Thymic Neuroendocrine Tumors: Demographics, Treatment And Survival
Charles Bakhos1, Aitua Salami2, Larry Kaiser1, Roman Petrov1, Abbas Abbas1
1Temple University Hospital, Philadelphia, PA, USA, 2Einstein Medical Center, Philadelphia, PA, USA
Background Thymic neuroendocrine tumors (TNET) are exceedingly rare thymic non-thymomatous malignancies. The current treatment modalities and survival outcomes of TNET have not been thoroughly examined. We analyzed the clinical, treatment, and survival characteristics of TNET.
Methods We retrospectively identified all patients with a histologic diagnosis of TNET in the national cancer database between 2004 and 2015. Exclusion criteria were age<18 years and unstaged tumors. Descriptive statistics, survival analysis, and multivariable Cox regression analyses were used in elucidating associations.
Results A total of 295 patients were included. The median age of the study population was 57 years, most patients were male (70.5%), Caucasian (79%), and had tumors of regional stage (47.5%). Treatment characteristics were as follows: surgery (58.3%), chemotherapy (34.9%), radiation therapy (39.3%), chemoradiation (10.2%), and trimodality therapy (11.5%). Overall median survival was 6.7 years, and 5-year survival was 61%. Following multivariable analysis, age, tumor stage, treatment with chemotherapy and trimodality therapy were independent predictors for survival. Among patients treated with surgery, neoadjuvant chemotherapy, adjuvant radiation therapy (ART), age, tumor stage and resection margin were independent predictors for survival. Specifically, ART conferred a survival benefit to patients with positive resection margins. Lymph node status did not seem to influence survival outcomes in patients who underwent surgery.
Conclusions Surgery, particularly a R0 resection, remains the mainstay treatment of TNET. Trimodality therapy seems to improve the survival of TNET, while ART confers a benefit for margin positive tumors. Prospective studies are still warranted to better clarify the treatment algorithm of these rare tumors.
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