Arthur Petat1, Eric Dansin2, Fabien Calcagno3, Laurent Greillier4, Eric Pichon5, Mallorie Kerjouan6, Christelle Clement-Duchene7, Bertrand Mennecier8, Virginie Westeel9, François Thillays10, Xavier Quantin11, Youssef Oulkhouir12, Luc Thiberville13, Charles Ricordel6, Vincent Thomas De Montpreville14, Lara Chalabreysse15, Véronique Hofman16, Thierry Molina17, Pierre Fournel18, Laurence Bigay Game19, Benjamin Besse20, Nicolas Girard21. 1. Respiratory Medicine Department, Hospices Civils de Lyon, Lyon, France; University of Lyon, University Claude Bernard Lyon 1, Lyon, France. 2. Medical Oncology Department, Centre Oscar Lambret, Lille, France. 3. Medical Oncology Department, University Hospital, Besançon, France. 4. Multidisciplinary Oncology and Therapeutic Innovations Department, Hôpital Nord, APHM, Aix Marseille Univ, INSERM, CNRS, CRCM, Marseille, France. 5. Respiratory Medicine Department, University Hospital, Tours, France. 6. Respiratory Medicine Department, University Hospital, Rennes, France. 7. Medical Oncology Department, Cancer Institute, Nancy, France. 8. Respiratory Medicine Department, University Hospital, Strasbourg, France. 9. Respiratory Medicine Department, University Hospital, Besançon, France. 10. Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France. 11. Respiratory Medicine Department, Montpellier Cancer Institute, Montpellier, France. 12. Respiratory Medicine Department, University Hospital, Caen, France. 13. Respiratory Medicine Department, University Hospital, Rouen, France. 14. Pathology Department, Marie Lannelongue Center, Le Plessis Robinson, France. 15. Pathology Department, Hospices Civils de Lyon, Lyon, France. 16. Pathology Department, University Hospital, Nice, France. 17. Pathology Department, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 18. Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Etienne, France. 19. Respiratory Medicine Department, University Hospital, Toulouse, France. 20. Medical Oncology Department, Gustave Roussy, Villejuif, France. 21. Institut Curie, Institut du Thorax Curie Montsouris, Paris, France. Electronic address: nicolas.girard2@curie.fr.
Abstract
BACKGROUND: Thymic carcinomas are aggressive and difficult to treat a subset of thymic epithelial tumours that represent a heterogeneous group of rare intrathoracic malignancies. The treatment strategy of thymic carcinomas is based on whether surgical resection may be achieved, which represents the most significant favourable prognostic factor on survival. For this study, we took advantage of the unique prospective Réseau tumeurs THYMiques et Cancer (RYTHMIC) database to describe baseline characteristics, analyse treatment strategies in light of existing guidelines and provide landmark patient outcomes data with regards to response and survival of patients in a real-life clinical practice setting. METHODS: Inclusion criteria for this analysis were the following: (1) histologically-confirmed thymic carcinomas - excluding neuroendocrine tumours-after pathological review by the RYTHMIC pathology panel, (2) discussion of the case at the RYTHMIC multidisciplinary tumour board, (3) at least one active treatment modality. RESULTS: A total of 213 patients were analysed. Overall, 60 (28%) patients were considered as surgical candidates upfront, 91 (43%) patients received primary chemotherapy, and 62 (29%) patients received exclusive chemotherapy. Median overall survival (OS) was 49.2 months (IC95%: 34.8-63.6); OS was significantly longer in patients with a lower stage at diagnosis (p < 0.001), who were operated on upfront, as opposed to patients who received primary or exclusive chemotherapy (p < 0.001). Surgery, conducted upfront or after primary chemotherapy, was significantly associated with more prolonged OS (p < 0.001); complete resection and postoperative radiotherapy were also predictors of better outcome (p = 0.018 and p = 0.051, respectively). CONCLUSIONS: Our cohort is the first to analyse in-depth outcomes and treatment strategies in a prospective cohort of consecutive patients with thymic carcinoma. While we confirm the major prognostic impact of surgery, our data highlight the need for optimised multidisciplinary management and innovative therapies as the survival of patients remains limited.
BACKGROUND: Thymic carcinomas are aggressive and difficult to treat a subset of thymic epithelial tumours that represent a heterogeneous group of rare intrathoracic malignancies. The treatment strategy of thymic carcinomas is based on whether surgical resection may be achieved, which represents the most significant favourable prognostic factor on survival. For this study, we took advantage of the unique prospective Réseau tumeurs THYMiques et Cancer (RYTHMIC) database to describe baseline characteristics, analyse treatment strategies in light of existing guidelines and provide landmark patient outcomes data with regards to response and survival of patients in a real-life clinical practice setting. METHODS: Inclusion criteria for this analysis were the following: (1) histologically-confirmed thymic carcinomas - excluding neuroendocrine tumours-after pathological review by the RYTHMIC pathology panel, (2) discussion of the case at the RYTHMIC multidisciplinary tumour board, (3) at least one active treatment modality. RESULTS: A total of 213 patients were analysed. Overall, 60 (28%) patients were considered as surgical candidates upfront, 91 (43%) patients received primary chemotherapy, and 62 (29%) patients received exclusive chemotherapy. Median overall survival (OS) was 49.2 months (IC95%: 34.8-63.6); OS was significantly longer in patients with a lower stage at diagnosis (p < 0.001), who were operated on upfront, as opposed to patients who received primary or exclusive chemotherapy (p < 0.001). Surgery, conducted upfront or after primary chemotherapy, was significantly associated with more prolonged OS (p < 0.001); complete resection and postoperative radiotherapy were also predictors of better outcome (p = 0.018 and p = 0.051, respectively). CONCLUSIONS: Our cohort is the first to analyse in-depth outcomes and treatment strategies in a prospective cohort of consecutive patients with thymic carcinoma. While we confirm the major prognostic impact of surgery, our data highlight the need for optimised multidisciplinary management and innovative therapies as the survival of patients remains limited.