ASO Author Reflections: Tumor Maximum Area is Better for Representing Tumor Size in Thymic Epithelial Tumors
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Tumor Maximum Area is Better for Representing Tumor Size in Thymic Epithelial Tumors Dong Tian, MD, PhD1,2,3
, Hao-Ji Yan, MD2, and Jun Nakajima, MD, PhD1
Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 2Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; 3Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China 1
PAST Thymic epithelial tumors (TETs) are uncommon tumors but account for more than half of anterior mediastinal tumors. Due to their rarity and histologic heterogeneity, the analysis of prognostic factors in TET patients is controversial.1 Tumor size was reported as one of the prognostic factors in TET patients, and previous studies have suggested larger TETs indicate worse survival outcomes;2 however, data from the International Association for the Study of Lung Cancer/International Thymic Malignancy Interest Group and the European Society of Thoracic Surgeons demonstrated there was no association between tumor size and survival outcomes.3,4 All these previous literatures defined tumor size as the maximum length of the TETs. Due to the morphological variances of TETs, tumor length may not represent the real tumor size well. In contrast, the tumor maximum area (TMA) in TETs may be better than tumor length to reflect tumor size; however, the clinical significance of TMA to predict survival outcomes has not been reported. PRESENT In our present study,5 we demonstrated that TMA was significantly associated with the survival outcomes of TET patients. The best cut-off value of TMA was identified as
Ó Society of Surgical Oncology 2020 First Received: 26 August 2020 Accepted: 28 August 2020 J. Nakajima, MD, PhD e-mail: [email protected]
1392 mm2 (area under the curve [AUC] 0.793) for dividing TET patients into two groups. TET patients with a larger TMA showed worse overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) compared with TET patients with a smaller TMA (p \ 0.05). Subsequently, in both univariate and multivariate analyses, TMA was demonstrated to be an independent prognostic factor (p \ 0.05). Furthermore, the AUC of TMA was significantly greater than that in tumor length for predicting OS (AUC 0.793 vs. 0.660; p \ 0.05). This finding could indicate that TMA was better for representing tumor size in TETs. FUTURE Our current study indicated TMA was an important prognostic factor, correlating with the OS, PFS, and DFS of TET patients. Meanwhile, our results reached a consensus with previous studies that tumor size is a significant independent predictor of TET patients. We believe the TMA is better for representing tumor size, compared with tumor length, and should be considered in clinical decision making for TET patients. However, due to the limited sample size and single-center study design, our TMA cutoff value may not be effective in other centers. Thus, multicenter studie
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