Prognostic factors for patients with metastatic or recurrent thymic carcinoma receiving palliative-intent chemotherapy

Yusuke Okuma; Ryo Ko; Takehito Shukuya; Kazunari Tateishi; Hisao Imai; Shunichiro Iwasawa; Eisaku Miyauchi; Tetsuya Kojima; Yuka Fujita; Toshihiko Hino; Shinsuke Yamanda; Toshiro Suzuki; Aya Fukuizumi; Tomohiro Sakakibara; Toshiyuki Harada; Satoshi Morita; Kunihiko Kobayashi; Toshihiro Nukiwa; Kazuhisa Takahashi; North East Japan Study Group

doi:10.1016/j.lungcan.2020.08.014

Prognostic factors for patients with metastatic or recurrent thymic carcinoma receiving palliative-intent chemotherapy

Lung Cancer. 2020 Oct:148:122-128. doi: 10.1016/j.lungcan.2020.08.014. Epub 2020 Aug 20.

Authors

Yusuke Okuma¹, Ryo Ko², Takehito Shukuya², Kazunari Tateishi³, Hisao Imai⁴, Shunichiro Iwasawa⁵, Eisaku Miyauchi⁶, Tetsuya Kojima⁷, Yuka Fujita⁸, Toshihiko Hino⁹, Shinsuke Yamanda¹⁰, Toshiro Suzuki¹¹, Aya Fukuizumi¹², Tomohiro Sakakibara¹³, Toshiyuki Harada¹⁴, Satoshi Morita¹⁵, Kunihiko Kobayashi¹⁶, Toshihiro Nukiwa¹⁷, Kazuhisa Takahashi²; North East Japan Study Group

Affiliations

¹ Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious disease Center Komagome Hospital, Tokyo, Japan. Electronic address: yokuma@ncc.go.jp.
² Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
³ First department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
⁴ Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan; Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan.
⁵ Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan.
⁶ Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan.
⁷ Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Japan.
⁸ Department of Respiratory Medicine, Asahikawa Medical Center, Asahikawa, Japan.
⁹ Department of Respiratory Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan.
¹⁰ Department of Thoracic Surgery, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan.
¹¹ Department of Respiratory Medicine, Iwate Prefectural Isawa Hospital, Oshu, Japan.
¹² Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan .; Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
¹³ Department of Respiratory Medicine, Tohoku Rosai Hospital, Sendai, Japan.
¹⁴ Center for Respiratory Diseases, JCHO Hokkaido Hospital, Sapporo, Japan.
¹⁵ Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
¹⁶ Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan.
¹⁷ Professor Emeritus, Tohoku University, Sendai, Japan.

PMID: 32890794
DOI: 10.1016/j.lungcan.2020.08.014

Abstract

Background: Thymic malignancies are a model of rare cancer. However, little clinical data is available based on the large database. We aimed to clarify the prognostic factors, particularly the metastatic sites, for thymic malignancies using one of the largest, representative, multi-institutional databases, the NEJ023 database.

Patients and methods: Patients with Stage IVA/IVB or recurrent thymic carcinoma were enrolled between 1995 and 2014. Clinicopathologic information was evaluated, and the patients were subdivided according to the metastatic organs of involvement (serosal dissemination, liver, lymph node, pulmonary, and bone metastasis). A Kaplan-Meier analysis and multivariate Cox regression were used to evaluate survival.

Results: Two hundred and seventy-nine patients with metastases and a predominantly squamous histology (66.7%) were included. Most patients (53.0%) had serosal dissemination, whereas 26.5%, 21.9%, 19.7%, and 15.8% had pulmonary, lymph node, bone and liver metastases, respectively. Over a median follow-up time of 21.5 months, the median overall survival (mOS) was 30.7 months. When the subjects were grouped according to involved metastatic sites, patients with more than 3 involved metastatic organs had the worst survival outcome. Among patients with isolated involvement, those with bone metastasis had the poorest survival, followed by patients with liver metastasis. Subjects with hypoalbuminemia also had poor survival outcomes. When patients treated with platinum and anthracycline-containing pharmacotherapy were compared with those treated with platinum and non-anthracycline-containing pharmacotherapy, no significant difference was observed. Bone metastasis (P = 0.0005), liver metastasis (P = 0.047), and hypoalbuminemia (P = 0.0021) were identified as prognostic factors in a multivariate analysis.

Conclusion: The site of metastatic involvement affects the survival outcomes of patients with thymic carcinoma, and this result may reflect the sensitivity of metastatic sites to pharmacotherapy. As a next step, controlling liver metastasis with pharmacotherapy could help to improve the prognosis of patients with thymic carcinoma.

Keywords: Hypoalbuminemia; Liver metastasis; Prognostic factor; Thymic carcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Lung Neoplasms*
Prognosis
Retrospective Studies
Thymoma* / drug therapy
Thymus Neoplasms* / drug therapy