managing TETs. The studies were assessed for their methodologies, including imaging protocols, feature extraction techniques, and model performance metrics. The Radiomics Quality Score (RQS) was used to evaluate study quality. RESULTS A total of 23 studies, including 4701 patients, were analyzed. Radiomics-based models showed high accuracy in distinguishing TETs from other mediastinal masses, predicting risk subtypes, and improving the accuracy of TNM and Masaoka-Koga (MK) staging. Additionally, radiomics demonstrated potential in predicting the risk of MG in thymoma patients. However, all studies were retrospective, and only 6 studies included external validation, with an average RQS of 13.87, accounting for 38.52% of the maximum score. CONCLUSION Radiomics shows great potential in advancing the diagnosis, risk stratification, and staging of TETs. However, its clinical implementation requires overcoming challenges in standardization, validation, and interpretability. Future research should focus on multi-center prospective studies, external validation, and integrating multi-modal imaging and molecular biomarkers to improve risk assessment and treatment strategies.
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Affiliation(s)
- Xiaolian Wang
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Pei Huang
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Medical College of Nanchang University, Nanchang University, Nanchang, China
| | - Zonghuo Wang
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yangchun Liu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Wentao Dong
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
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5
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Yang Y, Cheng J, Cui C, Huang H, Cheng M, Wang J, Zuo M. Multi-dimensional interpretable deep learning-radiomics based on intra-tumoral and spatial habitat for preoperative prediction of thymic epithelial tumours risk categorisation. Acta Oncol 2025; 64:391-405. [PMID: 40079653 PMCID: PMC11971837 DOI: 10.2340/1651-226x.2025.42982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 02/26/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND AND PURPOSE This study aims to develop and compare combined models based on enhanced CT-based radiomics, multi-dimensional deep learning, clinical-conventional imaging and spatial habitat analysis to achieve accurate prediction of thymoma risk classification. MATERIALS AND METHODS 205 consecutive patients with thymoma confirmed by surgical pathology were recruited from three medical centers. Venous phase enhanced CT images were used to delineate the tumor, and radiomics, 2D and 3D deep learning models based on the whole tumor were established and feature extraction was performed. The tumors were divided into different sub-regions by K-means clustering method and the corresponding features were obtained. The clinical-conventional imaging data of the patients were collected and evaluated, and the univariate and multivariate analysis were used for screening. The above types of features were fused with each other to construct a variety of combined models. Quantitative indicators such as area under the receiver operating characteristic (ROC) curve (AUC) were calculated to evaluate the performance of the model. RESULTS The AUC of RDLCSM developed based on LightGBM classifier was 0.953 in the training cohort, 0.930 in the internal validation cohort, 0.924 and 0.903 in the two external validation cohorts, respectively. RDLCSM performs better than RDLM (AUC range: 0.831-0.890) and 2DLCSM (AUC range: 0.785-0.916) based on KNN. In addition, RDLCSM had the highest accuracy (0.818-0.882) and specificity (0.926-1.000). INTERPRETATION The RDLCSM, which combines whole-tumor radiomics, 2D and 3D deep learning, clinical-visual radiology, and subregional omics, can be used as a non-invasive tool to predict thymoma risk classification.
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Affiliation(s)
- Yuhua Yang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, China
| | - Jia Cheng
- Department of Radiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Can Cui
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, China
| | - Huijie Huang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, China
| | - Meiling Cheng
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, China
| | - Jiayi Wang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, China
| | - Minjing Zuo
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, China.
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Hashinokuchi A, Takamori S, Zhu J, Abe M, Ozono K, Takenaka T, Osoegawa A, Yoshizumi T, Komiya T. Prognostic Impact of Primary Tumor Size in Thymic Epithelial Tumor: An NCDB-Based Study. Ann Surg Oncol 2025; 32:1662-1669. [PMID: 39730963 DOI: 10.1245/s10434-024-16732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 12/05/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND Thymic epithelial tumor (TET) staging has been based on Masaoka-Koga systems or the 8th edition of the TNM classification, which do not use tumor size as a T descriptor. The 9th edition of the TNM classification incorporates tumor size; however, the study on which this classification is based included only 4.4% of patients from North America. This study investigated the prognostic impact of primary tumor size in TET patients in the US population. METHODS Using data from the National Cancer Database (NCDB), we analyzed patients with surgically resected TETs diagnosed in 2004-2020. Survival analysis was performed by using the Kaplan-Meier method and multivariate Cox regression analyses; propensity score matching (PSM) analyses were performed. Thymoma data from our facilities (n = 166) were used for validation. RESULTS Of 4,151 and 647 thymoma and thymic-carcinoma patients, respectively, we classified 1,618 and 268 patients into small-tumor (primary tumor size ≤ 5 cm) and large-tumor groups, respectively. Thymoma patients in the small-tumor group had a significantly longer overall survival (OS) than those in the large-tumor group (>5 cm) (median OS 193.2 vs. 161.4 months, respectively; log-rank P < 0.0001; hazard ratio 0.72; 95% confidence interval 0.64-0.82). After PSM, multivariate analysis showed that tumor size was an independent prognostic factor for OS (P < 0.0001). Validation cohort analysis supported these results. Tumor size did not have a significant impact on OS (P = 0.0994) in thymic-carcinoma patients. CONCLUSIONS Tumor size in thymoma, but not in thymic carcinoma, was an important prognostic factor in the U.S. POPULATION
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Affiliation(s)
- Asato Hashinokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Miyuki Abe
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Keigo Ozono
- Division of Cancer Therapy and Research, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Osoegawa
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takefumi Komiya
- Division of Hematology Oncology, Penn State College of Medicine, Hershey, PA, USA
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Hashinokuchi A, Takamori S, Takenaka T, Yoshizumi T, Komiya T. ASO Author Reflections: Impact of Primary Tumor Size in Thymic Epithelial Tumor. Ann Surg Oncol 2025; 32:1683-1684. [PMID: 39757339 DOI: 10.1245/s10434-024-16827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 12/16/2024] [Indexed: 01/07/2025]
Affiliation(s)
- Asato Hashinokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takefumi Komiya
- Division of Hematology Oncology, Penn State College of Medicine, Hershey, PA, USA
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8
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Okamoto K, Kikunaga S, Karasaki T, Ogawa Y, Ohkura Y, Honda A, Fujimori S, Ueno M, Udagawa H. Synchronous Thymoma and Esophageal Cancer Treated With Minimally Invasive Unilateral Video-Assisted Thoracoscopic Surgery: A Case Report. Cureus 2025; 17:e79020. [PMID: 40099098 PMCID: PMC11911115 DOI: 10.7759/cureus.79020] [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] [Accepted: 02/14/2025] [Indexed: 03/19/2025] Open
Abstract
The treatment of multi-organ synchronous neoplasms requires a customized strategy for each case. Here, we present our treatment strategy for synchronous double neoplasms involving thymoma and esophageal cancer, which is a rare occurrence in clinical practice. A 68-year-old man was diagnosed with thymoma and advanced esophageal cancer in the middle thoracic esophagus. Following neoadjuvant chemotherapy for esophageal cancer, a concurrent resection of both lesions was performed using minimally invasive unilateral video-assisted thoracoscopic surgery and laparoscopic surgery with gastric conduit reconstruction via the posterior mediastinal route. The patient was discharged on the 14th postoperative day without any adverse events. Minimally invasive, video-assisted unilateral simultaneous surgery for thymoma and esophageal cancer represents a viable therapeutic approach, offering both curative potential and decreased invasiveness. Furthermore, reconstructing the gastric conduit via the posterior mediastinal route was deemed appropriate, as it may help minimize the risk of invasion of the gastric conduit and radiation exposure in the event of thymoma disease progression. Additionally, we propose a treatment strategy flow for synchronous neoplasms located in adjacent multi-organs. This strategy can be applied to various tumor types and may benefit other complex cases.
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Affiliation(s)
- Kazuya Okamoto
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, JPN
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Shinichiro Kikunaga
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, JPN
| | - Takahiro Karasaki
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, JPN
| | - Yusuke Ogawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Aya Honda
- Department of Gastroenterological Surgery, Toranomon Hospital Kajigaya, Kawasaki, JPN
| | - Sakashi Fujimori
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, JPN
- Department of Research, Okinaka Memorial Institute for Medical Research, Tokyo, JPN
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
- Department of Research, Okinaka Memorial Institute for Medical Research, Tokyo, JPN
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
- Department of Research, Okinaka Memorial Institute for Medical Research, Tokyo, JPN
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9
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Valsecchi C, Petrella F, Freguia S, Frattini M, Argentieri G, Puligheddu C, Treglia G, Rizzo S. Lung Cancers Associated with Cystic Airspaces. Cancers (Basel) 2025; 17:307. [PMID: 39858089 PMCID: PMC11764308 DOI: 10.3390/cancers17020307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/07/2025] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
Lung cancer, the second most common malignancy in both men and women, poses a significant health burden. Early diagnosis remains pivotal in reducing lung cancer mortality. Given the escalating number of computed tomography (CT) examinations in both outpatient and inpatient settings, radiologists play a crucial role in identifying early-stage pulmonary cancers, particularly non-nodular cancers. Screening programs have been instituted to achieve this goal, and they have raised attention within the scientific community to lung cancers associated with cystic airspaces. These cancers, although they have been known for at least a decade, remain understudied. Limited investigations with small sample sizes have estimated their prevalence and explored their radiological and pathological features. Lung cancers associated with cystic airspaces exhibit varying complexities within their cystic components and demonstrate suspicious changes over time. Adenocarcinoma is the predominant histological type, often with a peripheral location. Differential diagnosis on CT scans includes inflammatory processes or emphysema-related changes. Unfortunately, prospective studies specifically analyzing the prevalence of cystic airspace-associated lung cancers are lacking. However, it is estimated that they constitute approximately one-fourth of delayed radiological diagnoses. Increased awareness among radiologists could lead to more timely identification and potentially reduce lung cancer mortality in a cost-effective manner.
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Affiliation(s)
- Clara Valsecchi
- Clinic of Radiology EOC, Istituto Imaging della Svizzera Italiana (IIMSI), Via Tesserete 46, 6900 Lugano, CH, Switzerland; (G.A.); (C.P.); (S.R.)
| | - Francesco Petrella
- Department of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, IT, Italy;
| | - Stefania Freguia
- Istituto Cantonale di Patologia EOC, Via in Selva 24, 6600 Locarno, CH, Switzerland; (S.F.); (M.F.)
| | - Milo Frattini
- Istituto Cantonale di Patologia EOC, Via in Selva 24, 6600 Locarno, CH, Switzerland; (S.F.); (M.F.)
| | - Gianluca Argentieri
- Clinic of Radiology EOC, Istituto Imaging della Svizzera Italiana (IIMSI), Via Tesserete 46, 6900 Lugano, CH, Switzerland; (G.A.); (C.P.); (S.R.)
| | - Carla Puligheddu
- Clinic of Radiology EOC, Istituto Imaging della Svizzera Italiana (IIMSI), Via Tesserete 46, 6900 Lugano, CH, Switzerland; (G.A.); (C.P.); (S.R.)
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Via G.Buffi 13, 6900 Lugano, CH, Switzerland;
- Clinic of Nuclear Medicine, Istituto Imaging della Svizzera Italiana (IIMSI), Via Tesserete 46, 6900 Lugano, CH, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, CH, Switzerland
| | - Stefania Rizzo
- Clinic of Radiology EOC, Istituto Imaging della Svizzera Italiana (IIMSI), Via Tesserete 46, 6900 Lugano, CH, Switzerland; (G.A.); (C.P.); (S.R.)
- Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Via G.Buffi 13, 6900 Lugano, CH, Switzerland;
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10
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Chiappetta M, Moser B. Number of Involved Structures in Thymic Epithelial Tumors. Ann Surg Oncol 2024; 31:9371-9372. [PMID: 39316195 DOI: 10.1245/s10434-024-16282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 09/17/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Marco Chiappetta
- UOC di Chirurgia Toracica Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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11
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Sorin V, Kirshenboim Z, Klug M, Ahuja J, Marom EM. The Ninth Edition TNM Staging Classification for Thymic Epithelial Tumors. Semin Ultrasound CT MR 2024; 45:420-429. [PMID: 39069277 DOI: 10.1053/j.sult.2024.07.006] [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: 07/30/2024]
Abstract
Staging classification is essential in cancer management and is based on three components: tumor extent (T), lymph node involvement (N), and distant metastatic disease (M). For thymic epithelial malignancies, clinical Tumour, Node, Metastasis (cTNM) staging is primarily determined by imaging, making radiologists integral to clinical practice, treatment decisions, and maintaining the quality of staging databases. The ninth edition of the TNM classification for thymic epithelial tumors will be implemented in January 2025. This review outlines the definitions for the TNM categories in the updated edition, provides examples, and elaborates on the radiologist's role and imaging considerations.
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Affiliation(s)
- Vera Sorin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | | | - Maximiliano Klug
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Nicolì V, Giangreco M, Pardini E, Petrini I, Bacchin D, Aprile V, Melfi F, Lucchi M, Guida M, Ricciardi R, Maestri M, Lari M, Migliore L, Stoccoro A, Coppedè F. DNA methylation analysis of multiple genes in thymic epithelial tumors. Epigenomics 2024; 16:1337-1350. [PMID: 39513235 PMCID: PMC11706250 DOI: 10.1080/17501911.2024.2419362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 10/16/2024] [Indexed: 11/15/2024] Open
Abstract
Aim: To investigate DNA methylation levels of a panel of genes in thymic epithelial tumors (TETs).Materials & methods: We selected 15 genes among the most promising epigenetic biomarkers of TETs and evaluated their methylation levels in 71 TET samples.Results: thymic carcinomas (TCs) showed hypermethylation of GHSR and ELF3 genes and reduced IL1RN methylation levels compared with thymomas (TMs) and healthy thymic tissues. RAG1 was hypomethylated in TMs compared with healthy thymic tissues. No difference in the methylation levels of the investigated genes was seen among TM stages and subtypes. No changes in blood methylation levels of the investigated genes were seen among TET subtypes.Conclusion: The present study confirms GHSR, ELF3, IL1RN and RAG1 as TET epigenetic biomarkers.
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Affiliation(s)
- Vanessa Nicolì
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
| | - Marianna Giangreco
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
| | - Eleonora Pardini
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
| | - Iacopo Petrini
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
| | - Diana Bacchin
- Thoracic Surgery, Department of Surgical, Medical & Molecular Pathology & Critical Care Medicine, University of Pisa, 56126, Pisa, Italy
| | - Vittorio Aprile
- Thoracic Surgery, Department of Surgical, Medical & Molecular Pathology & Critical Care Medicine, University of Pisa, 56126, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive & Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56126, Pisa, Italy
| | - Marco Lucchi
- Thoracic Surgery, Department of Surgical, Medical & Molecular Pathology & Critical Care Medicine, University of Pisa, 56126, Pisa, Italy
| | - Melania Guida
- Neurology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | - Roberta Ricciardi
- Neurology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Pisa, Italy
| | - Martina Lari
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
| | - Lucia Migliore
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
- Interdepartmental Research Center of Biology & Pathology of Aging, University of Pisa, 56126, Pisa, Italy
| | - Andrea Stoccoro
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
- Interdepartmental Research Center of Biology & Pathology of Aging, University of Pisa, 56126, Pisa, Italy
| | - Fabio Coppedè
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, 56126, Pisa, Italy
- Interdepartmental Research Center of Biology & Pathology of Aging, University of Pisa, 56126, Pisa, Italy
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13
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Liou DZ, Berry MF, Brown LM, Demmy TL, Huang J, Khullar OV, Padda SK, Shah RD, Taylor MD, Toker SA, Weiss E, Wightman SC, Worrell SG, Hayanga JWA. The Society of Thoracic Surgeons Expert Consensus Document on the Surgical Management of Thymomas. Ann Thorac Surg 2024; 118:975-1004. [PMID: 38718878 DOI: 10.1016/j.athoracsur.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, California
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sukhmani K Padda
- Department Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rachit D Shah
- Section of Thoracic and Foregut Surgery, VCU Health System, Richmond, Virginia
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Seyfi Alper Toker
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, VCU Health, Richmond, Virginia
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie G Worrell
- Thoracic Surgery Section, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - J W Awori Hayanga
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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14
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Bayram D, Sekmek S, Kayaalp M, Bardakçı M, Hafızoğlu E, Uçar G, Algin E, Bal O, Civelek B, Şendur MAN, Kos FT, Uncu D. Clinical features and prognostic factors in thymoma and thymic carcinoma. Indian J Thorac Cardiovasc Surg 2024; 40:660-668. [PMID: 39416339 PMCID: PMC11473478 DOI: 10.1007/s12055-024-01741-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 10/19/2024] Open
Abstract
Introduction Thymic epithelial tumors represent the most common cause of anterior mediastinal masses in adults. Among these tumors, thymomas constitute the majority, whereas thymic carcinomas are less prevalent and associated with a poorer prognosis. This study seeks to investigate the clinical and prognostic factors of these rare entities, thymoma, and thymic carcinomas. Materials and methods We conducted a retrospective analysis on a cohort of 60 patients diagnosed with thymoma and thymic carcinoma, who were under follow-up at our clinic between January 1998 and February 2023. The clinical characteristics and prognostic factors of these patients were analyzed separately. Results Thymomas accounted for 75% of the cases. The median age at diagnosis was 46 years in both patient groups. Masaoka stage 4 was observed in 28.9% of thymoma patients and 66.7% of thymic carcinoma patients. The median overall survival (mOS) for thymoma patients was 261.4 months, while it was 9.23 months for patients with thymic carcinoma. Curative surgery emerged as a prognostic factor significantly influencing overall survival in both thymoma and thymic carcinoma patients. Conclusion Our study highlights the significance of Eastern Cooperative Oncology Group (ECOG) performance status and curative surgery as prognostic factors affecting overall survival in thymoma patients. In thymic carcinoma, only curative surgery was found as a prognostic factor. These findings may enhance patient care and guide personalized treatment strategies. Further investigations and prospective studies are warranted to corroborate and expand upon these results.
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Affiliation(s)
- Doğan Bayram
- Department of Medical Oncology, Ankara City Hospital, Ankara, 06000 Turkey
| | - Serhat Sekmek
- Department of Medical Oncology, Ankara City Hospital, Ankara, 06000 Turkey
| | - Mehmet Kayaalp
- Department of Medical Oncology, Ankara University, Ankara, Turkey
| | - Murat Bardakçı
- Department of Medical Oncology, Ankara City Hospital, Ankara, 06000 Turkey
| | - Emre Hafızoğlu
- Department of Medical Oncology, Ankara City Hospital, Ankara, 06000 Turkey
| | - Gökhan Uçar
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Efnan Algin
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Oznur Bal
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Burak Civelek
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ali Nahit Şendur
- Department of Medical Oncology, Ankara City Hospital, University of Yildirim Beyazit, Ankara, Turkey
| | - Fahriye Tugba Kos
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dogan Uncu
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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15
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Yudai M, Takashi K, Hiroto I, Eriko F, Toru K, Naoko O, Soichiro F, Yasushi S. The role of calcification in predicting invasion of thymoma to adjacent organs. Surg Today 2024; 54:1154-1161. [PMID: 38600335 DOI: 10.1007/s00595-024-02826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/01/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Thoracoscopic procedures such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) have gained popularity for the treatment of thymoma. Accurate preoperative assessments of tumor invasion are crucial to identifying the appropriate surgical approach. Although imaging techniques have been used to predict invasion, a quantifiable method is still needed in clinical practice. METHODS The ubjects of this retrospective study were 226 patients with thymoma who underwent surgery at our hospital. Clinicopathological data, tumor staging, and recurrence rates were analyzed. Calcification identified through computed tomography (CT) defined the "calcified group" as having a long diameter of ≥ 5 mm. Statistical analyses were performed to assess relationships and survival outcomes. RESULTS The calcified group had higher Masaoka and World Health Organization classification than the noncalcified group, with significantly higher organ invasion rates. The calcified group also had remarkably higher recurrence rates. CONCLUSION Thymoma calcification appears to correlate with increased invasiveness and recurrence rates, suggesting its potential as a predictor of tumor stage and prognosis. Despite its retrospective nature and inherent limitations, this study highlights the potential clinical significance of calcification in the surgical planning and prognostication of patients with thymoma.
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Affiliation(s)
- Miyashita Yudai
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kanou Takashi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Ishida Hiroto
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Fukui Eriko
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kimura Toru
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ose Naoko
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Funaki Soichiro
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shintani Yasushi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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16
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Klug M, Kirshenboim Z, Truong MT, Sorin V, Gilat EK, Strange CD, Marom EM. RadioGraphics Update: The Ninth Edition TNM Staging System for Thymic Epithelial Tumors. Radiographics 2024; 44:e240196. [PMID: 39115998 DOI: 10.1148/rg.240196] [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: 08/10/2024]
Abstract
Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.
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Affiliation(s)
- Maximiliano Klug
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
| | - Zehavit Kirshenboim
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
| | - Mylene T Truong
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
| | - Vera Sorin
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
| | - Efrat Keren Gilat
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
| | - Chad D Strange
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
| | - Edith Michelle Marom
- From the Division of Diagnostic Imaging, Sheba Medical Center, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel (M.K., Z.K., V.S., E.K.G., E.M.M.); Cardiothoracic Imaging Division, University of Pittsburgh Medical Center, Pittsburgh, Pa (Z.K.); and Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (M.T.T., C.D.S.)
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17
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E H, Yang C, Zhang L, Xia L, Xu L, Song N, Hu X, Zhu Y, Chen C, Zhao D. Perioperative outcomes comparison of robotic and video-assisted thoracoscopic thymectomy for thymic epithelial tumor: a single-center experience. Updates Surg 2024; 76:1511-1519. [PMID: 38060172 DOI: 10.1007/s13304-023-01702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The advent of robot-assisted thoracoscopic surgery (RATS) has completely revolutionized the modality of thymectomy, which could reportedly achieve equivalent efficacy compared with a minimally invasive approach. This study was conducted to further compare the perioperative outcomes between these two modalities. METHODS A retrospective single-center study that included patients receiving either a robotic or video-assisted thoracoscopic (VAT) thymectomy between February 2021 and January 2023 was conducted. All the patients were pathologically confirmed with thymic epithelial tumors. Clinical and pathological characteristics and perioperative outcomes were collected and compared between these two cohorts. RESULTS A total of 190 patients were included in this study, with 61 (32.1%) and 129 (67.9%) receiving robotic and video-assisted thymectomy, respectively. The clinicopathological characteristics were not significantly different between these 2 groups. The size of the resected specimens in the RATS cohort was larger than the VATS cohort [median (IQR), 13.0 (8.0-16.0) vs. 9.0 (6.7-12.0) cm, p < 0.001], while the procedural duration was longer for the RATS group than its counterpart [median (IQR), 105 (85-143) vs. 85 (69-115) min, p = 0.001]. Moreover, no other significant difference was observed between these two groups. Since more than half of the robotic thymectomy was performed using a subxiphoid approach, a subgroup analysis was further conducted. Similarly, the robotic group through a subxiphoid approach harbored a longer procedural duration, and the size of the specimens obtained was larger than the VATS group [median (IQR), 14.0 (11.0-16.5) vs. 12.5 (8.5-15.0) cm, p = 0.061]. CONCLUSIONS The early clinical efficacy of robotic thymectomy was proven comparable to the established VATS approach, and such a modality might have strength when obtaining larger specimens, which could contribute to improving long-term efficacy. Despite the longer procedural duration recorded in the early stage of conducting robotic thymectomy, further accumulation would help decrease the time.
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Affiliation(s)
- Haoran E
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lang Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China.
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18
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Chiappetta M, Lococo F, Sassorossi C, Aigner C, Ploenes T, Van Raemdonck D, Vanluyten C, Van Schil P, Agrafiotis A, Guerrera F, Lyberis P, Casiraghi M, Spaggiari L, Zisis C, Magou C, Moser B, Bauer J, Thomas PA, Brioude G, Passani S, Zsanto Z, Sperduti I, Margaritora S. ASO Author Reflections: The Number of Involved Structures is a Promising Prognostic Factor in Thymic Epithelial Tumors. Ann Surg Oncol 2024; 31:4327-4328. [PMID: 38643340 DOI: 10.1245/s10434-024-15285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carolina Sassorossi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Till Ploenes
- Ruhrlandklinik - West German Lung Center University Hospital Essen, Essen, Germany
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), TU Dresden, Dresden, Sachsen, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Department of Thoracic Surgery, Fachkrankenhaus Coswig GmbH, Coswig, Saxony, Germany
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cedric Vanluyten
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Apostolos Agrafiotis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Francesco Guerrera
- Department of Surgical Sciences, Thoracic Surgery Unit, University of Turin, Torino, Italy
| | - Paraskevas Lyberis
- Department of Surgical Sciences, Thoracic Surgery Unit, University of Turin, Torino, Italy
| | - Monica Casiraghi
- Division of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Charalambos Zisis
- Department of Pathology, Evangelismos Hospital, Athens, Greece
- Department of Thoracic Surgery, Chest Disease Hospital "Sotiria", Athens, Greece, Athens, Greece
| | - Christina Magou
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - Bernhard Moser
- Head ESTS Thymic Working group. Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jonas Bauer
- Head ESTS Thymic Working group. Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, North Hospital, APHM & Aix-Marseille University, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, North Hospital, APHM & Aix-Marseille University, Marseille, France
| | | | - Zalan Zsanto
- Department of Surgery Medical School, University of Pécs, Pécs, Hungary
| | - Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute - IRCCS, Rome, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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19
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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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20
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Chiappetta M, Lococo F, Sassorossi C, Aigner C, Ploenes T, Van Raemdonck D, Vanluyten C, Van Schil P, Agrafiotis AC, Guerrera F, Lyberis P, Casiraghi M, Spaggiari L, Zisis C, Magou C, Moser B, Bauer J, Thomas PA, Brioude G, Passani S, Zsanto Z, Sperduti I, Margaritora S. The Prognostic Role of the Number of Involved Structures in Thymic Epithelial Tumors: Results from the ESTS Database. Ann Surg Oncol 2024; 31:4298-4307. [PMID: 38530530 DOI: 10.1245/s10434-024-15194-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The role of the number of involved structures (NIS) in thymic epithelial tumors (TETs) has been investigated for inclusion in future staging systems, but large cohort results still are missing. This study aimed to analyze the prognostic role of NIS for patients included in the European Society of Thoracic Surgeons (ESTS) thymic database who underwent surgical resection. METHODS Clinical and pathologic data of patients from the ESTS thymic database who underwent surgery for TET from January 2000 to July 2019 with infiltration of surrounding structures were reviewed and analyzed. Patients' clinical data, tumor characteristics, and NIS were collected and correlated with CSS using Kaplan-Meier curves. The log-rank test was used to assess differences between subgroups. A multivariable model was built using logistic regression analysis. RESULTS The final analysis was performed on 303 patients. Histology showed thymoma for 216 patients (71.3%) and NET/thymic carcinoma [TC]) for 87 patients (28.7%). The most frequently infiltrated structures were the pleura (198 cases, 65.3%) and the pericardium in (185 cases, 61.1%), whereas lung was involved in 96 cases (31.7%), great vessels in 74 cases (24.4%), and the phrenic nerve in 31 cases (10.2%). Multiple structures (range, 2-7) were involved in 183 cases (60.4%). Recurrence resulted in the death of 46 patients. The CSS mortality rate was 89% at 5 years and 82% at 10 years. In the univariable analysis, the favorable prognostic factors were neoadjuvant therapy, Masaoka stage 3, absence of metastases, absence of myasthenia gravis, complete resection, thymoma histology, and no more than two NIS. Patients with more than two NIS presented with a significantly worse CSS than patients with no more than two NIS (CSS 5- and 10-year rates: 9.5% and 83.5% vs 93.2% and 91.2%, respectively; p = 0.04). The negative independent prognostic factors confirmed by the multivariable analysis were incomplete resection (hazard ratio [HR] 2.543; 95% confidence interval [CI] 1.010-6.407; p = 0.048) and more than two NIS (HR 1.395; 95% CI 1.021-1.905; p = 0.036). CONCLUSIONS The study showed that more than two involved structures are a negative independent prognostic factor in infiltrative thymic epithelial tumors that could be used for prognostic stratification.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carolina Sassorossi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Till Ploenes
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), TU Dresden, Dresden, Sachsen, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Department of Thoracic Surgery, Fachkrankenhaus Coswig GmbH, Coswig, Saxony, Germany
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cedric Vanluyten
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Apostolos C Agrafiotis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Francesco Guerrera
- Thoracic Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paraskevas Lyberis
- Thoracic Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Monica Casiraghi
- Division of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Charalambos Zisis
- Department of Thoracic Surgery, Chest Disease Hospital "Sotiria", Athens, Greece
| | - Christina Magou
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - Bernhard Moser
- Head ESTS Thymic Working Group, Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jonas Bauer
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, North Hospital, APHM, Aix-Marseille University, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, North Hospital, APHM, Aix-Marseille University, Marseille, France
| | | | - Zalan Zsanto
- Department of Surgery Medical School, University of Pécs, Pecs, Hungary
| | - Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute - IRCCS, Rome, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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21
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Basse C, Khalifa J, Thillays F, Le Pechoux C, Maury JM, Bonte PE, Coutte A, Pourel N, Bourbonne V, Pradier O, Belliere A, Le Tinier F, Deberne M, Tanguy R, Denis F, Padovani L, Zaccariotto A, Molina T, Chalabreysse L, Brioude G, Delatour B, Faivre JC, Cao K, Giraud P, Riet FG, Thureau S, Antoni D, Massabeau C, Keller A, Bonnet E, Lerouge D, Martin E, Girard N, Botticella A. Recommendations for Post-Operative RadioTherapy After Complete Resection of Thymoma-a French DELPHI Consensus Initiative. J Thorac Oncol 2024; 19:1095-1107. [PMID: 38608932 DOI: 10.1016/j.jtho.2024.04.003] [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: 10/22/2023] [Revised: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Thymomas are rare intrathoracic malignancies that can relapse after surgery. Whether or not Post-Operative RadioTherapy (PORT) should be delivered after surgery remains a major issue. RADIORYTHMIC is an ongoing, multicenter, randomized phase 3 trial addressing this question in patients with completely R0 resected Masaoka-Koga stage IIb/III thymoma. Experts in the field met to develop recommendations for PORT. METHODS A scientific committee from the RYTHMIC network identified key issues regarding the modalities of PORT in completely resected thymoma. A DELPHI method was used to question 24 national experts, with 115 questions regarding the following: (1) imaging techniques, (2) clinical target volume (CTV) and margins, (3) dose constraints to organs at risk, (4) dose and fractionation, and (5) follow-up and records. Consensus was defined when opinions reached more than or equal to 80% agreement. RESULTS We established the following recommendations: preoperative contrast-enhanced computed tomography (CT) scan is recommended (94% agreement); optimization of radiation delivery includes either a four-dimensional CT-based planning (82% agreement), a breath-holding inspiration breath-hold-based planning, or daily control CT imaging (81% agreement); imaging fusion based on cardiovascular structures of preoperative and planning CT scan is recommended (82% agreement); right coronary and left anterior descending coronary arteries should be delineated as cardiac substructures (88% agreement); rotational RCMI/volumetric modulated arc therapy is recommended (88% agreement); total dose is 50 Gy (81% agreement) with 1.8 to 2 Gy per fraction (94% agreement); cardiac evaluation and follow-up for patients with history of cardiovascular disease are recommended (88% agreement) with electrocardiogram and evaluation of left ventricular ejection fraction at 5 years and 10 years. CONCLUSION This is the first consensus for PORT in thymoma. Implementation will help to harmonize practices.
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Affiliation(s)
- Clémence Basse
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France
| | - Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Rigaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Cécile Le Pechoux
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; IVPC UMR754 INRA, Univ Lyon, Université Claude Bernard Lyon 1, EPHE, Lyon, France
| | | | | | - Nicolas Pourel
- Radiation Department, Institut Sainte Catherine, Avignon, France
| | - Vincent Bourbonne
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Olivier Pradier
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Aurélie Belliere
- Department of Radiotherapy, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Mélanie Deberne
- Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France
| | - Ronan Tanguy
- Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France
| | - Fabrice Denis
- Department of Radiotherapy, Centre de Cancérologie de la Sarthe, ELSAN, Le Mans, France
| | - Laetitia Padovani
- Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Audrey Zaccariotto
- Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Thierry Molina
- Pathology Department, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lara Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Bron Cedex Lyon, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Disease of the Oesophagus and Lung Transplantations, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Bertrand Delatour
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | | | - Kim Cao
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Philippe Giraud
- Paris City University, Department of Radiation Oncology, Hopital Européen Georges Pompidou, Paris, France
| | | | | | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut de Cancérologie de Strasbourg, Strasbourg, France
| | - Carole Massabeau
- Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France
| | - Audrey Keller
- Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France
| | - Emilie Bonnet
- Department of Radiotherapy, IMR de Valence, Valence, France
| | | | - Etienne Martin
- Department of Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France.
| | - Angela Botticella
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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22
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Mizuno T, Chen-Yoshikawa TF, Yoshino I, Okumura M, Ikeda N, Kuroda K, Maniwa Y, Kanzaki M, Suzuki M, for the Japanese Association for Research on the Thymus. Updated outcomes of surgical treatment for recurrent thymic tumour: a report from the Japanese nationwide database. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae064. [PMID: 38897650 PMCID: PMC11193311 DOI: 10.1093/icvts/ivae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 03/26/2024] [Accepted: 06/18/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES This study aimed to analyse the surgical outcomes for recurrent thymic epithelial tumours and identify the factors associated with post-recurrence survival, using an updated Japanese nationwide database. METHODS The cohort that developed recurrence after the initial resection was extracted from an updated database of patients whose thymic epithelial tumours were treated surgically between 1991 and 2010. Furthermore, we reviewed clinicopathological and prognostic factors of re-resected cases. Post-recurrence survival outcomes and cause-specific deaths in non-re-resected cases were also reviewed. RESULTS We enrolled 191 patients who underwent re-resection and 259 patients who did not. In the surgery group, more patients with early stage disease, less aggressive World Health Organization (WHO) histological classification, initial complete resection and shorter recurrence-free intervals were included. Non-thymic carcinoma, absence of preoperative treatment, longer recurrent-free interval, single-site recurrence and R0-1 re-resection were all significantly favourable prognostic factors for post-recurrence survival in the surgery group, according to univariable analyses. Non-thymic carcinoma histology, longer recurrence-free interval and R0-1 re-resection were identified as independent prognostic factors according to multivariable analysis. The post-recurrence survival of the entire cohort with R2 re-resection was significantly better than that of the non-surgery group, although it was not demonstrated that patients with thymoma who underwent R2 re-resection had significantly better post-recurrence and lower cause-specific death. CONCLUSIONS R0-1 re-resection was newly identified as a prognostic factor after re-resection, in addition to non-thymic carcinoma histological classification and longer recurrence-free intervals, as documented in the initial report.
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Affiliation(s)
- Tetsuya Mizuno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Meinoshin Okumura
- Division of Thoracic Surgery, Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koji Kuroda
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Makoto Suzuki
- Department of Thoracic Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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23
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Evison M, Robinson SD, Sharman A, Datta S, Rammohan K, Duerden R, Montero-Fernandez MA, Gilligan D. Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group. Clin Radiol 2024; 79:404-412. [PMID: 38565483 DOI: 10.1016/j.crad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies.
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Affiliation(s)
- M Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
| | - S D Robinson
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, UK.
| | - A Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Datta
- Department of Radiology, Royal Alexandra Hospital, NHS Glasgow and Clyde, Glasgow, UK
| | - K Rammohan
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Duerden
- Department of Radiology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - M A Montero-Fernandez
- Department of Histopathology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gilligan
- Department of Oncology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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24
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Tsai PC, Tseng YC, Ting YC, Huang CS, Hsu WH, Tang EK, Hsu HS. Long-term follow-up of non-myasthenic patients with early-stage thymoma who underwent extended thymectomy or limited resection. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108349. [PMID: 38640605 DOI: 10.1016/j.ejso.2024.108349] [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: 03/08/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUD The standard resection for early-stage thymoma is total thymectomy and complete tumour excision with or without myasthenia gravis but the optimal surgery mode for patients with early-stage non-myasthenic thymoma is debatable. This study analysed the oncological outcomes for non-myasthenic patients with early-stage thymoma treated by thymectomy or limited resection in the long term. METHODS Patients who had resections of thymic neoplasms at Taipei Veteran General Hospital, Taiwan between December 1997 and March 2013 were recruited, exclusive of those combined clinical evidence of myasthenia gravis were reviewed. A total of 113 patients were retrospectively reviewed with pathologic early stage (Masaoka stage I and II) thymoma who underwent limited resection or extended thymectomy to compare their long-term oncologic and surgical outcomes. RESULTS The median observation time was 134.1 months [interquartile range (IQR) 90.7-176.1 months]. In our cohort, 52 patients underwent extended thymectomy and 61 patients underwent limited resection. Shorter duration of surgery (p < 0.001) and length of stay (p = 0.006) were demonstrated in limited resection group. Six patients experienced thymoma recurrence, two of which had combined myasthenia gravis development after recurrence. There was no significant difference (p = 0.851) in freedom-from-recurrence, with similar 10-year freedom-from-recurrence rates between the limited resection group (96.2 %) and the thymectomy group (93.2 %). Tumour-related survival was also not significantly different between groups (p = 0.726).result CONCLUSION: Patients with early-stage non-myasthenic thymoma who underwent limited resection without complete excision of the thymus achieved similar oncologic outcomes during the long-term follow-up and better peri-operative results compared to those who underwent thymectomy.
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Affiliation(s)
- Ping-Chung Tsai
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Chiang Tseng
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Che Ting
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Sheng Huang
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hu Hsu
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - En-Kuei Tang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
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25
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Chao F, Wang R, Han X, Huang W, Wang R, Yu Y, Lin X, Yuan P, Yang M, Gao J. Intratumoral metabolic heterogeneity by 18F-FDG PET/CT to predict prognosis for patients with thymic epithelial tumors. Thorac Cancer 2024; 15:1437-1445. [PMID: 38757212 PMCID: PMC11194121 DOI: 10.1111/1759-7714.15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the impact of intratumoral metabolic heterogeneity and quantitative 18F-FDG PET/CT imaging parameters in predicting patient outcomes in thymic epithelial tumors (TETs). METHODS This retrospective study included 100 patients diagnosed with TETs who underwent pretreatment 18F-FDG PET/CT. The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were measured. Heterogeneity index-1 (HI-1; standard deviation [SD] divided by SUVmean) and heterogeneity index-2 (HI-2; linear regression slopes of the MTV according with different SUV thresholds), were evaluated as heterogeneity indices. Associations between these parameters and patient survival outcomes were analyzed. RESULTS The univariate analysis showed that Masaoka stage, TNM stage, WHO classification, SUVmax, SUVmean, TLG, and HI-1 were significant prognostic factors for progression-free survival (PFS), while MTV, HI-2, age, gender, presence of myasthenia gravis, and maximum tumor diameter were not. Subsequently, multivariate analyses showed that HI-1 (p < 0.001) and TNM stage (p = 0.002) were independent prognostic factors for PFS. For the overall survival analysis, TNM stage, WHO classification, SUVmax, and HI-1 were significant prognostic factors in the univariate analysis, while TNM stage remained an independent prognostic factor in multivariate analyses (p = 0.024). The Kaplan Meier survival analyses showed worse prognoses for patients with TNM stages III and IV and HI-1 ≥ 0.16 compared to those with stages I and II and HI-1 < 0.16 (log-rank p < 0.001). CONCLUSION HI-1 and TNM stage were independent prognostic factors for progression-free survival in TETs. HI-1 generated from baseline 18F-FDG PET/CT might be promising to identify patients with poor prognosis.
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Affiliation(s)
- Fangfang Chao
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Ran Wang
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xingmin Han
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Wenpeng Huang
- Department of Nuclear MedicinePeking University First HospitalBeijingChina
| | - Ruihua Wang
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yanxia Yu
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xuyang Lin
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Ping Yuan
- Department of Thoracic SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Meng Yang
- Department of Nuclear MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jianbo Gao
- Department of RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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Doreswamy S, Mishra S, Venigalla T, Al Turaihi Z, Sekhar S. Thymic Carcinoma Presenting as a Mediastinal Mass Resembling a Cardiac Tumor. Cureus 2024; 16:e61455. [PMID: 38947614 PMCID: PMC11214866 DOI: 10.7759/cureus.61455] [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] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Thymoma and thymic carcinomas are a few of the rarest malignancies seen in humankind. They are mostly seen in the Asian population, many of which are reported in the Southeast Asia region like Japan, China, Vietnam, etc. They usually can be a sequela of other underlying conditions such as myasthenia gravis or some unknown mutations that express later in life. Our patient is a young 41-year-male, a healthy and active individual who presented for evaluation of acute shortness of breath, two months after recovering from SARS-CoV-19 infection. His shortness of breath progressed while on oxygen and diuretics, a Point of Care Ultrasound (POCUS) showed cardiac tamponade and moderate pleural effusion. A Computerized Tomographic (CT) scan of the chest/abdomen/pelvis showed cardiomegaly, pleural effusion, and a mass abutting the heart. A pericardiocentesis revealed malignant cells. Thymic carcinoma was confirmed with a core biopsy and the patient was initiated on treatment rapidly to help improve symptoms and contain the growing mass. .
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Affiliation(s)
- Shriya Doreswamy
- Internal Medicine, Jefferson Einstein Montgomery Hospital, East Norriton, USA
- Otolaryngology - Head and Neck Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Sakshi Mishra
- Internal Medicine, Jefferson Einstein Montgomery Hospital, East Norriton, USA
| | - Tejaswi Venigalla
- Internal Medicine, Einstein Medical Center Montgomery, East Norriton, USA
| | | | - Supriya Sekhar
- Internal Medicine, Jefferson Einstein Montgomery Hospital, East Norriton, USA
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Hao X, Gu Z, Liu H, Zhang X, Xu N, Mao T, Fang W. Internal jugular vein pressure monitoring guided venous reconstruction could improve perioperative safety after superior vena cava resection for mediastinal tumors: a cohort study. Int J Surg 2024; 110:2730-2737. [PMID: 38320105 DOI: 10.1097/js9.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION After superior vena cava (SVC) resection, the decision on unilateral or bilateral reconstruction was mostly based on the expertise of surgeons without objective measurements. This study explored the use of internal jugular vein pressure (IJVP) monitoring to guide the SVC reconstruction strategy. METHODS In a retrospective cohort, perioperative outcomes of unilateral and bilateral reconstruction based on surgeons' experience were compared. Then, IJVP threshold was measured when temporarily clamping the left innominate vein in a testing cohort. Venous reconstruction according to IJVP monitoring was performed in a prospective validation cohort afterward. Perioperative outcomes were compared between the prospective and the retrospective cohorts. For some interested variables, intuitive explanations would be given using Bayesian methods. Potential risk factors for postoperative complications were investigated by multivariable analysis. RESULTS From March 2009 to September 2022, 57 patients underwent SVC reconstruction based on surgeons' experience. Bayesian analysis indicated a posterior probability of 80.49% that unilateral reconstruction had less blood loss than bilateral reconstruction (median 550 ml vs. 1200 ml). Cerebral edema occurred in two patients after unilateral reconstruction. In the testing cohort, median IJVP was 22.7 (18-27) cmH 2 O after temporary left innominate vein clamping in 10 patients. In the prospective cohort, unilateral reconstruction only was performed if the contralateral IJVP was <30 cmH 2 O in 16 patients. Bilateral reconstruction was performed if IJVP was ≥30 cmH 2 O after unilateral bypass in nine patients. No cerebral edema occurred in the prospective cohort. Less postoperative complications occurred in the prospective cohort than the retrospective cohort (12.0 vs. 38.6%, P =0.016). Upon multivariable analysis, IJVP-monitoring guided SVC reconstruction was associated with significantly less postoperative complications ( P =0.033). CONCLUSIONS Intraoperative IJVP-monitoring is a useful strategy for selection of unilateral or bilateral SVC reconstruction and improving perioperative safety in patients with mediastinal tumors.
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Affiliation(s)
- Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Yu F, Gu Z, Zhang X, Xu N, Hao X, Wang C, Zhao Y, Mao T, Fang W. A Re-Examination of Neoadjuvant Therapy for Thymic Tumors: A Long and Winding Road. Cancers (Basel) 2024; 16:1680. [PMID: 38730630 PMCID: PMC11083666 DOI: 10.3390/cancers16091680] [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: 02/05/2024] [Revised: 04/07/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
For most patients with advanced thymic epithelial tumors (TETs), a complete resection is a strong indicator of a better prognosis. But sometimes, primary surgery is unsatisfactory, and preoperative therapy is needed to facilitate complete resection. Neoadjuvant chemotherapy is the most used form of preoperative therapy. But studies on neoadjuvant chemotherapy have included mainly patients with thymoma; its efficacy in patients with thymic carcinoma is less known. Neoadjuvant chemoradiation has also been explored in a few studies. Novel therapies such as immunotherapy and targeted therapy have shown efficacy in patients with recurrent/metastatic TETs as a second-line option; their role as preoperative therapy is still under investigation. In this review, we discuss the existing evidence on preoperative therapy and the insight it provides for current clinical practice and future studies.
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Affiliation(s)
- Fenghao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
| | - Xuefei Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
| | - Ning Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
| | - Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China;
| | - Yizhuo Zhao
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China;
| | - Teng Mao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; (F.Y.); (Z.G.); (X.Z.); (N.X.); (X.H.); (T.M.)
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Rimner A, Ahmad U, Lobaugh SM, Zhang Z, Shepherd AF, Huang J, Antonicelli A, Girard N, Moser B, Filosso P, Lucchi M, Marom EM, Roden A, Detterbeck F, Ruffini E, Simone CB. Postoperative Radiation Therapy for Thymic Carcinoma: An Analysis of the International Thymic Malignancy Interest Group/European Society of Thoracic Surgeons Database. J Thorac Oncol 2024; 19:626-635. [PMID: 38070599 DOI: 10.1016/j.jtho.2023.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION R0 resection and radiation therapy have been associated with improved overall survival (OS) in patients with thymic carcinoma (TC). Here, we analyzed which subgroups of patients derive the greatest benefit from postoperative radiation therapy (PORT). METHODS Clinical, pathologic, treatment, and survival information of 462 patients with TC from the International Thymic Malignancy Interest Group/European Society of Thoracic Surgeons database were analyzed. Variables included age, sex, continent of treatment, paraneoplastic syndrome, carcinoma subtype, tumor size, pathologic Masaoka stage, resection status, and use of chemotherapy. OS was the primary end point using the Kaplan-Meier method. Time to recurrence (TTR) was the secondary end point using a competing risk analysis. A 3-month landmark analysis was performed. RESULTS PORT was associated with a significant OS benefit (5-y OS 68% versus 53%, p = 0.002). In patients with R0 resection, PORT was associated with increased OS for advanced (stages III-IV, p = 0.04), but not early (stages I-II, p = 0.14) stage TC. In patients with an R1/2 resection of advanced-stage TC, PORT was associated with significantly longer OS (5-y OS 53% versus 38%; p < 0.001). Subset analyses did not reveal clear associations of PORT with TTR. On multivariable analysis, lower pathologic stage, PORT, and R0 resection status were associated with an OS benefit, whereas only higher age and lower pathologic stage had an association with longer TTR. CONCLUSIONS In the largest individual patient data set on patients with TC reported to date, PORT was associated with a meaningful OS benefit in patients with advanced-stage TC after an R0 or R1/2 resection.
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Affiliation(s)
- Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Usman Ahmad
- Department of Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie M Lobaugh
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annemarie F Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Huang
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alberto Antonicelli
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Nicolas Girard
- Department of Thoracic Oncology, Institut Curie, Paris, France
| | - Bernhard Moser
- Department of Thoracic Surgery, University of Vienna, Vienna, Austria
| | | | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
| | - Anja Roden
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Turin, Italy
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Ströbel P, Marx A. The Way Ahead: Lessons Learned from Decades of Cancer Research on Thymomas and Thymic Carcinomas. Cancers (Basel) 2024; 16:1040. [PMID: 38473397 DOI: 10.3390/cancers16051040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
The history of thymoma (TH) research begins in the early 20th century, when Bell first recognized the epithelial nature of these tumors and their association with myasthenia gravis (MG) [...].
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Affiliation(s)
- Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, D-37075 Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Center Göttingen, D-37075 Göttingen, Germany
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Tanaka K, Suzuki H, Inage T, Ito T, Sakairi Y, Yoshino I. Lobulated tumor contour as a predictor of preoperative tumor invasion of the lung or pericardium in thymoma patients. Surg Today 2024; 54:162-167. [PMID: 37340140 DOI: 10.1007/s00595-023-02719-4] [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: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Preoperative investigations to detect invasion to neighboring organs are important for deciding on the most appropriate surgical approach for thymoma. We evaluated preoperative computed tomography (CT) findings in thymoma patients to identify the CT features associated with tumor invasion. METHODS Clinicopathologic information on 193 patients who underwent surgical resection for thymoma at Chiba University Hospital between 2002 and 2016 was collected retrospectively. The surgical pathology identified invasion of thymoma in 35 patients: in the lung (n = 18), pericardium (n = 11), or both (n = 6). Contact lengths between the tumor contour and lung (CLTL) or pericardium (CLTP) were measured at the maximum section of the tumor on axial CT. Univariate and multivariate analyses were performed to analyze the relationship between pathological invasion of the lung or pericardium and the clinicopathologic features. RESULTS The mean CLTL and CLTP were significantly longer in patients with invasion of the neighboring organs than in those without invasion. A lobulated tumor contour was identified in 95.6% of the patients with invasion of the neighboring organs. A multivariate analysis revealed that a lobulated tumor contour was significantly associated with both lung and pericardial invasion. CONCLUSIONS A lobulated tumor contour was significantly associated with lung and/or pericardial invasion in thymoma patients.
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Affiliation(s)
- Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan.
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
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Ambrogi MC, Aprile V, Lenzini A, Bacchin D, Mastromarino MG, Korasidis S, Lucchi M. TNM Staging System in Thymoma: A Critical Appraisal? J Clin Med 2024; 13:610. [PMID: 38276116 PMCID: PMC10817025 DOI: 10.3390/jcm13020610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Thymomas are rare tumors of the anterior mediastinum with peculiar clinical and pathological features. They have been deeply analyzed by pioneer authors, who strictly linked their name to the main pathological and staging classifications. Before the latest edition of the WHO classification of thymic epithelial tumors, the history of thymoma pathological classification inherited the name of the pathologists who systematically addressed the issue, from Levine-Rosai to Muller-Hermelink. Similarly, the thymoma staging system is intimately related to the name of two surgeons, Masaoka and Koga, who historically dealt with this disease. More recently, the traditional tumor-nodes-metastasis (TNM) system has been developed for the staging of this condition, in a rational attempt to put thymomas in conformity with the other solid tumors. The efforts of the International Thymic Malignancies Interest Group (ITMIG) and the Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) of the International Association for the Study of Lung Cancer (IASLC) resulted in the TNM classification of thymic tumors, which have been included in the eighth edition of the American Joint Committee on Cancer's (AJCC) Cancer Staging Manual. Herein, we report a narrative review of the evolution of the thymic epithelial tumors (TET) staging system and present a critical appraisal of the actual TNM classification compared with the historical Masaoka-Koga classification, with special focus on the proposal for the ninth edition of the TNM, expected in 2024.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Alessandra Lenzini
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Diana Bacchin
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Maria Giovanna Mastromarino
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
| | - Stylianos Korasidis
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
| | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
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von der Thüsen J. Thymic epithelial tumours: histopathological classification and differential diagnosis. Histopathology 2024; 84:196-215. [PMID: 37994555 DOI: 10.1111/his.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
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Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
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Akamine T, Nakagawa K, Ito K, Watanabe H, Yotsukura M, Yoshida Y, Yatabe Y, Kusumoto M, Watanabe SI. Impact of 18F-FDG PET on TNM Staging and Prognosis in Thymic Epithelial Tumors. Ann Surg Oncol 2024; 31:192-200. [PMID: 37743455 DOI: 10.1245/s10434-023-14328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Preoperative fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) of thymic epithelial tumors (TETs) is well known for identifying malignant-grade TETs; however, its predictive power for determining locally advanced tumors, lymph node (LN) metastasis, and prognosis remains unknown. PATIENTS AND METHODS We retrospectively evaluated patients with resectable TETs who were preoperatively assessed using 18F-FDG PET from January 2012 to January 2023. The receiver operating characteristic curve was used to evaluate the cutoff value of the maximum standardized uptake value (SUVmax) to predict advanced-stage disease. Recurrence/progression-free survival (RFS/PFS) was analyzed using the Kaplan-Meier method. The staging was classified according to the tumor-node-metastasis system. RESULTS Our study included 177 patients; 145 (81.9%) had pathological early-stage TET (stage I or II), and 32 (19.1%) had advanced stage (stage III or IV). The area under the curve value for predicting the advanced stage was 0.903, and the cutoff value was 5.6 (sensitivity 81.3%, specificity 84.8%). SUVmax > 5.6 was associated with worse prognosis for RFS/PFS. LN metastasis was preoperatively detected by FDG uptake in 30.8% of patients with pathological LN positivity, whereas LN metastasis was not pathologically detected in patients with SUVmax < 5.9. In patients with advanced-stage TETs, LN recurrence was more frequent in patients who were preoperatively detected by 18F-FDG PET than those who were not (75.0% versus 7.1%). CONCLUSIONS 18F-FDG PET is a potentially valuable tool for predicting advanced stage and poor prognosis of recurrence in patients with TETs. SUVmax can help thoracic surgeons to guide them in selecting appropriate therapeutic strategies for TETs.
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Affiliation(s)
- Takaki Akamine
- Departments of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Departments of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Kimiteru Ito
- Departments of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Watanabe
- Departments of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Yotsukura
- Departments of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Departments of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Departments of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Departments of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Departments of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Suster D, Suster S. On the Histologic Classification of Thymoma. Adv Anat Pathol 2024; 31:22-33. [PMID: 37702296 DOI: 10.1097/pap.0000000000000412] [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: 09/14/2023]
Abstract
The classification of thymoma continues to be a source of controversy in pathology. The difficulties in histologic classification are evident from the number of proposals that have been offered over the years, as well as for the continuous changes and modifications introduced by the World Health Organization to their classification system over the past 20 years. We analyze here some of the issues involved in the classification of these tumors and the difficulties encountered for practicing pathologists in deciphering the "letters and numbers" system devised by the World Health Organization. We would like to propose an alternate approach to thymoma histologic classification that capitalizes on the basic observation of their cytologic features and incorporates the pattern of growth resulting from the interplay of the tumor cells with other cellular constituents as a secondary characteristic. The proposed histologic classification provides a simplified, reproducible means of histologically categorizing these tumors and can be easily understood by most practicing pathologists in simple and clear morphologic terms.
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Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University Hospital, Newark, NJ
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
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Gao J, Ao Y, Wang S, Chen Z, Zhang Y, Ding J, Jiang J. WHO histological classification and tumor size are predictors of the locally aggressive behavior of thymic epithelial tumors. Lung Cancer 2024; 187:107446. [PMID: 38113654 DOI: 10.1016/j.lungcan.2023.107446] [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: 09/06/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim of this study was to explore the influencing factors that affect the local invasive behavior of thymic epithelial tumors (TETs). METHOD We retrospectively analyzed 524 patients with TETs who underwent surgical treatment at our center from January 2010 to January 2022. Cox regression analysis was applied to identify predictors associated with the prognosis of TET. Logistic regression analysis was used to analyze the factors associated with the locally invasive behavior of TETs. Receiver operating characteristic analysis and the Youden index were applied to determine the predictive efficiency and cutoff value. RESULTS There were 275 males and 249 females with a median age of 56 years. Seventy-seven patients had locally invasive behavior. The prognosis of local invasive TETs was significantly worse that of noninvasive TETs (P < 0.001). WHO classification and tumor size were two hazard factors for tumor invasive behavior. The risk of local invasion increased by 2.196 (OR (95 % CI): 1.813-2.659) times for each grade in WHO classification with a change from type A to thymic carcinoma. The tumor size cutoff of 6 cm represented a distinct boundary in predicting the hazard of local invasion (AUC: 0.784, specificity: 0.711, sensitivity: 0.726). CONCLUSION WHO classification and tumor size are important factors in predicting the locally aggressive behavior of TETs. The invasion capability of TETs is constantly increasing with an escalation in WHO classification. Tumors greater than 6 cm in size have a higher risk for local invasion.
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Affiliation(s)
- Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongqiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwei Chen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jiahao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Kline S, Manley SR, Timothy C, Jennings SH, Nolen-Walston R, Conrado FO. Spindle-cell thymoma colliding with a bronchogenic cyst in a Yorkshire terrier. Vet Clin Pathol 2023; 52:709-715. [PMID: 37914539 DOI: 10.1111/vcp.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 11/03/2023]
Abstract
An 8-year-old male Yorkshire terrier was presented to the Tufts Veterinary Hospital for evaluation of increased respiratory effort. A mediastinal mass composed of a spindle-cell thymoma within a bronchogenic cyst was diagnosed with computed tomography thoracic imaging, ultrasound-guided fine-needle aspirate biopsy, and histopathologic evaluation after surgical removal. Histologic evaluation showed a multilocular cyst structure as well as a mass characterized by spindle to polygonal thymic epithelial cells. The cyst was characterized by a lining of ciliated pseudostratified respiratory epithelium. To the authors' knowledge, this is the first report of a spindle-cell thymoma being associated with a mediastinal bronchogenic cyst in a dog.
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Affiliation(s)
- Stephanie Kline
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Sabrina R Manley
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Clare Timothy
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | | | - Rose Nolen-Walston
- Department of Comparative Pathobiology, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Francisco O Conrado
- Department of Comparative Pathobiology, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
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Ruffini E, Huang J, Cilento V, Goren E, Detterbeck F, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Falkson C, Fang W, Filosso PL, Giaccone G, Girard N, Guerrera F, Infante M, Kim DK, Lucchi M, Marino M, Marom EM, Nicholson AG, Okumura M, Rami-Porta R, Rimner A, Simone CB, Asamura H. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: Proposal for a Stage Classification for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol 2023; 18:1655-1671. [PMID: 37689391 DOI: 10.1016/j.jtho.2023.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 09/11/2023]
Abstract
INTRODUCTION A TNM-based system for all types of thymic epithelial tumors was introduced in the eighth edition of the TNM classification of thoracic malignancies. The Thymic Domain of the Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer, composed of multispecialty international experts, was charged to develop proposals for the ninth edition. This article outlines the proposed definitions for the T, the N, and the M components and their combination into stage groups. METHODS A large central database of 11,347 patients with thymic epithelial tumors was assembled thanks to the contribution of the major thymic organizations worldwide and analyses were carried out for the T, the N, and the M components and the stage groups. Overall survival was the outcome measure for patients with completely and incompletely resected tumors, and recurrence for those with complete resection. When the number of patients was sufficient, analyses were performed separately for thymomas, thymic carcinomas, and neuroendocrine thymic tumors. RESULTS Tumor size is included in the T1 category as T1a (≤5cm) and T1b (>5 cm); the mediastinal pleura is dropped as a T descriptor; invasion of the lung or phrenic nerve is reclassified as T2 (instead of T3). No changes are proposed for the N and the M components from the eighth edition. The stage groups remain the same. CONCLUSIONS The proposed changes for the ninth edition of the TNM classification set the stage for further progress in the future for these rare tumors.
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Affiliation(s)
| | - James Huang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vanessa Cilento
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Emily Goren
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | | | - Usman Ahmad
- Thoracic Surgery in the Heart, Vascular, and Thoracic Institute at Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | | | | | - Cecilia Brambilla
- Royal Brompton and Harefield National Health Service (NHS) Hospitals, London, United Kingdom; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | - Wentao Fang
- Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People's Republic of China
| | | | | | - Nicolas Girard
- Institut Curie, Thorax Institute Curie Montsouris, Paris, France; Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
| | | | | | - Dong Kwan Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Marco Lucchi
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mirella Marino
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
| | - Andrew G Nicholson
- Royal Brompton and Harefield National Health Service (NHS) Hospitals, London, United Kingdom; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Meinoshin Okumura
- National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Ramon Rami-Porta
- Hospital Universitari Mutua Terrassa, Terrassa, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
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Okumura M, Marino M, Cilento V, Goren E, Ruffini E, Dibaba D, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Detterbeck F, Falkson C, Fang W, Filosso PL, Giaccone G, Girard N, Guerrera F, Huang J, Infante M, Kim DK, Lucchi M, Marom EM, Nicholson AG, Rami-Porta R, Rimner A, Simone CB, Asamura H. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Proposal for the T Component for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol 2023; 18:1638-1654. [PMID: 37634808 DOI: 10.1016/j.jtho.2023.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION A TNM-based stage classification system of thymic epithelial tumors was adopted for the eighth edition of the stage classification of malignant tumors. The Thymic Domain of the Staging and Prognostics Factor Committee of the International Association for the Study of Lung Cancer developed a new database with the purpose to make proposals for the ninth edition stage classification system. This article outlines the proposed definitions for the T categories for the ninth edition TNM stage classification of thymic malignancies. METHODS A worldwide collective database of 11,347 patients with thymic epithelial tumors was assembled. Analysis was performed on 9147 patients with available survival data. Overall survival, freedom-from-recurrence, and cumulative incidence of recurrence were used as outcome measures. Analysis was performed separately for thymomas, thymic carcinomas, and neuroendocrine thymic tumors. RESULTS Proposals for the T categories include the following: T1 category is divided into T1a (≤5 cm) and T1b (>5 cm), irrespective of mediastinal pleura invasion; T2 includes direct invasion of the pericardium, lung, or phrenic nerve; T3 denotes direct invasion of the brachiocephalic vein, superior vena cava, chest wall, or extrapericardial pulmonary arteries and veins; and T4 category remains the same as in the eighth edition classification, involving direct invasion of the aorta and arch vessels, intrapericardial pulmonary arteries and veins, myocardium, trachea, or esophagus. CONCLUSIONS The proposed T categories for the ninth edition of the TNM classification provide good discrimination in outcome for the T component of the TNM-based stage system of thymic epithelial tumors.
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Affiliation(s)
- Meinoshin Okumura
- National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Mirella Marino
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Vanessa Cilento
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Emily Goren
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | | | - Daniel Dibaba
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Usman Ahmad
- Thoracic Surgery in the Heart, Vascular & Thoracic Institute at Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | | | | | - Cecilia Brambilla
- Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Wentao Fang
- Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People's Republic of China
| | | | | | - Nicolas Girard
- Institut Curie, Thorax Institute Curie Montsouris, Paris, France; Paris Saclay University, UVSQ, Versailles, France
| | | | - James Huang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Dong Kwan Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Marco Lucchi
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ramon Rami-Porta
- Hospital Universitari Mutua Terrassa, Terrassa, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Hisao Asamura
- Keio University, Tokyo, Japan; Present Address: Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Roden AC, Judge M, den Bakker MA, Fang W, Jain D, Marx A, Moreira AL, Rajan A, Stroebel P, Szolkowska M, Cooper WA. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2023; 83:967-980. [PMID: 37722860 DOI: 10.1111/his.15047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
AIMS Thymic epithelial tumours (TET), including thymomas and thymic carcinomas and thymic neuroendocrine neoplasms, are malignant neoplasms that can be associated with morbidity and mortality. Recently, an updated version of the World Health Organization (WHO) Classification of Thoracic Tumours 5th Edition, 2021 has been released, which included various changes to the classification of these neoplasms. In addition, in 2017 the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC) published the 8th Edition Staging Manual which, for the first time, includes a TNM staging that is applicable to thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. METHODS AND RESULTS To standardize reporting of resected TET and thymic neuroendocrine neoplasms the accrediting bodies updated their reporting protocols. The International Collaboration on Cancer Reporting (ICCR), which represents a collaboration between various National Associations of Pathology, updated its 2017 histopathology reporting guide on TET and thymic neuroendocrine neoplasms accordingly. This report will highlight important changes in the reporting of TET and thymic neuroendocrine neoplasms based on the 2021 WHO, emphasize the 2017 TNM staging, and also comment on the rigour and various uncertainties for the pathologist when trying to follow that staging. CONCLUSION The ICCR dataset provides a comprehensive, standardized template for reporting of resected TET and thymic neuroendocrine neoplasms.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Michael A den Bakker
- Maasstad Hospital, Rotterdam, The Netherlands
- Academic Hospital Erasmus MC, Rotterdam, The Netherlands
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philipp Stroebel
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Malgorzata Szolkowska
- Department of Pathology, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, NSW, Sydney, Australia
- Institute of Medicine and Health Pathology, University of Sydney, NSW, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Sassorossi C, Bertoglio P, Lococo F, Santoro G, Meacci E, Nachira D, Congedo MT, Brandolini J, Petroncini M, Nocera A, Charles-Davies D, Solli P, Margaritora S, Chiappetta M. Unsolved Issues in Thymic Epithelial Tumour Stage Classification: The Role of Tumour Dimension. Diagnostics (Basel) 2023; 13:3468. [PMID: 37998604 PMCID: PMC10670816 DOI: 10.3390/diagnostics13223468] [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: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
According to the different classifications now in use, thymic tumours are staged by the extent of local invasiveness, and tumour size is not included as a major determinant for the T category. The aim of this double-site retrospective study is to analyse the correlation between tumour dimension and overall survival (OS) in patients who underwent surgical treatment. From January 2000 to December 2020, patients with thymic epithelial tumours who underwent surgical resection were included in this study. Data from a total of 332 patients were analysed. Five- and ten-year overall survival (5-10 YOS) was 89.26% and 87.08%, respectively, while five- and ten-year disease-free survival (DFS) was 88.12% and 84.2%, respectively. Univariate analysis showed a significant correlation between male sex (p-value 0.02), older age (p-value < 0.01), absence of myasthenia gravis (p-value < 0.01), increase in pTNM (pathological Tumor Node Metastasis) (p-value 0.03) and increase in the number of infiltrated organs (p-value 0.02) with an increase in tumour dimension. Tumour dimension alone was not effective in the prediction of DFS and OS, both when considered as a continuous variable and when considered with a cut-off of 3 and 5 cm. However, with multivariate analysis, it was effective in predicting OS in the aforementioned conditions (p-value < 0.01). Moreover, multivariate analysis was also used in the thymoma and Masaoka I subgroups. In our experience, the role of tumour dimension as a descriptor of the T parameter of the TNM (Tumor Node Metastasis) staging system seemed to be useful in improving this system.
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Affiliation(s)
- Carolina Sassorossi
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Pietro Bertoglio
- Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy; (P.B.); (J.B.); (M.P.); (P.S.)
- Chirurgia Toracica, Alma Mater Studiorum, Università di Bologna, 40126 Bologna, Italy
| | - Filippo Lococo
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gloria Santoro
- UOC di Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Elisa Meacci
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Dania Nachira
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Teresa Congedo
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Jury Brandolini
- Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy; (P.B.); (J.B.); (M.P.); (P.S.)
| | - Matteo Petroncini
- Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy; (P.B.); (J.B.); (M.P.); (P.S.)
| | - Adriana Nocera
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Diepriye Charles-Davies
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Agostino Gemelli, 00168 Roma, Italy;
| | - Piergiorgio Solli
- Divisione di Chirurgia Toracica IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy; (P.B.); (J.B.); (M.P.); (P.S.)
| | - Stefano Margaritora
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Chiappetta
- UOC di Chirurgia Toracica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (F.L.); (E.M.); (D.N.); (M.T.C.); (A.N.); (S.M.)
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Okumura M, Yoshino I, Funaki S, Okuda K, Watanabe SI, Tsuboi M, Shimizu K, Date H, Chen-Yoshikawa TF, Nakajima J, Toyooka S, Asamura H. Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database. Surg Today 2023; 53:1247-1259. [PMID: 37460670 DOI: 10.1007/s00595-023-02705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/06/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Patients with a thymic epithelial tumor (TET), comprising thymoma, thymic carcinoma (TC), and thymic neuroendocrine neoplasm (TNEN), are rarely encountered. The present study was conducted to determine the recent outcomes of surgical treatment for TET in Japan and clarify the significance of prognostic factors by analyzing a nationwide database created by the Japanese Association for Research on the Thymus (JART). METHODS The JART database includes records of 2471 thymoma, 285 TC, and 56 TNEN cases surgically treated between 1991 and 2010. At the time of the final follow-up examination, 439 patients had died, with tumor the cause of death in 188. The disease-specific survival was examined using the Kaplan-Meier method, with Cox's proportional hazards model utilized to determine independent prognostic factors. RESULTS The 10-year survival rate according to TNM-based Stage I, II, IIIA, IIIB, IVA, and IVB classification was 98.7%, 76.8%, 85.0%, 68.9%, 66.2%, and 59.8%, respectively. The T factor, M factor, and tumor size were independent prognostic factors in both thymoma and thymic carcinoma cases, while the N factor had tendency to be a prognostic factor in thymoma but not in thymic carcinoma cases. The WHO histological type was an independent factor in thymoma cases. CONCLUSION The significance of pathology and TNM classification as prognostic factors was confirmed.
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Affiliation(s)
- Meinoshin Okumura
- Department of General Thoracic Surgery, National Hospital Organization (NHO), Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuhiro Okuda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Rimner A, Ruffini E, Cilento V, Goren E, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Detterbeck F, Falkson C, Fang W, Filosso PL, Giaccone G, Girard N, Guerrera F, Huang J, Infante M, Kim DK, Lucchi M, Marino M, Marom EM, Nicholson AG, Okumura M, Rami-Porta R, Simone CB, Asamura H. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: An Overview of the Central Database Informing Revision of the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol 2023; 18:1386-1398. [PMID: 37702630 DOI: 10.1016/j.jtho.2023.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION In 2014, a TNM-based system for thymic epithelial tumors was proposed. The TNM stage classification system was published as a result of a joint project from the International Association for the Study of Lung Cancer and the International Thymic Malignancy Interest Group for the eighth edition of the American Joint Commission on Cancer and the Union for International Cancer Control stage classification system. The Thymic Domain of the Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer received the mandate to make proposals for the ninth edition of the TNM stage classification. METHODS A central thymic database was collected by the Cancer Research And Biostatistics with the contribution of the major thymic associations in the world. RESULTS A total of 11,347 patients were collected. Submitting organizations were the following: Japanese Association for Research in the Thymus, European Society of Thoracic Surgeons, Chinese Alliance for Research in Thymoma, Korean Association for Research in the Thymus, International Thymic Malignancy Interest Group, and Réseau tumeurs THYMiques et Cancer. Additional contributions came from centers in the United States, United Kingdom, Turkey, Australia, Spain, and Italy. A total of 9147 cases were eligible for analysis. Eligible cases for analysis came from Asia and Australia (5628 cases, 61.5%), Europe (3113 cases, 34.0%), and North America (406 cases, 4.4%). CONCLUSIONS This report provides an overview of the database that has informed the proposals for the updated T, N, and M components and the stage groups for the ninth TNM of malignant tumors.
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Affiliation(s)
- Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Vanessa Cilento
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Emily Goren
- Cancer Research And Biostatistics (CRAB), Seattle, Washington
| | - Usman Ahmad
- Thoracic Surgery in the Heart, Vascular & Thoracic Institute at Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | | | | | - Cecilia Brambilla
- Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Wentao Fang
- Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People's Republic of China
| | | | | | - Nicolas Girard
- Institut Curie, Thorax Institute Curie Montsouris, Paris, France; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Paris Saclay University, Versailles, France
| | | | - James Huang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Dong Kwan Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Marco Lucchi
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mirella Marino
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Meinoshin Okumura
- National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Ramon Rami-Porta
- Hospital Universitari Mutua Terrassa, Terrassa, Spain, and Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
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Sert F, Balci B, Ergonul AG, Yalman D, Ozkok S. Evaluation of the relationship between the eighth edition of TNM staging, the mMasoaka, and World Health Organization histopathological classification for thymoma. J Cancer Res Ther 2023; 19:2025-2030. [PMID: 37727012 DOI: 10.4103/jcrt.jcrt_865_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022]
Abstract
AIM OF STUDY The aim of this study was to describe the correlation between the eighth tumor, node, and metastasis (TNM), mMasaoka staging, and the World Health Organization (WHO) histopathologic classification and to identify prognostic values in predicting survival and recurrence of thymoma. MATERIALS AND METHODS Medical files of 90 patients with thymoma diagnosed between 1992 and 2018 were evaluated for this trial. RESULTS The distributions of patients were similar between mMasaoka and eighth TNM staging according to early (I, II) and advanced stages (IIIA, IIIB, IV). Interestingly, 55 of 63 stage I patients with TNM staging showed difference as 31 of them up-staged to stage IIA and 24 of them up-staged to stage IIB in mMasoaka staging. Both staging systems closely correlated with WHO classification (p < 0.001); stages I and II were associated with low-risk groups (type A, AB, B1), and stages III and IV were associated with high-risk groups (type B2, B3). WHO classification was not a prognostic factor for overall survival (OS) ( P = 0.13) and progression-free survival (PFS) (p = 0.08), but it was a prognostic factor for 10-year cancer-specific survival (CSS) (p = 0.04). Myasthenia gravis was associated to early stages (stage I, II) (p = 0.007) and related with better prognosis. CONCLUSIONS Our study showed a correlation between both staging system and WHO classification. A certain difference was found between eighth TNM staging and the mMasoaka staging in terms of stage I disease. Both staging systems effectively prognosticated OS, CSS, and PFS. To clarify the prognostic relevance and clinical usefulness of the WHO classification may be beneficial in clinical practice for the treatment decision.
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Affiliation(s)
- Fatma Sert
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Beril Balci
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Ayse Gul Ergonul
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Deniz Yalman
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Ozkok
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
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Alqaidy D. Thymoma: An Overview. Diagnostics (Basel) 2023; 13:2982. [PMID: 37761349 PMCID: PMC10527963 DOI: 10.3390/diagnostics13182982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Thymomas are considered one of the most prevalent types of mediastinal epithelial tumors, which frequently develop in the anterior mediastinum. Due to their rarity, these tumors' nomenclature, classification, and staging are likely to be the subject of debate and argument for most expert pathologists. Furthermore, the significance of thymoma histologic classifications have been debated over the past twenty years. While certain advocates argue that staging at the time of diagnosis is more significant, others believe that histologic subtyping has a significant impact on how patients behave clinically. In this review, we will focus on some of the challenges that diagnostic surgical pathologists may experience while evaluating the histopathology of thymomas and staging these tumors. We will additionally glance over the clinical characteristics of these distinct tumors and the current management strategy.
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Affiliation(s)
- Doaa Alqaidy
- Department of Pathology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Ma YH, Zhang J, Yan WQ, Lan JT, Feng XL, Wang SM, Yang G, Hu YC, Cui GB. Risk factor analysis for major mediastinal vessel invasion in thymic epithelial tumors based on multi-slice CT Imaging. Front Oncol 2023; 13:1239419. [PMID: 37752995 PMCID: PMC10518454 DOI: 10.3389/fonc.2023.1239419] [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: 06/13/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Objective To explore the characteristics and risk factors for major mediastinal vessel invasion in different risk grades of thymic epithelial tumors (TETs) based on computed tomography (CT) imaging, and to develop prediction models of major mediastinal artery and vein invasion. Methods One hundred and twenty-two TET patients confirmed by histopathological analysis who underwent thorax CT were enrolled in this study. Clinical and CT data were retrospectively reviewed for these patients. According to the abutment degree between the tumor and major mediastinal vessels, the arterial invasion was divided into grade I, II, and III (< 25%, 25 - 49%, and ≥ 50%, respectively); the venous invasion was divided into grade I and II (< 50% and ≥ 50%). The degree of vessel invasion was compared among different defined subtypes or stages of TETs using the chi-square tests. The risk factors associated with TET vascular invasion were identified using multivariate logistic regression analysis. Results Based on logistic regression analysis, male patients (β = 1.549; odds ratio, 4.824) and the pericardium or pleural invasion (β = 2.209; odds ratio, 9.110) were independent predictors of 25% artery invasion, and the midline location (β = 2.504; odds ratio, 12.234) and mediastinal lymphadenopathy (β = 2.490; odds ratio, 12.06) were independent predictors of 50% artery invasion. As for 50% venous invasion, the risk factors include midline location (β = 2.303; odds ratio, 10.0), maximum tumor diameter larger than 5.9 cm (β = 4.038; odds ratio, 56.736), and pericardial or pleural effusion (β = 1.460; odds ratio, 4.306). The multivariate logistic model obtained relatively high predicting efficacy, and the area under the curve (AUC), sensitivity, and specificity were 0.944, 84.6%, and 91.7% for predicting 50% artery invasion, and 0.913, 81.8%, and 86.0% for 50% venous invasion in TET patients, respectively. Conclusion Several CT features can be used as independent predictors of ≥50% artery or venous invasion. A multivariate logistic regression model based on CT features is helpful in predicting the vascular invasion grades in patients with TET.
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Affiliation(s)
- Yu-Hui Ma
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi’an, Shaanxi, China
| | - Jie Zhang
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Wei-Qiang Yan
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Jiang-Tao Lan
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Xiu-Long Feng
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Shu-Mei Wang
- Department of Pathology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Guang Yang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
| | - Yu-Chuan Hu
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi’an, Shaanxi, China
| | - Guang-Bin Cui
- Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, Shaanxi, China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi’an, Shaanxi, China
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Pardini E, Cucchiara F, Palumbo S, Tarrini G, Di Vita A, Coppedè F, Nicolì V, Guida M, Maestri M, Ricciardi R, Aprile V, Ambrogi MC, Barachini S, Lucchi M, Petrini I. Somatic mutations of thymic epithelial tumors with myasthenia gravis. Front Oncol 2023; 13:1224491. [PMID: 37671056 PMCID: PMC10475716 DOI: 10.3389/fonc.2023.1224491] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/14/2023] [Indexed: 09/07/2023] Open
Abstract
Background Thymic epithelial tumors are rare malignant neoplasms that are frequently associated with paraneoplastic syndromes, especially myasthenia gravis. GTF2I is an oncogene mutated in a subgroup of thymomas that is reputed to drive their growth. However, for GTF2I wild-type tumors, the relevant mutations remain to be identified. Methods We performed a meta-analysis and identified 4,208 mutations in 339 patients. We defined a panel of 63 genes frequently mutated in thymic epithelial tumors, which we used to design a custom assay for next-generation sequencing. We sequenced tumor DNA from 67 thymomas of patients with myasthenia gravis who underwent resection in our institution. Results Among the 67 thymomas, there were 238 mutations, 83 of which were in coding sequences. There were 14 GTF2I mutations in 6 A, 5 AB, 2 B2 thymomas, and one in a thymoma with unspecified histology. No other oncogenes showed recurrent mutations, while sixteen tumor suppressor genes were predicted to be inactivated. Even with a dedicated assay for the identification of specific somatic mutations in thymic epithelial tumors, only GTF2I mutations were found to be significantly recurrent. Conclusion Our evaluation provides insights into the mutational landscape of thymic epithelial tumors, identifies recurrent mutations in different histotypes, and describes the design and implementation of a custom panel for targeted resequencing. These findings contribute to a better understanding of the genetic basis of thymic epithelial tumors and may have implications for future research and treatment strategies.
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Affiliation(s)
- Eleonora Pardini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Federico Cucchiara
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Sara Palumbo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Tarrini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Alessia Di Vita
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Fabio Coppedè
- Medical Genetics, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Vanessa Nicolì
- Medical Genetics, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Melania Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Ricciardi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Aprile
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Marcello C. Ambrogi
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Serena Barachini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Iacopo Petrini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
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Mix L, Knoll M, Häring MF, Bethge WA, Schröder JC, Forchhammer S, Krumm P, Schürch CM, Schaller M, Lengerke C. Case Report: Paraneoplastic psoriasis in thymic carcinoma. Front Oncol 2023; 13:1218517. [PMID: 37655107 PMCID: PMC10466787 DOI: 10.3389/fonc.2023.1218517] [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: 05/07/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Thymic carcinomas are exceedingly rare and very aggressive malignancies of the anterior mediastinum. While thymomas exhibit a high association with paraneoplastic syndromes, these phenomena are a rarity in thymic carcinomas. In general, acanthotic syndromes such as acroceratosis neoplastica and acanthosis nigricans maligna are commonly observed as paraneoplastic phenomena in patients with carcinomas. In contrast, psoriasis vulgaris, another acanthotic disease, rarely occurs as a paraneoplasia. We report the case of a 36-year-old patient with progressive thymic carcinoma (undifferentiated carcinoma, T3N2M1a) and paraneoplastic psoriasis occurring ten months before the initial diagnosis of the carcinoma. Over the course of the disease, new psoriatic flares heralded relapse or progression of the carcinoma. To our knowledge, this is the first reported case of paraneoplastic psoriasis in thymic carcinoma.
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Affiliation(s)
- Lucas Mix
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Manuel Knoll
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Max-Felix Häring
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Wolfgang Andreas Bethge
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Jan C. Schröder
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | | | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Christian M. Schürch
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Martin Schaller
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Claudia Lengerke
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
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Tamburini N, D'Urbano F, Bagolini F, Trapella GS, Quarantotto F, Cavallesco G, Maniscalco P. Unilateral Thoracoscopic Thymectomy for Thymoma: Does Side Matter? A Single Institutional Experience. Thorac Cardiovasc Surg 2023; 71:418-424. [PMID: 34521142 DOI: 10.1055/s-0041-1731778] [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: 10/20/2022]
Abstract
BACKGROUND Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased intraoperative blood loss, and fewer complications compared with transsternal thymectomy. Unilateral video-assisted thoracic surgery (VATS) thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. However, the side that provides better outcomes remains controversial. The purpose of this study was to compare the efficacy of right and left approaches in performing unilateral thoracoscopic thymectomy for thymoma. METHODS Consecutive patients affected by thymoma who underwent VATS thymectomy on either side between February 2001 and March 2020 were enrolled in the study. Clinicopathologic, surgical, and oncological outcomes were retrospectively analyzed and compared among the two surgical approaches. RESULTS Unilateral VATS approaches were performed on 29 patients: 12 (41%) on the left side and 17 (59%) on the right side. The mean age was 63.1 ± 11.3 years and the female/male ratio was 1.73:1. The mean operative time and the hospital stay for the left-side VATS and right-side VATS groups were, respectively, 168 ± 49.5 versus 171 ± 47.9 minutes (p = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days (p = 0.7). Postoperative complications occurred in one patient (3%) for left-side VATS group and one patient (3%) for right-side VATS. The 5-year disease-free survival was comparable between two groups (p = 0.74). CONCLUSION Unilateral VATS thymectomy in patients with thymoma can be safely and effectively performed by experienced surgeons in either side of the thorax with equivalent oncological outcomes.
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Affiliation(s)
- Nicola Tamburini
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Francesco D'Urbano
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Francesco Bagolini
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Giulia Salerno Trapella
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Francesco Quarantotto
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Giorgio Cavallesco
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Pio Maniscalco
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
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Huang YY, Liu X, Liang SH, Wu LL, Ma GW. Nomogram predicts the prognosis of patients with thymic carcinoma: A population-based study using SEER data. TUMORI JOURNAL 2023; 109:282-294. [PMID: 35897150 DOI: 10.1177/03008916221109334] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thymic carcinoma (TC) is a rare malignant tumor that can have a poor prognosis, and accurate prognostication prediction remains difficult. We aimed to develop a nomogram to predict overall survival (OS) and cancer-specific survival (CSS) based on a large cohort of patients. METHODS The Surveillance Epidemiology and End Results (SEER) database was searched to identify TC patients (1975-2016). Univariate and multivariable Cox regression analyses were used to identify predictors of OS and CSS, which were used to construct nomograms. The nomograms were evaluated using the concordance index (C-index), calibration curve, receiver operating characteristic curve, and decision curve analysis (DCA). Subgroup analysis was performed to identify high-risk patients. RESULTS The analysis identified six predictors of OS (Masaoka stage, surgical method, lymph node metastasis, liver metastasis, bone metastasis, and radiotherapy) and five predictors of CSS (Masaoka stage, surgical method, lymph node metastasis, tumor size, and brain metastasis), which were used to create nomograms for predicting three-year and five-year OS and CSS. The nomograms had reasonable C-index values (OS: 0.687 [training] and 0.674 [validation], CSS: 0.712 [training] and 0.739 [validation]). The DCA curve revealed that the nomograms were better for predicting OS and CSS, relative to the Masaoka staging system. CONCLUSION We developed nomograms using eight clinicopathological factors that predicted OS and CSS among TC patients. The nomograms performed better than the traditional Masaoka staging system and could identify high-risk patients. Based on the nomograms' performance, we believe they will be useful prognostication tools for TC patients.
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Affiliation(s)
- Yang-Yu Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xuan Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shen-Hua Liang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guo-Wei Ma
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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