|
|
18例不可切除IV期胸腺鳞癌的临床特征及预后分析
|
Abstract:
目的：探讨不可切除IV期胸腺鳞癌的临床特征、治疗方式和预后。方法：收集2018年1月1日至2022年12月31日期间就诊于青岛大学附属医院的18例不可切除IV期胸腺鳞癌患者的临床资料和治疗资料，并随访至2024年2月29日。结果：18例患者中男性12例，女性6例，中位发病年龄60岁；TNM分期IVA期9例，IVB期9例；单纯化疗8例，单纯放疗1例，序贯放化疗4例，同步放化疗2例，化疗联合免疫疗法3例。18例患者总进展率66.7%，中位PFS 27 (19~36)个月。IVA期和IVB期进展率分别为33.3%和100.0% (p = 0.009)，中位PFS分别为50 (21~79)和21 (5~37)个月(p = 0.008)。单纯化疗，放化疗和化疗联合免疫疗法进展率分别为75.0%，66.7%，和33.3% (p = 0.793)，中位PFS分别为24 (16~32)，50 (27~73)，和10 (4~16)个月(p = 0.057)。结论：不可切除IV期胸腺鳞癌主要采用以化疗为主的综合治疗，总体预后差，IVA期较IVB期好，化疗联合放疗或免疫疗法较单纯化疗好，建议对非广泛转移阶段的患者行精准治疗。
Objective: To investigate the clinicopathological characteristics, treatment, and prognosis of Thymic Squamous Cell Carcinoma (TSCC). Methods: We collected the data of 18 TSCC patients hospitalized in the Affiliated Hospital of Qingdao University from 1 January 2018 to 31 December2022 and followed them up until 29 February 2024. Results: Of the 18 cases, there were 12 males and 6 females. The median age was 60 years old. There were 10 cases with TNM stage IVA and 8 cases with stage IVB. 8 cases received chemotherapy alone, 1 case received radiotherapy alone, 4 cases received sequential chemoradiotherapy, 2 cases received concurrent chemoradiotherapy, and 3 cases received chemotherapy combined with immunotherapy. The progression rate of all cases was 66.7% and the median PFS was 27 (19~36) months. The progression rates of stage IVA and IVB were 33.3% and 100.0%, respectively (p = 0.009), and the median PFS was 50 (21~79) and 21 (5~37) months, respectively (p = 0.008). The progression rates of chemotherapy alone, chemoradiotherapy, and chemotherapy combined with immunotherapy were 75.0%, 66.7%, and 33.3%, respectively (p = 0.793), and the median PFS was 24 (16~32), 50 (27~73), and 10 (4~16) months, respectively (p = 0.057). Conclusions: Unresectable stage IV TSCC is mainly treated with chemotherapy as the main treatment. The prognosis is poor, with stage IVA better than stage IVB, and chemotherapy combined with radiotherapy or immunotherapy better than chemotherapy alone. Precision treatment is recommended for patients who haven’t experienced extensive metastasis.
| [1] | Ettinger, D.S., Riely, G.J., Akerley, W., et al. (2013) Thymomas and Thymic Carcinomas: Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 11, 562-576. https://doi.org/10.6004/jnccn.2013.0072 |
| [2] | Scorsetti, M., Leo, F., Trama, A., et al. (2016) Thymoma and Thymic Carcinomas. Critical Reviews in Oncology/Hematology, 99, 332-350. https://doi.org/10.1016/j.critrevonc.2016.01.012 |
| [3] | Shin, D.W., Cho, J.H., Ha, J. and Jung, K.W. (2022) Trends in Incidence and Survival of Patients with Thymic Epithelial Tumor in a High-Incidence Asian Country: Analysis of the Korean Central Cancer Registry 1999 to 2017. Journal of Thoracic Oncology, 17, 827-837. https://doi.org/10.1016/j.jtho.2022.02.001 |
| [4] | Ruffini, E., Huang, J., Cilento, V., et al. (2023) The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: Proposal for a Stage Classification for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. Journal of Thoracic Oncology, 18, 1655-1671. https://doi.org/10.1016/j.jtho.2023.09.002 |
| [5] | Roden, A.C., Ahmad, U., Cardillo, G., et al. (2022) Thymic Carcinomas—A Concise Multidisciplinary Update on Recent Developments from the Thymic Carcinoma Working Group of the International Thymic Malignancy Interest Group. Journal of Thoracic Oncology, 17, 637-650. https://doi.org/10.1016/j.jtho.2022.01.021 |
| [6] | Yang, Y., Fan, X.W., Wang, H.B., et al. (2017) Stage IVb Thymic Carcinoma: Patients with Lymph Node Metastases Have Better Prognoses than Those with Hematogenous Metastases. BMC Cancer, 17, Article No. 217. https://doi.org/10.1186/s12885-017-3228-2 |
| [7] | Hurd, J., Haridas, C., Potter, A., et al. (2022) A National Analysis of Open versus Minimally Invasive Thymectomy for Stage I-III Thymic Carcinoma. European Journal of Cardio-Thoracic Surgery, 62, ezac159. https://doi.org/10.1093/ejcts/ezac159 |
| [8] | Zhou, M.X., Chen, Y.Y., Huang, C., et al. (2023) Identification of Predictors of Long-Term Survival and Prognostic Outcomes in Thymic Squamous Cell Carcinoma: A Real-World Study. Cancer Medicine, 12, 14025-14036. https://doi.org/10.1002/cam4.6049 |
| [9] | Zhao, Y., Zhao, H., Hu, D., et al. (2013) Surgical Treatment and Prognosis of Thymic Squamous Cell Carcinoma: A Retrospective Analysis of 105 Cases. The Annals of Thoracic Surgery, 96, 1019-1024. https://doi.org/10.1016/j.athoracsur.2013.04.078 |
| [10] | Wang, J., Liu, Y., Zhuang, W. and Zhao, Y. (2022) Modified Subcostal Arch Xiphoid Thoracoscopic Expanded Thymectomy for Thymic Carcinoma: A Case Report and Review of Literature. Journal of Cardiothoracic Surgery, 17, Article No. 234. https://doi.org/10.1186/s13019-022-01981-w |
| [11] | Zhai, Y., Hui, Z., Gao, Y., et al. (2020) Debulking Surgery Plus Radiation: Treatment Choice for Unresectable Stage III Thymic Carcinoma. The Thoracic and Cardiovascular Surgeon, 68, 440-445. https://doi.org/10.1055/s-0039-1688723 |
| [12] | Wei, M. L., Kang, D., Gu, L., et al. (2013) Chemotherapy for Thymic Carcinoma and Advanced Thymoma in Adults. Cochrane Database of Systematic Reviews, 2013, CD008588. https://doi.org/10.1002/14651858.CD008588.pub2 |
| [13] | Jin, J. N., Hao, Y., Wang, W. X., et al. (2023) Chemoradiotherapy for Untreated Masaoka-Koga Stage IVB Thymic Carcinoma: A Single-Center Retrospective Study. Strahlentherapie und Onkologie, 199, 313-321. https://doi.org/10.1007/s00066-022-02042-w |
| [14] | Chun, S. G.,Rimner, A., Amini, A., et al. (2023) American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma. JAMA Oncology, 9, 971-980. https://doi.org/10.1001/jamaoncol.2023.1175 |
| [15] | Maniar, R. and Loehrer Sr, P.J. (2023) Understanding the Landscape of Immunotherapy in Thymic Epithelial Tumors. Cancer, 129, 1162-1172. https://doi.org/10.1002/cncr.34678 |
| [16] | Kaira, K., Imai, H. and Kagamu, H. (2021) Perspective of Immune Checkpoint Inhibitors in Thymic Carcinoma. Cancers, 13, Article 1065. https://doi.org/10.3390/cancers13051065 |
| [17] | Cho, J., Kim, H.S., Ku, B.M., et al. (2019) Pembrolizumab for Patients with Refractory or Relapsed Thymic Epithelial Tumor: An Open-Label Phase II Trial. Journal of Clinical Oncology, 37, 2162-2170. https://doi.org/10.1200/JCO.2017.77.3184 |
| [18] | Chen, C., Sun, P. and Long, J. (2022) Robust and Durable Response to First-Line Treatment of Pembrolizumab Combined with Chemotherapy in Two Patients with Metastatic Thymic Squamous Cell Carcinoma: Case Report. Frontiers in Immunology, 13, Article 941092. https://doi.org/10.3389/fimmu.2022.941092 |
| [19] | Nishii, Y.,Furuhashi, K., Ito, K., et al. (2022) Good Response of Advanced Thymic Carcinoma with Low PD-L1 Expression to Chemotherapy Plus Pembrolizumab as First-Line Therapy and to Pembrolizumab as Maintenance Therapy: A Case Report. Pharmaceuticals, 15, Article 889. https://doi.org/10.3390/ph15070889 |
| [20] | Kashima, J., Hishima, T., Okuma, Y. et al. (2021) CD70 in Thymic Squamous Cell Carcinoma: Potential Diagnostic Markers and Immunotherapeutic Targets. Frontiers in Oncology, 11, Article 808396. https://doi.org/10.3389/fonc.2021.808396 |
| [21] | Remon, J., Girard, N., Mazieres, J., et al. (2016) Sunitinib in Patients with Advanced Thymic Malignancies: Cohort from the French RYTHMIC Network. Lung Cancer, 97, 99-104. https://doi.org/10.1016/j.lungcan.2016.04.024 |
