Skeletal muscle and related protein expression as prognostic factors in thymic squamous cell carcinoma

Keita Nakanishi; Naoki Ozeki; Hisashi Tateyama; Yuka Kadomatsu; Harushi Ueno; Masaki Goto; Shota Nakamura; Koichi Fukumoto; Toyofumi Fengshi Chen-Yoshikawa

doi:10.21037/jtd-22-385

Skeletal muscle and related protein expression as prognostic factors in thymic squamous cell carcinoma

J Thorac Dis. 2022 Sep;14(9):3245-3254. doi: 10.21037/jtd-22-385.

Authors

Keita Nakanishi¹, Naoki Ozeki¹, Hisashi Tateyama², Yuka Kadomatsu¹, Harushi Ueno¹, Masaki Goto¹, Shota Nakamura¹, Koichi Fukumoto¹, Toyofumi Fengshi Chen-Yoshikawa¹

Affiliations

¹ Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Pathology, Clinical Laboratory, Kasugai Municipal Hospital, Kasugai, Japan.

Abstract

Background: Sarcopenia and its marker, the psoas muscle index (PMI), have attracted attention as prognostic factors for various types of cancers. The fragile X-related 1 (FXR1) gene is highly expressed in myocytes, and FXR1 overexpression is a candidate biomarker for poor survival in several types of cancers. Thymic squamous cell carcinoma (TSQCC) is rare, and no studies assessing its prognostic factors, particularly in terms of skeletal muscle mass and FXR1 expression, are available.

Methods: We retrospectively investigated the prognostic significance of PMI in 34 patients who underwent TSQCC resection, considering the status of FXR1 and tumor programmed death-ligand 1 (PD-L1). PMI was calculated from the bilateral psoas muscle using preoperative computed tomography (CT). Patients were divided into two groups: low PMI (<58.2%, n=17) and normal PMI (≥58.2%, n=17). Immunohistochemical analysis was performed to determine the FXR1 and PD-L1 expression levels.

Results: Low PMI was significantly associated with worse overall survival (OS) (5-year survival rate; 86% vs. 100%; P=0.026) and marginally associated with worse disease-free survival (DFS) (5-year survival rate; 39% vs. 66%; P=0.090) compared with normal PMI. The immunohistochemical analysis revealed that the FXR1 intensity score (0-1+: 6% vs. 0%; 2+-3+: 94% vs. 100%; P=0.31), median FXR1 distribution (95% vs. 90%; P=0.63), and PD-L1 status (high: 47% vs. 59%; P=0.49) were not significantly different between the two groups.

Conclusions: Our findings suggest that PMI might be considered as a potential prognostic factor in TSQCC and that FXR1 is widely expressed regardless of the PMI status. Skeletal muscle mass may play a role in the prognosis of TSQCC.

Keywords: Thymic squamous cell carcinoma (TSQCC); fragile X-related 1 (FXR1) gene; programmed death-ligand 1 (PD-L1); psoas muscle index (PMI); surgery.