The comparison of predictive factors regarding prognoses and invasion of thymic neuroendocrine tumors preoperatively and postoperatively

Abstract

Background: Thymic neuroendocrine tumors (TNT), in the anterior mediastinum, are extremely rare diseases which have significantly poor prognoses. Studies have rarely provided conclusive evidence of the prognostic factors of TNT. Standard therapies have been controversial. Methods: TNT patients (n=173) were enrolled from Surveillance, Epidemiology and End Results database (SEER). Univariate and multivariate analyses were utilized to evaluate predictive factors of prognoses.Logistic regression analysis was used to assess the plausible correlation between histological grade, and cancer invasion. Stratification analysis was used to evaluate the effectiveness of adjuvant therapies.Results: According to our analysis, local Masaoka stage, surgery, radiotherapy, and non-chemotherapy predicted better overall survival (OS) (P<0.05, for all) in 173 TNT patients. We found that the higher the histological grade of the tumor, the greater the rate of metastasis (P<0.05). The focus was on 125 surgically treated patients, who were females with poor prognostic factors of OS, upgraded histological grade, and advanced Masaoka stage (P<0.01, for all). The effectiveness of radiotherapy treatments had discrepancies at different clinical stages. In the local stage, radiotherapy caused significantly worse OS (P=0.011), while in the advanced stage, patients demonstrated significantly better OS with this treatment (P=0.028). Chemotherapy incidence of TNT has increased recently (4). In most body parts, the malignancy of carcinoid is significantly lower than carcinoma (5). However, the thymus carcinoid has a higher degree of malignancy than thymoma and thymus carcinoma (2). Five-and 10-year survival rates are 56% and 26%, which are significantly worse than thymoma (2).Previous studies reported male to female ratio of TNT incidence as approximately 3:1, with an average age of 54 years (5,6). Two major factors attribute to symptoms of TNT. First, tumors invade or compress surrounding or adjacent structures. Second, TNT could secrete bioactive amines excessively and cause carcinoid syndrome, including wheezing, skin flushing, diarrhea, and fibrotic valvular heart disease (7,8). In addition to this, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) are the most commonly secreted by TNT to cause the pertinent endocrine symptoms (2,6,8).The most common clinical staging system for TNT is Masaoka stage classification (2). Besides, three grade-groups have been categorized by histological classification, which are typical carcinoid tumor (CT), atypical carcinoid tumor (AT), and neuroendocrine carcinoma (NT) (6,9).With the differences in gender, clinical stage, and histological grade, TNT has revealed significantly different characteristics, prognoses, and metastatic rate. According to various patients and tumors characteristics, the treatments of TNT have been enormously controversial (1-5), which includes procedures with or without adjuvant radiotherapy/ chemotherapy/targeted-therapy at each clinical stage, type of regimen...

A Single Center Analysis of Thymic Neuroendocrine Tumors

“…A definite conclusion could not be made whether radiotherapy and chemotherapy helped improve survival [21,[26][27][28][29], although it is generally accepted that TNET are more aggressive than thymomas, and adjuvant radiotherapy is now mostly recommended for aggressive thymomas. Corsini et al found that neither radiation nor chemotherapy impacted OS (p = 0.594, p = 0.234) [16].…”

Immunohistochemistry biomarker TP53 expression predicts the survival of thymomas

“…The prognostic factors of surgical treated thymomas are (17,18). It is worth noting that thoracic surgeons ignore the LND before, which influences the accuracy of TNM staging.…”

The secondary surgery provides significant benefits to recurrent thymoma: a retrospective analysis based on Surveillance, Epidemiology and End Results database

“…Previous studies investigated independent predictive factors of thymoma including age, Masaoka stage, WHO pathologic grade, resected marginal status, and adjuvant therapies ( 2 , 4 , 13 - 16 ). Besides, patients with myasthenia gravis could influence survival ( 17 ).…”

“…As a large population retrospective database, SEER has its limitations inevitably. It does not include the details of recurrence ( 16 ). Fortunately, as an indolent tumor, the distant recurrence rate of thymoma is extremely low.…”

“…On the other hand, the overwhelming majority of RT occurs in mediastinum or thoracic cavity, which provides opportunity to perform secondary surgery. Secondly, the information concerning adjuvant chemotherapeutic regimen, dosage, toxicity, side-effects is not enrolled in SEER ( 16 ). Although, these factors are not focuses in the present work, based on strict statistical calculation, the efficacy of the adjuvant therapies and the discrapancy of survival based on different therapies are clear, reasonable, and reliable.…”