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European Spine Journal

, Volume 28, Issue 6, pp 1520–1528 | Cite as

Treatments and outcomes of spinal metastasis from thymic epithelial tumors: 10-year experience with 15 patients in a single center

  • Qi Jia
  • Jian Yang
  • Jinbo Hu
  • Tielong Liu
  • Cheng Yang
  • Haifeng WeiEmail author
  • Xinghai YangEmail author
  • Jianru XiaoEmail author
Original Article

Abstract

Purpose

Although thymic epithelial tumors (TETs) are rare, their spinal metastases are even rarer, and they have only been described in a few case reports. The aim of the present study is to discuss the possible treatments and outcomes of patients with spinal metastasis from TETs.

Methods

Included in this retrospective study were 15 patients with metastasis of TETs who received either radical or debulking surgery plus radiochemotherapy as adjuvant therapy in our center between 2007 and 2017. Possible prognostic factors for progression-free survival (PFS) and overall survival (OS) were analyzed by log-rank analysis.

Results

Our series comprised seven men and eight women, with a median age of 52 years. The period from the primary diagnosis to spinal metastasis varied from 0 to 16 months. The metastatic lesions were mainly located in the thoracic spine (n = 11; 73.3%), followed by the cervical and lumbar spine (n = 2; 13.3%, respectively). The median follow-up period was 28 months. Local tumor progression was detected in four patients (26.7%), and seven patients (46.7%) died of the disease during the follow-up period. Log-rank analysis indicated that radical resection was associated with longer PFS, whereas PFS, response to systemic chemotherapy and WHO B1–B2 were favorable factors of OS for patients with spinal metastatic TETs.

Conclusions

Radical surgery is associated with longer PFS, while PFS is associated with better OS. Postoperative radiotherapy seems to be a useful supplementary treatment after debulking surgery, and patients who respond to postoperative chemotherapy were demonstrated with greater OS. WHO type B3–C seemed to be an adverse factor for spinal metastasis from TETs.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Thymic epithelial tumors Spine metastasis Surgery Prognostic factors Adjuvant therapy 

Notes

Funding

This work was supported by grants from National Key Research and Development Program of China (2016YFC0902100).

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no conflicts of interest.

Ethical standards

This research was approved by the hospital ethics committee of the hospital, and written informed consent was obtained from patients or their legal guardians.

Supplementary material

586_2019_5982_MOESM1_ESM.pptx (1.1 mb)
Supplementary material 1 (PPTX 1082 kb)
586_2019_5982_MOESM2_ESM.pdf (262 kb)
Supplementary material 2 (PDF 262 kb)
586_2019_5982_MOESM3_ESM.pdf (130 kb)
Supplementary material 3 (PDF 129 kb)

References

  1. 1.
    Sadohara J, Fujimoto K, Müller NL et al (2006) Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas. Eur J Radiol 60(1):70–79CrossRefGoogle Scholar
  2. 2.
    Achey RL, Lee BS, Sundar S, Benzel EC, Krishnaney AA (2018) Rare thymoma metastases to the Spine: case reports and review of the literature. World Neurosurg 110:423–431CrossRefGoogle Scholar
  3. 3.
    Suster S, Moran CA (2008) Histologic classification of thymoma: the World Health Organization and beyond. Hematol Oncol Clin North Am 22(3):381–392CrossRefGoogle Scholar
  4. 4.
    Kondo K, Yoshizawa K, Tsuyuguchi M et al (2004) WHO histologic classification is a prognostic indicator in thymoma. Ann Thorac Surg 77(4):1183–1188CrossRefGoogle Scholar
  5. 5.
    Vladislav T, Jain RK, Alvarez R et al (2012) Extrathoracic metastases of thymic origin: a review of 35 cases. Mod Pathol 25(3):370–377CrossRefGoogle Scholar
  6. 6.
    Jee TK, Lee S-H, Kim HJ, Kim E-S, Eoh W (2014) Spinal metastasis of thymic carcinoma as a rare manifestation: a summary of 7 consecutive cases. Korean J Spine 11(3):157–161CrossRefGoogle Scholar
  7. 7.
    Liu T, Qiu G, Tian Y (2011) Thymic carcinoma with primary spine metastasis. J Clin Neurosci 18(6):840–842CrossRefGoogle Scholar
  8. 8.
    Hong B, Nakamura M, Hartmann C, Brandis A, Ganser A, Krauss JK (2013) Delayed distant spinal metastasis in thymomas. Spine (Phila Pa 1976) 38(26):E1709–E1713CrossRefGoogle Scholar
  9. 9.
    Marotta N, Mancarella C, Colistra D, Landi A, Dugoni DE, Delfini R (2015) First description of cervical intradural thymoma metastasis. World J Clin Cases 3(11):946–950CrossRefGoogle Scholar
  10. 10.
    Kim JY, Lee YS, Kang DH et al (2017) Epidural metastasis in malignant thymoma mimicking epidural abscess: case report and literature review. Korean J Spine 14(4):162–165CrossRefGoogle Scholar
  11. 11.
    Low HM, Wong CF, H’ng MW (2016) Thymic carcinoma presenting with an unusual and delayed metastasis to the neural foramen, mimicking thoracic spinal radiculopathy. Med J Malays 71(6):368–369Google Scholar
  12. 12.
    Farin A, Aryan HE, Abshire BB (2005) Thymoma metastatic to the extradural spine. J Clin Neurosci 12(7):824–827CrossRefGoogle Scholar
  13. 13.
    Shivapathasundram G, Sammons V, Bazina R (2016) Metastatic thymoma presenting as spontaneous epidural lumbar haematoma. Eur Spine J 25(Suppl 1):33–37CrossRefGoogle Scholar
  14. 14.
    Frankel HL, Hancock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia: I. Paraplegia 7(3):179–192Google Scholar
  15. 15.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefGoogle Scholar
  16. 16.
    Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine: terminology and surgical staging. Spine (Phila Pa 1976) 22(9):1036–1044CrossRefGoogle Scholar
  17. 17.
    Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26(3):298–306CrossRefGoogle Scholar
  18. 18.
    Aoude A, Fortin M, Aldebeyan S, Ouellet J, Amiot LP, Weber MH, Jarzem P (2018) The revised Tokuhashi score; analysis of parameters and assessment of its accuracy in determining survival in patients afflicted with spinal metastasis. Eur Spine J 27(4):835–840CrossRefGoogle Scholar
  19. 19.
    Versteeg AL, Verlaan JJ, Sahgal A et al (2016) The spinal instability neoplastic score: impact on oncologic decision-making. Spine Phila Pa (1976) 41(Suppl 20):S231–S237CrossRefGoogle Scholar
  20. 20.
    Venuta F, Rendina EA, Longo F et al (2003) Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg 76(6):1866–1872CrossRefGoogle Scholar
  21. 21.
    Mou H, Liao Q, Hou X, Chen T, Zhu Y (2018) Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: analysis of the surveillance, epidemiology, and end results (SEER) registry (1988–2013). Int J Radiat Biol 94(5):495–502CrossRefGoogle Scholar
  22. 22.
    Lim Yu Jin, Song Changhoon, Kim Jae-Sung (2017) Improved survival with postoperative radiotherapy in thymic carcinoma: a propensity-matched analysis of surveillance, epidemiology, and end results (SEER) database. Lung Cancer 108(2017):161–167CrossRefGoogle Scholar
  23. 23.
    Shin DY, Kim DW, Keam B et al (2014) The presence of extrathoracic metastasis is more prognostic of survival than Masaoka stage (IVa/IVb) in metastatic thymic epithelial tumor.—A retrospective cohort study. Lung Cancer 85(2):320–325CrossRefGoogle Scholar
  24. 24.
    Jia Qi, Yin Huabin, Yang Jian et al (2018) Treatment and outcome of metastatic paraganglioma of the spine. Eur Spine J 2018(27):859–867CrossRefGoogle Scholar
  25. 25.
    Kondo Kazuya, Monden Yasumasa (2003) Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg 2003(76):878–885CrossRefGoogle Scholar
  26. 26.
    Cassidy JT, Baker JF, Lenehan B (2018) The role of prognostic scoring systems in assessing surgical candidacy for patients with vertebral metastasis: a narrative review. Glob Spine J 8(6):638–651CrossRefGoogle Scholar
  27. 27.
    Valente M, Schinzari G, Ricciotti A, Barone C (2007) Role of chemotherapy in malignant thymoma. Ann Ital Chir 2007(78):377–380Google Scholar
  28. 28.
    Loehrer PJ Sr, Jiroutek M, Aisner S et al (2001) Combined etoposide, ifosfamide, and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma: an intergroup trial. Cancer 2001(91):2010–2015CrossRefGoogle Scholar
  29. 29.
    Giaccone G, Wilmink H, Paul MA, van der Valk P (2006) Systemic treatment of malignant thymoma A decade experience at a single institution. Am J Clin Oncol 29(4):336–344CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Oncology, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina

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