Stage III–IV thymic squamous cell carcinoma in complete pathological remission achieved with thymic cancer resection after immunotherapy combined with chemotherapeutic conversion therapy: a report of two cases from real-world data
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SUBMITTER: Li D
PROVIDER: S-EPMC10839697 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Remission has become both the gold standard for clinical care and the end point for clinical trials for children with juvenile idiopathic arthritis (JIA). Using gene expression microarrays, we found that when remission induced by methotrexate (MTX) or MTX plus a TNF inhibitor (etanercept, Et) (MTX+Et) was compared with healthy controls, there were notable differences in gene expression patterns, demonstrating that remission is not a restoration of immunologic normalcy. Differences were detected in PBMC as well as in granulocytes. Total RNA was extracted from isolated PBMC and granulocytes from patients with polyarticular JIA and from healthy controls. Patients had achieved remission (clinical remission on medicine as defined by Wallace et al, Arthritis Rheum. 2005;52(11):3354-3562) using either MTX or MTX+Et.
2013-10-24 | E-GEOD-41831 | biostudies-arrayexpress
Project description:Remission has become both the gold standard for clinical care and the end point for clinical trials for children with juvenile idiopathic arthritis (JIA). Using gene expression microarrays, we found that when remission induced by methotrexate (MTX) or MTX plus a TNF inhibitor (etanercept, Et) (MTX+Et) was compared with healthy controls, there were notable differences in gene expression patterns, demonstrating that remission is not a restoration of immunologic normalcy. Differences were detected in PBMC as well as in granulocytes.
2013-10-24 | GSE41831 | GEO
Project description:BackgroundThymic epithelial tumors (TETs) represent the predominant primary malignancy of the anterior mediastinum, often necessitating complex surgical interventions due to their invasive nature. The prognosis of advanced TET relies significantly on achieving complete resection with microscopically clear margins (R0). This frequently entails resection and reconstruction of major vascular structures like the superior vena cava (SVC) and brachiocephalic veins, and in some cases, extra pleural pneumonectomy (EPP). The aim of the study is to interrogate our series of advanced TET resections.MethodsWe analysed our experience with vascular resection and reconstruction in 14 patients with advanced stage III/IV TET undergoing extensive resection post-neoadjuvant chemotherapy. A comprehensive preoperative evaluation was performed, including computed tomography (CT), positron emission tomography (PET), biopsy, and exercise testing. We describe our surgical approach and the details of our series.ResultsFrom 2015 to 2023, 31 patients underwent surgery for advanced TET at our centre, with major vessel reconstruction performed in 14 cases. This included resection of SVC and innominate veins with subsequent reconstruction using polytetrafluoroethylene (PTFE) grafts. The median operative time was 350 minutes, with a median blood loss of 1,300 mL. Cardiopulmonary bypass (CPB) was required in 2 cases. The rate of R0 resection was 78.6%, with a recurrence rate of 14.3% at a median follow-up of 1,700 days. Postoperative complications occurred in 42.9% of patients, with an in-hospital mortality rate of 7.1%.ConclusionsMulti-disciplinary management, meticulous preoperative planning, and advanced surgical techniques are essential for the successful treatment of advanced TET. Complex vascular resections should be reserved for high-volume centres to optimize outcomes.
| S-EPMC11833585 | biostudies-literature
Project description:PurposeRectal cancer patients achieving pCR are known to have an excellent prognosis, yet no widely accepted consensus on risk stratification and post-operative management (e.g., adjuvant therapy) has been established. This study aimed to identify magnetic resonance imaging (MRI) high-risk factors for tumor relapse in pathological complete remission (pCR) achieved by rectal cancer patients who have undergone neoadjuvant concurrent chemoradiation therapy (CRT) and curative resection.Materials and methodsWe analyzed 88 (male/female = 55/33, median age, 59.5 years [range 34-78]) pCR-proven rectal cancer patients who had undergone pre-CRT MRI, CRT, post-CRT MRI and curative surgery between July 2005 and December 2012. Patients were observed for post-operative tumor relapse. We analyzed the pre/post-CRT MRIs for parameters including mrT stage, mesorectal fascia (mrMRF) status, tumor volume, tumor regression grade (mrTRG), nodal status (mrN), and extramural vessel invasion (mrEMVI). We performed univariate analysis and Kaplan-Meier survival analysis.ResultsPost-operative tumor relapse occurred in seven patients (8.0%, n = 7/88) between 5.7 and 50.7 (median 16.8) months. No significant relevance was observed between tumor volume, volume reduction rate, mrTRG, mrT, or mrN status. Meanwhile, positive mrMRF (Ppre-CRT = 0.018, Ppre/post-CRT = 0.006) and mrEMVI (Ppre-CRT = 0.026, Ppre-/post-CRT = 0.008) were associated with higher incidence of post-operative tumor relapse. Kaplan-Meier survival analysis revealed a higher risk of tumor relapse in patients with positive mrMRF (Ppre-CRT = 0.029, Ppre-/post-CRT = 0.009) or mrEMVI (Ppre-CRT = 0.024, Ppre-/post-CRT = 0.003).ConclusionPositive mrMRF and mrEMVI status was associated with a higher risk of post-operative tumor relapse of pCR achieved by rectal cancer patients, and therefore, can be applied for risk stratification and to individualize treatment plans.
| S-EPMC4701470 | biostudies-literature
Project description:Background Multilocular thymic cysts are sometimes associated with thymic epithelial tumors (TETs) and may be misdiagnosed as benign lesions. Cystic TETs generally progress during the course of follow-up. Case Description A 55-year-old woman was referred to our hospital in 2017. Her symptoms and physical exams were unremarkable. No abnormal lab results were detected other than elevated ESR (76 mm/lh). Contrast chest computed tomography (CT) showed an anterior mediastinal mass of 3×2×5 cm3 with heterogenous attenuation. The cystic feature was confirmed on contrast magnetic resonance imaging (MRI). Positron emission tomography (PET)-CT was also performed and there was no uptake in the lesion. Benign thymic cyst with infection was among the differential diagnoses. Therefore, intravenous antibiotics were administered for a week. A follow-up CT performed a month later showed a radical change: no visible lesion was present in the anterior mediastinum. Patient was cautioned that malignancy was still possible and that regular follow-up was necessary. The patient did not have another chest CT until the end of 2020. Follow-up chest CT showed lobulated anterior mediastinal mass with multiple pleural implants, highly suggestive of malignancy. Thymectomy plus pleurectomy was performed. Patient was discharged on post-operative day 10. Diagnosis: the pathology was thymic squamous cell carcinoma. The tumor invaded right pleura and pericardium, and pleural implants were confirmed metastasis (T2N0M1a, Stage IVa). Resection status was R0. Adjuvant radiation and chemotherapy were administered. Patient experienced recurrence after 10 months. Conclusions Multilocular thymic cysts can lead to misdiagnosis. Regular follow-up is needed if upfront surgery lacks evidence of malignancy and is deemed inappropriate at first. In cystic lesions or small lesions, it is sometimes difficult to make a clinical decision between surgery and follow-up based on imaging alone. Rash decision might result in unnecessary surgery or disease progression. Novel diagnostic tools might provide insights into the decision- making of these patients.
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Project description:Thymoma and thymic carcinoma are the most common tumors of the anterior mediastinum and a relatively rare type of thoracic cancer. The prerequisite for surgery is clinical staging and operative evaluation, both of which are based on medical imaging. The best strategy for treating a thymic epithelial tumor is surgical resection of the organ and surrounding tissue. Thymectomy modalities vary, including open surgery and minimally invasive surgery, and surgeons have used various innovations to better meet the needs of the procedure; therefore, it is critical to select the appropriate procedure based on the patient's characteristics. Evaluation of resectability is the first step of surgical resection for thymic tumors without distant metastasis. The decision regarding unresectability should be made carefully. During subsequent chemotherapy or chemoradiotherapy, reevaluation of whether an area is resectable or not remains essential. Despite numerous technological advances in the surgical treatment of thymic tumors, several contentious issues remain, including the selection of surgical approaches for difficult cases, the selection of video-assisted thoracoscopic approaches, the evaluation of resectability, minimally invasive surgery for locally advanced thymic tumors, lymphadenectomy in thymic tumors, neoadjuvant therapy for thymic tumors, debulking surgery, and salvage surgery. In solving these problems, the surgeon's judgment, surgical experience, and surgical skills are especially important.
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Project description: Not available
| S-EPMC11667699 | biostudies-literature
Project description:BackgroundPrimary tumor resection (PTR) as a treatment option for patients with stage IV pancreatic cancer (PC) is controversial.Patients and methodsStage IV PC patients, with treatment data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER), were screened. The main outcomes were overall survival (OS) and cancer-specific survival (CSS).ResultsWe enrolled 15,836 stage IV PC patients in this study. Propensity score-matched analyses revealed improved OS and CSS of patients receiving chemotherapy plus PTR versus chemotherapy (median survival time [MSTOS ]: 13 vs. 9 months, p = 0.024; MSTCSS : 14 vs. 10 months, p = 0.035), and chemoradiotherapy plus PTR versus chemoradiotherapy (MSTOS : 14 vs. 7 months, p = 0.044; MSTCSS : 14 vs. 7 months, p = 0.066). Multivariate adjusted analyses further confirmed these results. Stratified with different metastatic modalities, multivariate analyses suggested that PTR significantly improved the OS and CSS among patients with ≤1 metastatic organ, and that patients with brain metastasis might not benefit from chemotherapy treatment.ConclusionPTR improves the OS and CSS of stage IV PC patients on the basis of chemotherapy or chemoradiotherapy, provided that the metastases involve ≤1 organ. Chemotherapy, however, should be carefully considered in patients with metastases involving the brain.
| S-EPMC8419755 | biostudies-literature
Project description:ObjectiveTo develop and authenticate a neoadjuvant chemotherapy (NACT) pathological complete remission (pCR) model based on the expression of Reg IV within breast cancer tissues with the objective to provide clinical guidance for precise interventions.MethodData relating to 104 patients undergoing NACT were collected. Variables derived from clinical information and pathological characteristics of patients were screened through logistic regression, random forest, and Xgboost methods to formulate predictive models. The validation and comparative assessment of these models were conducted to identify the optimal model, which was then visualized and tested.ResultFollowing the screening of variables and the establishment of multiple models based on these variables, comparative analyses were conducted using receiver operating characteristic (ROC) curves, calibration curves, as well as net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Model 2 emerged as the most optimal, incorporating variables such as HER-2, ER, T-stage, Reg IV, and Treatment, among others. The area under the ROC curve (AUC) for Model 2 in the training dataset and test dataset was 0.837 (0.734-0.941) and 0.897 (0.775-1.00), respectively. Decision curve analysis (DCA) and clinical impact curve (CIC) further underscored the potential applications of the model in guiding clinical interventions for patients.ConclusionThe prediction of NACT pCR efficacy based on the expression of Reg IV in breast cancer tissue appears feasible; however, it requires further validation.
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