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European Journal of Cardio-thoracic... Apr 2015Observational studies on long-term outcomes following debulking surgery or surgical biopsy for unresectable thymoma showed various results. This meta-analysis was... (Meta-Analysis)
Meta-Analysis Review
Observational studies on long-term outcomes following debulking surgery or surgical biopsy for unresectable thymoma showed various results. This meta-analysis was designed to determine the effect of debulking surgery against surgical biopsy on overall survival in patients with unresectable thymoma. The PubMed database was queried for studies published in the English language on unresectable thymoma and overall survival. We compared overall survival following surgery in patients undergoing debulking surgery and patients undergoing surgical biopsy for unresectable thymoma. Meta-analysis was performed using the Mantel-Haenszel method, and potential publication bias was evaluated with a funnel plot of precision. No randomized trials on this topic were identified. Thirteen retrospective observational studies containing a sum of 314 patients with information on the number of deaths and person-years were suitable for analysis. Information on Masaoka stages, World Health Organization histology and indications for debulking surgery versus surgical biopsy was lacking in most studies. Diversity of neoadjuvant and adjuvant treatments was noted among the eligible studies. One hundred and seventy-two (54.8%) patients underwent debulking surgery and 142 (45.2%) underwent surgical biopsy. The pooled hazard ratio was 0.451 (95% confidence interval: 0.336-0.605, P < 0.001), favouring patients undergoing debulking surgery compared with patients undergoing surgical biopsy. The funnel plot of precision demonstrated no important publication bias. Our results suggest that debulking surgery for unresectable thymoma may be associated with improved overall survival and be considered for patients with unresectable thymoma.
Topics: Biopsy; Humans; Postoperative Complications; Survival Analysis; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 25015950
DOI: 10.1093/ejcts/ezu277 -
Thoracic Cancer May 2023This study aimed to examine the treatment and prognosis of patients with type B2 + B3 thymoma and compare it with those patients with type B2 and B3 thymoma.
BACKGROUND
This study aimed to examine the treatment and prognosis of patients with type B2 + B3 thymoma and compare it with those patients with type B2 and B3 thymoma.
METHODS
We conducted a retrospective analysis of the results of 39 patients with type B2 + B3 thymoma, 133 patients with type B2 thymoma, and 64 patients with type B3 thymoma. The Kaplan-Meier technique was used to generate survival curves. For multivariate analysis, the Cox proportional hazard model was applied.
RESULTS
With a median follow-up of 60 months (range: 1-128 months), the percentage of patients with tumor, node, metastasis (TNM) stage III and IV disease gradually increased from 19.5% to 25.6% to 35.9% among those with histological subtypes B2, B2 + B3, and B3, respectively, p = 0.045. Twenty-three patients experienced recurrence or metastasis. The total 10-year progression-free survival (PFS) rates were 86.0% overall (85.0% in type B2, 87.2% in type B2 + B3, and 87.5% in type B3). Age, R0 resection, and Masaoka-Koga stage were found to have a significant on PFS in all patients. There was no statistically significant difference in PFS between different histotypes of thymoma, p = 0.650. PFS was predicted by R0 resection in all histotypes and by the Masaoka-Koga stage in the type B2 subgroup.
CONCLUSION
Combining the two staging methods to guide the diagnosis and treatment of patients with B2 + B3 thymoma is recommended. R0 resection is recommended to reduce recurrence. Patients with B2 + B3 thymoma have a prognosis similar to those with a B2 thymoma or a B3 thymoma alone.
Topics: Humans; Thymoma; Retrospective Studies; Thymus Neoplasms; Prognosis; Progression-Free Survival; Neoplasm Staging; Treatment Outcome
PubMed: 37037477
DOI: 10.1111/1759-7714.14875 -
Thoracic Cancer Dec 2022Thymic epithelial tumors (TET) are a group of rare neoplasms of the anterior mediastinum comprising thymomas and thymic carcinomas. The carcinogenesis of TET is mostly... (Review)
Review
Thymic epithelial tumors (TET) are a group of rare neoplasms of the anterior mediastinum comprising thymomas and thymic carcinomas. The carcinogenesis of TET is mostly unknown. Many studies, mostly retrospective case series, have tried to establish prognostic factors in TET. TET is a very heterogeneous group of tumors with many subtypes for which diagnosis and treatment remains a very challenging task. Despite the disparities among retrospective studies, there are some prognostic factors that are more pertinent such as the completeness of resection, TNM stage and the Masaoka-Koga classification. On the other hand, the identification of different genetic pathways that result in the pathogenesis of TET represents a fascinating field of study that could possibly lead to the development of new targeted therapies. The aim of this review is to discuss the different prognostic factors and genetic markers of TET. The meticulous use of national and international databases could provide sufficient number of patients in order to draw more valid conclusions.
Topics: Humans; Prognosis; Retrospective Studies; Genetic Markers; Neoplasm Staging; Thymus Neoplasms; Thymoma; Neoplasms, Glandular and Epithelial
PubMed: 36349433
DOI: 10.1111/1759-7714.14725 -
BMC Medical Imaging Mar 2022To validate a contrast-enhanced CT (CECT)-based radiomics model (RM) for differentiating various risk subgroups of thymic epithelial tumors (TETs).
BACKGROUND
To validate a contrast-enhanced CT (CECT)-based radiomics model (RM) for differentiating various risk subgroups of thymic epithelial tumors (TETs).
METHODS
A retrospective study was performed on 164 patients with TETs who underwent CECT scans before treatment. A total of 130 patients (approximately 79%, from 2012 to 2018) were designated as the training set, and 34 patients (approximately 21%, from 2019 to 2021) were designated as the testing set. The analysis of variance and least absolute shrinkage and selection operator algorithm methods were used to select the radiomics features. A logistic regression classifier was constructed to identify various subgroups of TETs. The predictive performance of RMs was evaluated based on receiver operating characteristic (ROC) curve analyses.
RESULTS
Two RMs included 16 and 13 radiomics features to identify three risk subgroups of traditional risk grouping [low-risk thymomas (LRT: Types A, AB and B1), high-risk thymomas (HRT: Types B2 and B3), thymic carcinoma (TC)] and improved risk grouping [LRT* (Types A and AB), HRT* (Types B1, B2 and B3), TC], respectively. For traditional risk grouping, the areas under the ROC curves (AUCs) of LRT, HRT, and TC were 0.795, 0.851, and 0.860, respectively, the accuracy was 0.65 in the training set, the AUCs were 0.621, 0.754, and 0.500, respectively, and the accuracy was 0.47 in the testing set. For improved risk grouping, the AUCs of LRT*, HRT*, and TC were 0.855, 0.862, and 0.869, respectively, and the accuracy was 0.72 in the training set; the AUCs were 0.778, 0.716, and 0.879, respectively, and the accuracy was 0.62 in the testing set.
CONCLUSIONS
CECT-based RMs help to differentiate three risk subgroups of TETs, and RM established according to improved risk grouping performed better than traditional risk grouping.
Topics: Humans; Neoplasms, Glandular and Epithelial; Retrospective Studies; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 35249531
DOI: 10.1186/s12880-022-00768-8 -
Thoracic Cancer Nov 2019Thymic carcinomas (TCs) are rare aggressive tumors with no standard first-line treatment. This study was conducted to determine the optimal chemotherapy regimen for...
BACKGROUND
Thymic carcinomas (TCs) are rare aggressive tumors with no standard first-line treatment. This study was conducted to determine the optimal chemotherapy regimen for advanced TC.
METHODS
This retrospective study included 67 patients treated for stage IV TC in 2006-2015. The primary endpoints were the objective response rate (ORR) and progression-free survival (PFS) with different chemotherapy regimens. Multivariate Cox regression analysis was used to identify factors associated with PFS, including metastatic status, radiotherapy post-chemotherapy, primary lesion resection before chemotherapy, and chemotherapy regimen.
RESULTS
A total of 36 patients received a paclitaxel-platinum regimen, 31 received a gemcitabine-platinum regimen, 14 underwent primary lesion resection, and 33 underwent radiotherapy. ORR was 31% (11/36) and 29% (9/31) in the paclitaxel-platinum and gemcitabine-platinum groups, respectively (P = 0.890). Median PFS, one-year PFS rate, and two-year PFS rate were 7.0 months, 26%, and 6% with paclitaxel-platinum treatment and 12 months, 48%, and 24% with gemcitabine-platinum treatment (log-rank P = 0.030). Median PFS, one-year PFS rate, and two-year PFS rate were 18.0 months, 57%, and 33% with surgical resection and 7.3 months, 31%, and 7% without resection (log-rank P = 0.030). Median PFS, one-year PFS rate, and two-year PFS rate were 13.0 months, 52%, and 20% with radiotherapy and 4.3 months, 22%, and 7% without radiotherapy (log-rank P = 0.001). In multivariate analysis, metastatic status (hazard ratio [HR], 0.33, P = 0.004), surgical resection (HR, 0.32; P = 0.004), and radiotherapy (HR, 0.32; P < 0.001) were associated with superior PFS.
CONCLUSIONS
Both gemcitabine-platinum and paclitaxel-platinum regimens were efficacious for advanced TC. Primary lesion resection and radiotherapy may also benefit selected patients.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemoradiotherapy, Adjuvant; Combined Modality Therapy; Deoxycytidine; Female; Humans; Male; Middle Aged; Neoplasm Staging; Organoplatinum Compounds; Paclitaxel; Retrospective Studies; Survival Analysis; Thymoma; Thymus Neoplasms; Treatment Outcome; Young Adult; Gemcitabine
PubMed: 31574576
DOI: 10.1111/1759-7714.13181 -
Virchows Archiv : An International... Jan 2021Thymomas exhibit a unique genomic landscape, comprising the lowest on average total mutational burden among adult human cancers; a unique point mutation in the GTF2I... (Review)
Review
Thymomas exhibit a unique genomic landscape, comprising the lowest on average total mutational burden among adult human cancers; a unique point mutation in the GTF2I gene in WHO type A and AB thymomas (and rarely others); almost unique KMT2A-MAML2 translocations in rare WHO type B2 and B3 thymomas; a unique YAP1-MAML2 translocation in almost all metaplastic thymomas; and unique miRNA profiles in relation to GTF2I mutational status and WHO histotypes. While most thymomas can be diagnosed solely on the basis of morphological features, mutational analyses can solve challenging differential diagnostic problems. No molecular biomarkers have been identified that predict the response of unresectable thymomas to chemotherapy or agents with known molecular targets. Despite the common and strong expression of PDL1 in thymomas, immune checkpoint inhibitors are rarely applicable due to the poor predictability of common, life-threatening autoimmune side effects that are related to the unrivaled propensity of thymomas towards autoimmunity.
Topics: Biomarkers, Tumor; DNA Mutational Analysis; Humans; Mutation; Pathology, Molecular; Thymoma; Thymus Neoplasms
PubMed: 33674910
DOI: 10.1007/s00428-021-03068-8 -
Scientific Reports Feb 2024B-cell subsets in peripheral blood (PB) and tumor microenvironment (TME) were evaluated to determine myasthenia gravis (MG) severity in patients with thymoma-associated...
B-cell subsets in peripheral blood (PB) and tumor microenvironment (TME) were evaluated to determine myasthenia gravis (MG) severity in patients with thymoma-associated MG (TMG) and the distribution of B cells in type B TMG. The distribution of mature B cells, including Bm1-Bm5, CD19 and CD20 B cells and non-switched (NSMBCs) and switched (SMBCs) memory B cells, were determined in 79 patients with thymoma or TMG. Quantitative relationships between the T and TMG groups and the TMG-low and TMG-high subgroups were determined. NSMBCs and SMBCs were compared in TME and PB. Type B thymoma was more likely to develop into MG, with types B2 and B3 being especially associated with MG worsening. The percentage of CD19 B cells in PB gradually increased, whereas the percentage of CD20 B cells and the CD19/CD20 ratio were not altered. The (Bm2 + Bm2')/(eBm5 + Bm5) index was significantly higher in the TMG-high than in thymoma group. The difference between SMBC/CD19 and NSMBC/CD19 B cell ratios was significantly lower in the thymoma than TMG group. NSMBCs assembled around tertiary lymphoid tissue in thymomas of patients with TMG. Few NSMBCs were observed in patients with thymoma alone, with these cells being diffusely distributed. MG severity in patients with TMG can be determined by measuring CD19 B cells and Bm1-Bm5 in PB. The CD19/CD20 ratio is a marker of disease severity in TMG patients. Differences between NSMBCs and SMBCs in PB and TME of thymomas can synergistically determine MG severity in patients with TMG.
Topics: Humans; Thymoma; B-Lymphocyte Subsets; Thymus Neoplasms; B-Lymphocytes; Myasthenia Gravis; Tumor Microenvironment
PubMed: 38302676
DOI: 10.1038/s41598-024-53250-6 -
The Journal of Thoracic and... Apr 2021
Topics: Humans; Neoplasm Staging; Thymoma; Thymus Neoplasms
PubMed: 33293061
DOI: 10.1016/j.jtcvs.2020.11.009 -
Internal Medicine (Tokyo, Japan) Sep 2023
Topics: Humans; Cardiac Tamponade; Thymoma; Thymus Neoplasms; Pericardial Effusion
PubMed: 36642518
DOI: 10.2169/internalmedicine.0903-22 -
BMC Cancer Sep 2020Role of biomarkers for promotion of tumor proliferation (BPTPs) and for promotion of apoptosis (BPAs) in thymic malignant tumors is still unclear. The purpose of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Role of biomarkers for promotion of tumor proliferation (BPTPs) and for promotion of apoptosis (BPAs) in thymic malignant tumors is still unclear. The purpose of this study was to evaluate the relationship between BPTPs and/or BPAs and malignancy of thymic malignant tumors.
METHODS
Studies on thymic malignant tumors and biomarkers were searched in PubMed, ISI Web of Knowledge, and Embase databases, and all statistical analyses were conducted using Review Manager.
RESULTS
Twelve articles related to biomarkers and thymic malignant tumors were selected and analyzed. A relationship between BPAs and Masaoka stage was demonstrated for four markers, namely Bax, p73, Casp-9 and Bcl-2, included 138 stage I/II patients and 74 stage III/IV patients, and BPAs were significantly correlated with high Masaoka staging (P = 0.03). We further found a relationship between BPAs and degree of malignancy for four markers, namely Bax, p73, Casp-9 and Bcl-2, included 176 thymoma patients and 36 thymic carcinoma patients, and BPAs were significantly correlated with thymic carcinoma (P = 0.010). In addition, a relationship between BPTP and Masaoka staging was demonstrated for seven markers, namely Podoplanin, Glut-1, Muc-1, Egfr, Igf1r, c-Jun, and n-Ras, included 373 patients with stage I/II and 212 patients with stage III/IV, and BPTPs were significantly correlated with high Masaoka staging (P < 0.001). We also found a relationship between BPTPs and degree of malignancy for ten markers, namely Mesothelin, c-Kit (CD117), Egfr, Lat-1, Muc-1,Ema, Glut-1, Igf1r, c-Jun, and n-Ras, included 748 thymoma patients and 280 thymic carcinoma patients, and BPTPs were significantly correlated with thymic carcinoma (P < 0.001).
CONCLUSION
These findings show that high levels of BPTPs or BPAs are more closely related to thymic carcinoma and Masaoka stage III/IV, suggesting that BPTPs and BPAs may play an important role in the occurrence and development of thymic malignant tumors.
Topics: Adult; Aged; Apoptosis; Biomarkers, Tumor; Caspase 9; Cell Proliferation; Female; Humans; Male; Middle Aged; Neoplasm Staging; Proto-Oncogene Proteins c-bcl-2; Thymoma; Thymus Neoplasms; Tumor Protein p73; bcl-2-Associated X Protein
PubMed: 32993581
DOI: 10.1186/s12885-020-07332-z