Abstract
Several inflammation-based prognostic scores emerged in various types of cancer to predict clinical outcomes. So far, no accurate pre-treatment scoring systems exist for patients with thymic epithelial tumors (TETs), comprising thymomas and thymic carcinomas (TCs). Therefore, we sought to test the prognostic value of different clinical composite scores and their components, identify optimal cut-off values for TETs as well as combine predictive components to new suitable prognostic scores. One hundred eighty-four patients with TETs undergoing surgical tumor resection were analyzed. A significant advantage in Freedom-from-Recurrence and/or Cause-specific survival (CSS) was evident for patients with high Advanced-Lung- Cancer-Inflammation-Index, low CRP-Fibrinogen-Score (CFS), low Glasgow-Prognostic-Score (GPS), low high-sensitivity-modified GPS, low TET-adapted GPS (TET-aGPS) and low Systemic-Immune-Inflammation Index. On multivariable analysis high TET-aGPS (HR = 14.9;p = 0.001), incomplete resection status (HR = 13.5;p = 0.001) and TC (HR = 26.0;p = 0.001) were significant independent prognostic factors for worse CSS. The CFS had the highest coefficient of determination (R2 = 0.188) to predict tumor recurrence of all composite scores, comprising CRP (R2 = 0.141) and fibrinogen (R2 = 0.158), the best single factor predictors. Inflammation-based prognostic scores and selected components are suitable to predict survival and/or tumor recurrence in TET patients undergoing primary surgery. Due to excellent long-term survival and frequent tumor recurrence, cut-off values were tailored to increase prognostic power.
Highlights
The Masaoka-Koga staging system, the WHO histological classification and the recently proposed TNM staging system can only give reliable prognostic information according to pathological and histological features after surgical tumor resection
In our previous work we showed an association of systemic inflammatory proteins, such as CRP and fibrinogen and indices formed from inflammatory cell counts, such as neutrophil-to-lymphocyte ratio (NLR), with higher tumor stages and worse prognosis in patients with TETs17,18
The present study was conducted in order to evaluate whether inflammation-based prognostic scores, proposed for cancers other than Thymic epithelial tumors (TETs), the components of these scoring systems alone, the widely adapted American Society of Anesthesiologist (ASA) score and our newly developed scoring systems, the CRP-fibrinogen score (CFS) and the TET- adapted GPS are suitable predictors of long-term outcome for patients with TETs undergoing surgery alone or in conjunction with multimodal therapy
Summary
There were no significant differences between ASA 12 and ASA 34 patients in CSS (p = 0.273) and FFR (p = 0.243), in high ALI (>26.1) in CSS (p = 0.681) and FFR (p = 0.682), in CFS 0 and CFS 1 subgroups, in CSS (p = 0.250) and FFR (p = 0.114), in GPS in predicting CSS (p = 0.253) and FFR (p = 0.895), in HS-mGPS 0 compared to HS-mGPS1 + 2 patients in CSS (p = 0.215) and FFR (p = 0.122), in TET-aGPS 0 compared to patients with TET-aGPS 1 in CSS (p = 0.104) and FFR (p = 0.202) and in SII in predicting CSS (p = 0.197) and FFR (p = 0.374), respectively. Univariable analysis revealed significantly worse CSS in patients with TC (HR = 11.1; p < 0.001), high CFS (HR = 5.94; p = 0.002), high Masaoka-Koga tumor stage (HR = 5.52; p = 0.003), high GPS (HR = 4.90; p = 0.040), high HS-mGPS (HR = 4.87; p = 0.041), high TET-aGPS (HR = 5.18; p = 0.014) and low ALI (HR = 3.47; p = 0.049), respectively.
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