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Treatment Modalities and Outcomes in Patients With Advanced Invasive Thymoma or Thymic Carcinoma: A Retrospective Multicenter Study.

ABSTRACT: We investigated the relationships between treatment characteristics and long-term outcomes in patients with locally advanced thymoma or thymic carcinoma.We retrospectively reviewed 146 patients treated from 1980 to 2011 at 2 tertiary cancer care centers, 110 with Masaoka-Koga stages III to IVA invasive thymoma and 36 with stages I to IVA thymic carcinoma. Survival probabilities were estimated using the Kaplan-Meier method. Risk factors related to survival were identified by univariate and multivariate competing risk analysis, with overall survival (OS) as the competing risk. The Cox regression analysis was used to identify risk factors for OS.Median follow-up time for all patients was 64 months. At 5 and 10 years, rates of OS and freedom from recurrence (FFR) were 81% and 58% and 81% and 65%, respectively. Of the patients who underwent surgery, trimodality treatment produced better survival compared with less aggressive treatment among patients with stage III disease (P=0.03). Among patients who underwent trimodality treatment, patients with stage III disease had better OS (P=0.03) and FFR (P<0.001) than those with stage IVA disease. On Cox regression analysis, decreased OS was associated with thymic carcinoma (hazard ratio [HR], 7.36; 95% confidence interval [CI], 2.38-22.77; P=0.001), R2/unresectable disease (HR, 8.45; 95% CI, 1.44-49.42; P=0.02), and an Eastern Cooperative Oncology Group performance score of 1 (HR, 8.14; 95% CI, 1.55-42.75; P=0.01) or 2 to 3 (HR, 29.60; 95% CI, 4.0-218.98; P=0.001) versus 0.Aggressive treatment with chemotherapy, surgical resection, and postoperative radiation therapy can produce long-term survival for patients with invasive thymic malignancies.

SUBMITTER: Modh A

PROVIDER: S-EPMC5007217 | biostudies-other | 2016 Apr

REPOSITORIES: biostudies-other

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Treatment Modalities and Outcomes in Patients With Advanced Invasive Thymoma or Thymic Carcinoma: A Retrospective Multicenter Study.

Modh Ankit A Rimner Andreas A Allen Pamela K PK Greenfield Brad B Marom Edith M EM Rice David D Huang James J Rosenzweig Kenneth E KE Komaki Ritsuko R Gomez Daniel R DR

American journal of clinical oncology 20160401 2

<h4>Introduction</h4>We investigated the relationships between treatment characteristics and long-term outcomes in patients with locally advanced thymoma or thymic carcinoma.<h4>Methods</h4>We retrospectively reviewed 146 patients treated from 1980 to 2011 at 2 tertiary cancer care centers, 110 with Masaoka-Koga stages III to IVA invasive thymoma and 36 with stages I to IVA thymic carcinoma. Survival probabilities were estimated using the Kaplan-Meier method. Risk factors related to survival wer ...[more]

PMID: 24390276

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Project description:BackgroundCurrently there is no standard therapy recommended for second-line treatment for thymic carcinoma. Our study compared multidrug chemotherapy, single-agent chemotherapy, and PD-1 inhibitors in patients diagnosed with advanced thymic carcinoma who had previous platinum-based chemotherapy at the clinic.MethodsThe study included patients with thymic carcinoma who failed first-line platinum-based chemotherapy. Kaplan-Meier methods were applied in the study for estimating the progression-free survival (PFS) and overall survival (OS) curves. Pearson chi-square or Fisher's exact chi-square test was adopted to make comparisons of the objective response rate (ORR) between treatment groups. Cox regression was used for the multivariate analyses in PFS and OS.ResultsAmong the 92 patients enrolled, multidrug chemotherapy was used in 51 (55.4%) patients for second-line therapy. Thirty-six patients (35.9%) received single-agent chemotherapy, and eight patients (8.7%) underwent PD-1 inhibitors. The multidrug chemotherapy group showed better efficacy than the other two groups, with an ORR of 35.3% (p = 0.006). The median PFS of multidrug chemotherapy, single-agent chemotherapy and PD-1 inhibitors were 5.0 months, 3.0 months, and 4.0 months, respectively (p = 0.008). Patients in the multidrug chemotherapy group also showed an advantage in OS in comparison with the other two treatment groups (p = 0.045), with a median OS of 30.4 months. Multivariate analysis showed that second-line treatment was independent factor for both PFS (p = 0.035) and OS (p = 0.037). Grade 3-4 AEs were mostly detected in patients receiving multidrug chemotherapy and were primarily hematologic. Treatment-related mortality was not found in any of the groups.ConclusionsMultidrug chemotherapy had a trend toward a more positive response rate and outcomes in longer survival time than single-agent chemotherapy and PD-1 inhibitors. Multidrug chemotherapy is a choice worth considering for second-line therapy in patients with thymic carcinoma if tolerable.

Project description:BackgroundThe purpose of our study was to differentiate between thymoma and thymic carcinoma using a radiomics analysis based on the computed tomography (CT) image features.MethodsThe CT images of 61 patients with thymic epithelial tumors (TETs) who underwent contrast-enhanced CT with slice thickness <1 mm were analyzed. Pathological examination of the surgical specimens revealed thymoma in 45 and thymic carcinoma in 16. Tumor volume and the ratio of major axis to minor axis were calculated using a computer-aided diagnostic software. Sixty-one different radiomics features in the segmented CT images were extracted, then filtered and minimized by least absolute shrinkage and selection operator (LASSO) regression to select the optimal radiomics features for predicting thymic carcinoma. The association between the quantitative values and a diagnosis of thymic carcinoma were analyzed with logistic regression models. Parameters identified as significant in univariate analysis were included in multiple analyses. Receiver-operating characteristic (ROC) curves were assessed to evaluate the diagnostic performance.ResultsThymic carcinoma was significantly predominant in men (P=0.001). Optimal radiomics features for predicting thymic carcinoma were as follows: gray-level co-occurrence matrix (GLCM)-homogeneity, GLCM-energy, compactness, large zone high gray-level emphasis (LZHGE), solidity, size of minor axis, and kurtosis. Multiple logistic regression analysis of these features revealed solidity and GLCM-energy as independent indicators associated with thymic carcinoma [odds ratio, 14.7 and 14.3; 95% confidence interval (CI): 1.6-139.0 and 3.0-68.7; and P=0.045 and 0.002, respectively]. Area under the curve (AUC) for diagnosing thymic carcinoma was 0.882 (sensitivity, 81.2%; specificity, 91.1%). Multivariate analysis adjusted for sex similarly revealed two features (solidity and GLCM-energy) as independent indicators associated with thymic carcinoma (odds ratio, 14.6 and 23.9; 95% CI: 2.4-89.2 and 1.9-302.8; P=0.004 and 0.014, respectively). Adjusted AUC for diagnosing thymic carcinoma was 0.921 (95% CI: 0.82-0.97): sensitivity, 62.5% and specificity, 100%.ConclusionsTwo texture features (GLCM-energy and solidity) were significant predictors of thymic carcinoma.

Project description:Background: More and more elderly patients are being diagnosed with arteriovenous malformation (AVM) in this global aging society, while the treatment strategy remains controversial among these aging population. This study aimed to clarify the long-term outcomes of elderly AVMs after different management modalities. Methods: The authors retrospectively reviewed 71 elderly AVMs (>60 years) in two tertiary neurosurgery centers between 2011 and 2019. Patients were divided into four groups: conservation, microsurgery, embolization, and stereotactic radiosurgery (SRS). The perioperative complications, short-term and long-term neurological outcomes, obliteration rates, annualized rupture risk, and mortality rates were compared among different management modalities in the ruptured and unruptured subgroups. Kaplan-Meier survival analysis was employed to compare the death-free survival rates among different management modalities. Logistic regression analyses were conducted to calculate the odds ratios (ORs) and 95% confidence intervals (CI) for predictors of long-term unfavorable outcomes (mRS > 2). Results: A total of 71 elderly AVMs were followed up for an average of 4.2 ± 2.3 years. Fifty-four (76.1%) presented with hemorrhage, and the preoperative annualized rupture risk was 9.4%. Among these patients, 21 cases (29.6%) received conservative treatment, 30 (42.3%) underwent microsurgical resection, 13 (18.3%) received embolization, and 7 (9.9%) underwent SRS. In the prognostic comparison, the short-term and long-term neurological outcomes were similar between conservation and intervention both in the ruptured and unruptured subgroups (ruptured: p = 0.096, p = 0.904, respectively; unruptured: p = 0.568, p = 0.306, respectively). In the ruptured subgroup, the intervention cannot reduce long-term mortality (p = 0.654) despite the significant reduction of subsequent hemorrhage than conservation (p = 0.014), and the main cause of death in the intervention group was treatment-related complications (five of seven, 71.4%). In the logistic regression analysis, higher admission mRS score (OR 3.070, 95% CI 1.559-6.043, p = 0.001) was the independent predictor of long-term unfavorable outcomes (mRS>2) in the intervention group, while complete obliteration (OR 0.146, 95% CI 0.026-0.828, p = 0.030) was the protective factor. Conclusions: The long-term outcomes of elderly AVMs after different management modalities were similar. Intervention for unruptured elderly AVMs was not recommended. For those ruptured, we should carefully weigh the risk of subsequent hemorrhage and treatment-related complications. Besides, complete obliteration should be pursued once the intervention was initiated. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT04136860.

Dataset Information

Treatment Modalities and Outcomes in Patients With Advanced Invasive Thymoma or Thymic Carcinoma: A Retrospective Multicenter Study.

Publications

Treatment Modalities and Outcomes in Patients With Advanced Invasive Thymoma or Thymic Carcinoma: A Retrospective Multicenter Study.

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