Abstract
Simple SummaryAdvanced thymic carcinoma (ATC) is rare. Owing to its rarity, there is limited information on the prognostic factors, and the optimal serum tumor markers are also unknown. We conducted a multi-institutional retrospective study of patients with ATC. In this study, we collected data on patient characteristics, progression-free survival (PFS), overall survival (OS), and tumor marker values, and investigated the relationship between tumor marker values and PFS/OS. We found that the neuron-specific enolase (NSE) level may be a useful prognostic tumor marker for ATC, regardless of histology. The findings of the analysis limited to squamous cell carcinoma suggested that the NSE and squamous cell carcinoma antigen levels may be useful prognostic factors.The optimal tumor marker for predicting the prognosis of advanced thymic carcinoma (ATC) remains unclear. We conducted a multi-institutional retrospective study of patients with ATC. A total of 286 patients were treated with chemotherapy. Clinicopathological information, including serum tumor markers, was evaluated to determine the overall survival (OS) and progression-free survival (PFS). The carcinoembryonic antigen, cytokeratin-19 fragment, squamous cell carcinoma (SCC) antigen, progastrin-releasing peptide, neuron-specific enolase (NSE), and alpha-fetoprotein levels were evaluated. In the Kaplan–Meier analysis, the OS was significantly shorter in the patients with elevated NSE levels than in those with normal NSE levels (median, 20.3 vs. 36.8 months; log-rank test p = 0.029; hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.05–2.31 (Cox proportional hazard model)); a similar tendency regarding the PFS was observed (median, 6.4 vs. 11.0 months; log-rank test p = 0.001; HR, 2.04; 95% CI, 1.31–3.18). No significant differences in the OS and PFS were observed among the other tumor markers. In both univariate and multivariate analyses of the patients with SCC only, the NSE level was associated with the OS and PFS. Thus, the NSE level may be a prognostic tumor marker for thymic carcinoma, regardless of histology.
Highlights
Thymic epithelial tumors, including thymoma and thymic carcinoma (TC), are rare intrathoracic malignancies that occur in the prevascular mediastinum [1]
We examined the association between tumor markers and prognosis using data from 286 patients with advanced thymic carcinoma (ATC)
The results of this study indicate that the neuron-specific enolase (NSE) level may be a prognostic factor in patients with ATC
Summary
Thymic epithelial tumors, including thymoma and thymic carcinoma (TC), are rare intrathoracic malignancies that occur in the prevascular mediastinum [1]. TC is an even rarer malignancy, with an annual incidence of 0.13 cases/100,000 population, and accounting for ~15% of all thymic epithelial tumors [2,3]. It has a propensity to invade the surrounding tissues and metastasize, and one-half to two-third of all patients with TC are diagnosed with locally advanced or metastatic disease [4,5,6]. The 5-year survival rate of patients with TC is 90% for Masaoka stage 1–2 and 30% for stage 3–4. This indicates that the prognosis of advanced thymic carcinoma (ATC) is poor as it progresses [9]
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