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Li GS, Feng GY, Liu J, Xu ZY, Guo JJ, Huang T, Zhou HF, Liang GB, Yang N. Prognostic impact of surgery on thymic malignancies with concurrent or previous extrathymic malignancies: a retrospective analysis from 1998 to 2021. J Cardiothorac Surg 2025; 20:205. [PMID: 40241158 PMCID: PMC12001537 DOI: 10.1186/s13019-025-03442-6] [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: 10/23/2024] [Accepted: 04/06/2025] [Indexed: 04/18/2025] Open
Abstract
OBJECTIVE There is limited research on the impact of surgery on the cancer-specific survival (CSS) of patients with malignant thymoma and concurrent or previous extrathymic malignancies (PMTEMs). This retrospective analysis evaluated the prognostic value of surgery in PMTEMs. METHODS Data were sourced from the SEER database, encompassing PMTEMs aged 20-90 with confirmed diagnoses and comprehensive clinical information. Patients were categorized into surgical (n = 105) and nonsurgical (n = 25) groups. Propensity score matching (PSM) was employed to mitigate selection bias, resulting in well-balanced baseline characteristics between the groups. Kaplan-Meier curves and the log-rank test were used to investigate the prognostic value of surgery in PMTEMs. RESULTS Using PSM, the matching of characteristics between the surgical and nonsurgical groups was well-balanced, ensuring the reliability of subsequent analyses. Pre-PSM, the CSS in the surgical group was significantly better than that in the nonsurgical group (p <.001). Similarly, according to the post-PSM data, the CSS for PMTEMs in the surgical group remained superior to that in the nonsurgical group, which indicates that the survival advantage of the surgical group persisted after PSM (p =.030). Additionally, PMTEMs with smaller thymomas (≤ 5 cm) had a significant advantage in CSS compared to those with larger thymomas (p = .046). CONCLUSIONS In conclusion, this study shows that surgery may significantly improve the survival rate of PMTEMs.
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Affiliation(s)
- Guo-Sheng Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China
| | - Gui-Yu Feng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China
| | - Jun Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China
| | - Zhan-Yu Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China
| | - Jian-Ji Guo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China
| | - Tao Huang
- Department of Cardiothoracic Vascular Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Guangxi Zhuang Autonomous Region, Baise, P. R. China
- Key Laboratory of Metabolic Diseases of Baise, The Affiliated Hospital of Youjiang Medical University for Nationalities, Guangxi Zhuang Autonomous Region, Baise, P. R. China
| | - Hua-Fu Zhou
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China.
| | - Guan-Biao Liang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China.
| | - Nuo Yang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, No. 6, Shuangyong Road, Nanning, 530021, P. R. China.
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Manabe M, Tani Y, Inano N, Hagiwara Y, Sogabe N, Nanno S, Koh KR. Acute myeloid leukemia post‑cytotoxic therapy following chemotherapy for thymoma: A case report. MEDICINE INTERNATIONAL 2024; 4:9. [PMID: 38283133 PMCID: PMC10811442 DOI: 10.3892/mi.2024.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
The present study reports the case of a patient with acute myeloid leukemia post-cytotoxic therapy (AML-pCT) that developed following chemotherapy for thymoma. A 64-year-old female patient underwent surgical resection for a mediastinal tumor and was diagnosed with stage IVa thymoma. She received chemotherapy, including carboplatin/etoposide, carboplatin/paclitaxel and amrubicin monotherapy. At 56 months following surgery, she developed blastosis and was diagnosed with AML-pCT. As demonstrated herein, although treatment for thymoma is associated with a markedly lower frequency of myeloid neoplasms post-cytotoxic therapy (MN-pCT) than treatment for other malignancies, such as breast carcinoma, it is important to be aware that MN-pCT may occur as a late complication of thymoma treatment.
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Affiliation(s)
- Masahiro Manabe
- Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Naoyuki Inano
- Department of Clinical Laboratory, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
| | - Yuuji Hagiwara
- Department of Clinical Laboratory, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
| | - Nobuhiro Sogabe
- Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
| | - Satoru Nanno
- Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
| | - Ki-Rhang Koh
- Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
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Outcomes of thymoma after multimodal therapy and determinants of survival: A 16-year experience of a tertiary cancer center. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:487-495. [PMID: 35096446 PMCID: PMC8762900 DOI: 10.5606/tgkdc.dergisi.2021.20529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/18/2020] [Indexed: 11/21/2022]
Abstract
Background
In this study, we aimed to evaluate the factors that contribute to survival outcomes in patients with thymoma treated with multimodal approaches.
Methods
A total of 203 patients (105 males, 98 females; median age: 49 years; range, 17 to 77 years) with Masaoka-Koga Stage II-IV thymoma between January 2002 and December 2018 were retrospectively analyzed. Data including diagnosis of myasthenia gravis, diagnosis of diabetes mellitus, disease stage, histological type of tumor, capsule invasion and surgical margin status, lymphadenectomy, adjuvant radiotherapy or chemotherapy, time from surgery to the first day of adjuvant treatment, length of hospital stay, and overall and disease-free survival rates were recorded.
Results
Of the patients, 91 had Stage II, 67 had Stage III, and 45 had Stage IV disease. A total of 123 patients (61%) had myasthenia gravis. Seventy-six patients received adjuvant radiotherapy and 48 patients received either neoadjuvant (n=35) or adjuvant (n=25) chemotherapy. Higher disease stage, presence of R1 resection, and treatment with chemotherapy were significant factors for decreased disease-free survival time. Older age, higher disease stage, longer postoperative hospital stay, chemotherapy, and disease recurrence were effective contributors to decreased overall survival time. Adjuvant radiotherapy had a statistically significant positive effect on overall survival only in patients with completely resected Stage IV disease (five-year overall survival: 94.7% vs. 79.1%, respectively; p=0.015). In the multivariate analysis, older age (hazard ratio: 4.26), higher disease stage (hazard ratio: 2.95), and longer hospitalization time (hazard ratio: 3.81) were significant prognostic factors for overall survival. Patients with local recurrence who underwent complete resection had a survival time comparable to non-recurrent patients (p=0.753).
Conclusion
For patients with thymoma, higher disease stage, age ≥50 years, longer hospitalization, and need for chemotherapy are associated with worse survival rates. Adjuvant chemotherapy has a positive impact on Stage IV disease. Resection of recurrent lesions has a valuable impact on survival.
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Savu C, Melinte A, Gibu A, Hallabrin I, Zafiu A, Tudor VA, Diaconu C, Gherghiceanu F, Furtunescu F, Radavoi D, Balescu I, Bacalbasa N. A Large Thymoma Resected via Left Antero-lateral Thoracotomy. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:363-370. [PMID: 35403149 PMCID: PMC8988950 DOI: 10.21873/cdp.10048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Thymomas are a rare type of mediastinal tumors with a slow growth rate. Because of this, they are well tolerated and patients usually present with large masses, which can extend in either of the thoracic cavities. The surgical approach for such tumors is dictated by the size and localization of the mass. CASE REPORT We present the case of a patient with a large thymoma, resected through surgery performed by left antero-lateral thoracotomy. The patient presented in our clinic with a persistent cough, dyspnea, chest pain and tightness. Standard thoracic X-ray revealed a bilateral increase in size of the mediastinal shadow, mainly on the left side, with well-defined margins and subcostal intensity. A thoracic computed tomography (CT) scan discovered a tumoral mass within the antero-superior mediastinum, with compression of the mediastinal organs; presentation being suggestive for a thymoma. Surgery was performed, removing a 15/13/10 cm thymoma with a weight of 1126 g. Pathological examination as well as immunohistochemistry confirmed our diagnosis of type AB thymoma, stage I Masaoka-Koga. CONCLUSION In conclusion, surgical treatment remains the main therapeutic option in thymomas, but it is often difficult to perform due to tumor size and local invasion. However, even in large thymomas of stages I and II, surgery can be performed using an antero-lateral thoracotomy.
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Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
- Department of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Alexandru Gibu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Ionut Hallabrin
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Alexandru Zafiu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Vasilica-Adrian Tudor
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Florentina Gherghiceanu
- Department of Marketing and Medical Technology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Daniel Radavoi
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, Bucharest, Romania
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
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Radvansky B, Hunt ML, Augoustides JG, Shah RM, Valentine EA, Kucharczuk JC, Ibrahim R, Sanders J, Kumar N, Capdeville M. Perioperative Approaches to the Anterior Mediastinal Mass-Principles and Pearls From a Ten-Year Experience at an Experienced Referral Center. J Cardiothorac Vasc Anesth 2021; 35:2503-2512. [PMID: 33676802 DOI: 10.1053/j.jvca.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Mallory L Hunt
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Ronak M Shah
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth A Valentine
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John C Kucharczuk
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA
| | - Rowaa Ibrahim
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Joseph Sanders
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health Systems, Detroit, MI
| | - Nikhil Kumar
- Department of Cardiothoracic Anesthesia, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
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Successful treatment of combined thymic epithelial tumor with hepatic metastasis: a long disease-free survival case. Gen Thorac Cardiovasc Surg 2020; 68:1551-1554. [PMID: 32162069 DOI: 10.1007/s11748-020-01333-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/29/2020] [Indexed: 11/27/2022]
Abstract
A 73-year-old man presented with multiple liver nodules on an abdominal echogram. Fluorine-18-fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (PET-CT) showed multiple nodules in his anterior and posterior mediastinum, and liver. Following thymothymectomy with lymph node dissection, the liver nodules were completely resected. Finally, he was diagnosed with combined thymic tumor (small cell carcinoma and type B3 thymoma) with multiple mediastinal lymph nodes and liver metastases by type B3 thymoma. Follow-up PET-CT scan revealed multiple rib and celiac lymph node metastases, six courses of chemotherapy (paclitaxel and carboplatin) were administered, and the patient survived without any recurrence for 15 years after initial surgery.
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