Long-Term Follow-Up and Prognostic Factors for Advanced Thymic Carcinoma

Abstract

The aim of this study was to evaluate the long-term survival outcomes in patients with advanced thymic carcinoma and identify prognostic factors influencing the survival.We retrospectively analyzed 90 consecutive patients with pathologically confirmed advanced thymic carcinoma (Masaoka III and IV) in our institute, from December 2000 to 2012. Age, sex, clinical characteristics, laboratory findings, Masaoka and tumor node metastasis staging, pathologic grade, and treatment modalities were analyzed to identify prognostic factors associated with the progress-free survival (PFS) and the overall survival (OS) rates. Statistical analysis was conducted using SPSS, version 19.0 (SPSS, Inc, Chicago, IL).A total of 73 (81.1%) male and 17 (18.9%) female patients participated in the study. The median follow-up time was 75 months (range, 20–158 months). The 5-year PFS and OS rates were 23.6% (95% confidence interval [CI], 14.6%–33.8%) and 35.7% (95% CI, 25.1%–46.4%), respectively. The multivariate Cox regression model analysis showed that factors improving the PFS were the normal lactate dehydrogenase (LDH) level (P < 0.001), Masaoka III stage (P = 0.028), and radiotherapy (RT) (P < 0.001). The LDH (P < 0.001), T stage (P < 0.001), and the pathologic grade (P = 0.047) were independently prognostic of OS.Long-term follow-up of the advanced thymic carcinoma showed poor outcomes of PFS and OS. LDH, Masaoka stage, and RT affected the PFS, and LDH, T stage, and pathologic grade seemed to affect the OS. Establishing a better staging system for predicting outcomes would be warranted.

Stage IVb thymic carcinoma: patients with lymph node metastases have better prognoses than those with hematogenous metastases

“…Our study indicated that distant metastasis was an independent prognostic factor for poor OS, and patients with lymph node metastasis alone had prolonged survival. This data agreed with the results of previous studies [2, 19]. …”

“…Some studies have shown the prognostic value of positive lymph nodes [10, 20, 21], while other studies found no difference in survival based on their presence [2]. Park et al reported that dissection of more than 10 lymph nodes is required to predict prognosis accurately [22].…”

“…[2, 5, 21, 23, 24] Hishida et al analyzed 306 patients and found that stage IVb patients who underwent complete resections of loco-regional nodal and pulmonary metastases had relatively favorable survival rates (5-year OS: 60%) [11]. However, in advanced thymic carcinoma, complete resection is difficult to achieve without damaging major organs.…”

“…Thymic carcinoma accounts for 5% of all thymic malignancies [1], and it has a 5-year survival of 30–50% [2–5]. No specific staging system has been developed for thymic carcinoma because of its rarity.…”

Prognostic Role of Lactate Dehydrogenase Expression in Urologic Cancers: A Systematic Review and Meta-Analysis

“…LDH has demonstrated to have prognostic significance in several tumors, including pancreatic cancer [2], lung cancer [3], advanced thymic carcinoma [4], osteosarcoma [5], renal cancer [6], prostate cancer [7], bladder cancer [8], and upper urinary tract transitional cell carcinoma (UUTTCC) [9]. Therefore, it is possible that serum LDH level may also represent a prognostic marker in patients with urinary system cancer.…”