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Open Access 01-12-2021 | Thymectomy | Research

Nomogram predict relapse-free survival of patients with thymic epithelial tumors after surgery

Authors: Yang-Yu Huang, Lei-Lei Wu, Xuan Liu, Shen-Hua Liang, Guo-Wei Ma

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

Hematological indicators and clinical characteristics play an important role in the evaluation of the progression and prognosis of thymic epithelial tumors. Therefore, we aimed to combine these potential indicators to establish a prognostic nomogram to determine the relapse-free survival (RFS) of patients with thymic epithelial tumors undergoing thymectomy.

Methods

This retrospective study was conducted on 156 patients who underwent thymectomy between May 2004 and August 2015. Cox regression analysis were performed to determine the potential indicators related to prognosis and combine these indicators to create a nomogram for visual prediction. The prognostic predictive ability of the nomogram was evaluated using the consistency index (C-index), receiver operating characteristic (ROC) curve, and risk stratification. Decision curve analysis was used to evaluate the net benefits of the model.

Results

Preoperative albumin levels, neutrophil-to-lymphocyte ratio (NLR), T stage, and WHO histologic types were included in the nomogram. In the training cohort, the nomogram showed well prognostic ability (C index: 0.902). Calibration curves for the relapse-free survival (RFS) were in good agreement with the standard lines in training and validation cohorts.

Conclusions

Combining clinical and hematologic factors, the nomogram performed well in predicting the prognosis and the relapse-free survival of this patient population. And it has potential to identify high-risk patients at an early stage. This is a relatively novel approach for the prediction of RFS in this patient population.

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Charles R, Thomas CD Jr, et al. Thymoma: State of the Art. J Clin Oncol. 1999;17(7):2280–9.CrossRef

Marx A, Ströbel P, Badve SS, Chalabreysse L, Chan JKC, Chen G, et al. ITMIG consensus statement on the use of the WHO histological classification of Thymoma and Thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9(5):596–611. https://doi.org/10.1097/JTO.0000000000000154.CrossRefPubMed

Masaoka A, et al. Staging system of Thymoma. J Thorac Oncol. 2010;5(10):S304–12. https://doi.org/10.1097/JTO.0b013e3181f20c05.CrossRefPubMed

Filosso PL, Ruffini E, Lausi PO, Lucchi M, Oliaro A, Detterbeck F. Historical perspectives: the evolution of the thymic epithelial tumors staging system. Lung Cancer. 2014;83(2):126–32. https://doi.org/10.1016/j.lungcan.2013.09.013.CrossRefPubMed

Litvak AM, Woo K, Hayes S, Huang J, Rimner A, Sima CS, et al. Clinical characteristics and outcomes for patients with thymic carcinoma: evaluation of Masaoka staging. J Thorac Oncol. 2014;9(12):1810–5. https://doi.org/10.1097/JTO.0000000000000363.CrossRefPubMedPubMedCentral

Yanagiya M, Nitadori JI, Nagayama K, Anraku M, Sato M, Nakajima J. Prognostic significance of the preoperative neutrophil-to-lymphocyte ratio for complete resection of thymoma. Surg Today. 2018;48(4):422–30. https://doi.org/10.1007/s00595-017-1602-y.CrossRefPubMed

Fukui T, Fukumoto K, Okasaka T, Kawaguchi K, Nakamura S, Hakiri S, et al. Clinical evaluation of a new tumour-node-metastasis staging system for thymic malignancies proposed by the International Association for the Study of Lung Cancer staging and prognostic factors committee and the international Thymic malignancy interest group. Eur J Cardiothorac Surg. 2016;49(2):574–9. https://doi.org/10.1093/ejcts/ezv389.CrossRefPubMed

Ried M, Eicher MM, Neu R, Sziklavari Z, Hofmann HS. Evaluation of the new TNM-staging system for thymic malignancies: impact on indication and survival. World J Surg Oncol. 2017;15(1):214. https://doi.org/10.1186/s12957-017-1283-4.CrossRefPubMedPubMedCentral

Heus C, Bakker N, Verduin WM, Doodeman HJ, Houdijk APJ. Impact of body composition on surgical outcome in rectal Cancer patients, a retrospective cohort study. World J Surg. 2019;43(5):1370–6. https://doi.org/10.1007/s00268-019-04925-z.CrossRefPubMed

10.

Yanagiya M, Matsumoto J, Kawahara T, Yamaguchi H, Nagayama K, Anraku M, et al. Influence of smoking and histologic subtype on developing Extrathymic malignancy in Thymoma patients. Ann Thorac Surg. 2019;107(5):1532–9. https://doi.org/10.1016/j.athoracsur.2018.11.038.CrossRefPubMed

11.

Renfro LA, Loupakis F, Adams RA, Seymour MT, Heinemann V, Schmoll HJ, et al. Body mass index is prognostic in metastatic colorectal Cancer: pooled analysis of patients from first-line clinical trials in the ARCAD database. J Clin Oncol. 2016;34(2):144–50. https://doi.org/10.1200/JCO.2015.61.6441.CrossRefPubMed

12.

Caro JJ, Salas M, Ward A, et al. Anemia as an independant prognostic factor for survival in patients with cancera systematic, quantitative review. Am Cancer Soc. 2001;91:2214–21.

13.

De Giorgi U, Procopio G, Giannarelli D, et al. Association of Systemic Inflammation Index and Body Mass Index with survival in patients with renal cell Cancer treated with Nivolumab. Clin Cancer Res. 2019;25(13):3839–46. https://doi.org/10.1158/1078-0432.CCR-18-3661.CrossRefPubMed

14.

Gemenetzis G, Bagante F, Griffin JF, Rezaee N, Javed AA, Manos LL, et al. Neutrophil-to-lymphocyte ratio is a predictive marker for invasive malignancy in Intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2017;266(2):339–45. https://doi.org/10.1097/SLA.0000000000001988.CrossRefPubMed

15.

Xin Y, Cai H, Wu L, et al. The effect of Immunonutrition on the postoperative complications in Thymoma with myasthenia gravis. Mediat Inflamm. 2016;2016:8781740.CrossRef

16.

Liu Z, Meng X, Zhang H, Li Z, Liu J, Sun K, et al. Predicting distant metastasis and chemotherapy benefit in locally advanced rectal cancer. Nat Commun. 2020;11(1):4308. https://doi.org/10.1038/s41467-020-18162-9.CrossRefPubMedPubMedCentral

17.

Tang, Xin-Ran, Li, Ying-Qin,Liang, Shao-Bo., et al., Development and validation of a gene expression-based signature to predict distant metastasis in locoregionally advanced nasopharyngeal carcinoma: a retrospective, multicentre, cohort study. Lancet Oncol, 2018. 19(3): p. 382–393, doi: https://doi.org/10.1016/S1470-2045(18)30080-9.

18.

Fakhry C, Zhang Q, Nguyen-Tân PF, et al. Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer. J Clin Oncol. 35:4057–65.

19.

Diallo, Alhassane, Jacobi, Heike,Cook, Arron., et al., Survival in patients with spinocerebellar ataxia types 1, 2, 3, and 6 (EUROSCA): a longitudinal cohort study. Lancet Neurol, 2018. 17(4): p. 327–334, doi: https://doi.org/10.1016/S1474-4422(18)30042-5.

20.

Hwang, W. L.,Tendulkar, R. D.,Niemierko, A., Agrawal S., Stephans K. L., Spratt D. E., Hearn J. W., Koontz B. F., Lee W. R., Michalski J. M., Pisansky T. M., Liauw S. L., Abramowitz M. C., Pollack A., Moghanaki D., Anscher M. S., den R. B., Zietman A. L., Stephenson A. J., Efstathiou J. A., Comparison between adjuvant and early-salvage Postprostatectomy radiotherapy for prostate Cancer with adverse pathological features. JAMA Oncol, 2018. 4(5): p. e175230, doi: https://doi.org/10.1001/jamaoncol.2017.5230.

21.

Olofsson Bagge R, Kicinski M, Faries MB, et al. Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram. J Clin Oncol. 2020;38(14). https://doi.org/10.1200/JCO.19.01902.

22.

Wu LL, Liu X, Jiang WM, Huang W, Lin P, Long H, et al. Stratification of patients with stage IB NSCLC based on the 8th edition of the American joint committee on Cancer (AJCC) staging manual. Front Oncol. 2020;10:571. https://doi.org/10.3389/fonc.2020.00571.CrossRefPubMedPubMedCentral

23.

Zhang LL, Li YY, Hu J, Zhou GQ, Chen L, Li WF, et al. Proposal of a pretreatment nomogram for predicting local recurrence after intensity-modulated radiation therapy in T4 nasopharyngeal carcinoma: a retrospective review of 415 Chinese patients. Cancer Res Treat. 2018;50(4):1084–95. https://doi.org/10.4143/crt.2017.359.CrossRefPubMed

24.

Balachandran, Vinod P.,Gonen, Mithat,Smith, J. Joshua, et al., Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015. 16(4): p. e173-e180, doi: https://doi.org/10.1016/S1470-2045(14)71116-7.

25.

Ocana A, Nieto-Jimenez C, Pandiella A, et al. Neutrophils in cancer: prognostic role and therapeutic strategies. Mol Cancer. 2017;16(1):137. https://doi.org/10.1186/s12943-017-0707-7.CrossRefPubMedPubMedCentral

26.

Liu H, ZhiTao G, Qiu B, et al. A Recurrence Predictive Model for Thymic Tumors and Its Implication for Postoperative Management: a Chinese Alliance for Research in Thymomas database study. J Thorac Oncol. 2020;15(3):448–56.CrossRef

27.

Nicholson AG, Detterbeck FC, Marino M, Kim J, Stratton K, Giroux D, et al. The Thymic epithelial tumors staging project: proposals for the T component for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9):S73–80. https://doi.org/10.1097/JTO.0000000000000303.CrossRefPubMed

28.

Muriana P, Carretta A, Ciriaco P, Bandiera A, Negri G. Assessment of the prognostic role of neutrophil-to-lymphocyte ratio following complete resection of thymoma. J Cardiothorac Surg. 2018;13(1):119. https://doi.org/10.1186/s13019-018-0805-7.CrossRefPubMedPubMedCentral

29.

Sternberg CN. Are nomograms better than currently available stage groupings for bladder cancer? J Clin Oncol. 2006;24(24):3819–20. https://doi.org/10.1200/JCO.2006.07.1290.CrossRefPubMed

30.

Dalela D, Santiago-Jiménez M, Yousefi K, et al. Genomic Classifier Augments the Role of Pathological Features in Identifying Optimal Candidates for Adjuvant Radiation Therapy in Patients With Prostate Cancer: Development and Internal Validation of a Multivariable Prognostic Model. J Clin Oncol. 35:1982–90.

31.

Okereke IC, Kesler KA, Morad MH, Mi D, Rieger KM, Birdas TJ, et al. Prognostic indicators after surgery for thymoma. Ann Thorac Surg. 2010;89(4):1071–7; discussion 1077-9. https://doi.org/10.1016/j.athoracsur.2010.01.026.CrossRefPubMed

32.

Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76(3):878–84. https://doi.org/10.1016/S0003-4975(03)00555-1.CrossRefPubMed

33.

Weksler B, Dhupar R, Parikh V, Nason KS, Pennathur A, Ferson PF. Thymic carcinoma: a multivariate analysis of factors predictive of survival in 290 patients. Ann Thorac Surg. 2013;95(1):299–303. https://doi.org/10.1016/j.athoracsur.2012.09.006.CrossRefPubMed

Title: Nomogram predict relapse-free survival of patients with thymic epithelial tumors after surgery
Authors: Yang-Yu Huang
Lei-Lei Wu
Xuan Liu
Shen-Hua Liang
Guo-Wei Ma
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Thymectomy
Thymectomy
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08585-y

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