Publication: Neoplasias primarias del timo de estirpe no linfoide. Estudio de 58 casos
Authors
Ríos Zambudio, Antonio ; Torres Lanzas, Juan ; Galindo Fernández, Pedro José ; Roca Calvo, María José ; Alonso-Romero, José Luis ; Sola Pérez, Joaquín ; Parrilla Paricio, Pascual
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Publisher
Elsevier
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DOI
https://doi.org/10.1157/13061389
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info:eu-repo/semantics/article
Description
© Elsevier. This document is the Published version of a Published Work that appeared in final form in Medicina Clínica. To access the final edited and published work see https://doi.org/10.1157/13061389
Abstract
Fundamento y objetivo: Los tumores primarios del timo de estirpe no linfoide son infrecuentes, aunque presentan una gran variedad. El objetivo de este trabajo es identificar las variables clínicas, terapéuticas e histológicas que tienen valor pronóstico. Pacientes y método: Se estudiaron 58 tumores primarios del timo de estirpe no linfoide que correspondieron a 52 neoplasias epiteliales (NEPT) (90%), 4 timolipomas (7%) y 2 tumores neuroendocrinos(3%). La clínica más frecuente fue la miastenia grave (41%) y la disnea (21%).Cabe destacar la presencia de 13 pacientes asintomáticos (24%). Para el análisis estadístico se utilizaron las curvas de supervivencia de Kaplan-Meier y el modelo de regresión de Cox. Resultados: Se intervino a todos los pacientes con timectomía, excepto en 4 casos en que se efectuó una biopsia. La mortalidad perioperatoria fue del 3% (n = 2) y la morbilidad, del 31%(n = 18), principalmente por afecciones respiratorias y de la herida. Se administró tratamiento adyuvante con quimioterapia y/o radioterapia en las 24 NEPT grados de Masaoka III y IV, y en el carcinoma linfoepitelial. Con un seguimiento medio (DE) de 13 (5) años, fallecieron 12 pacientes con NEPT y 1 con un tumor neuroendocrino, debido a evolución de la enfermedad. La supervivencia acumulada fue del 80% a los 5 años, del 71% a los 7 años y del 63% a los 10años. Actualmente existen 2 recidivas locales en 2 NEPT, tras 9 y 8 años de seguimiento, respectivamente. Los principales factores pronósticos son el tipo y subtipo histológicos, así como el estadio clínico (p < 0,001).
Conclusiones: El diagnóstico precoz en los tumores primarios del timo de estirpe no linfoide es fundamental para instaurar un tratamiento correcto antes de que presenten un estadio clínico más avanzado. Los principales factores pronósticos son el tipo y subtipo histológicos, así como el estadio clínico.
Background and objective: Primary non-lymphoid thymus tumors (PNLTT) are an uncommonthough quite varied pathology. Our objective was to identify the clinical, therapeutic and histologicvariables with a prognostic value in these neoplasms. Patients and method: We studied 58 PNLTT cases, corresponding to 52 epithelial neoplams(PTEN), 4 thymolipomas (7%) and 2 neuroendocrine tumors (3%). Commonest clinical manifestationswere myasthenia gravis (41%) and dyspnea (21%). Three patients were symptomfree(24%). We used Kaplan-Meier survival curves and Cox regression model. Results: All patients underwent surgery which consisted of thymectomy. Four patients underwenta biopsy procedure alone. Perioperative mortality was 3% (n = 2) and morbidity was 31%(n = 18), mainly because of respiratory and wound problems. 24 patients with PTEN, Masaokadegrees III and IV, and a patient with a lymphoepithelial carcinoma received adjuvant chemotherapyand/or radiotherapy. With a follow-up of 13 + 5 years, 12 PTEN patients and one patientwith a neuroendrocrine tumor died as a consequence of the evolution of the disease. Cumulativesurvival was 80% at 5 years, 71% at 7 years and 63% at 10 years. There arecurrently two local relapses in two PTEN cases after 9 and 8 years of follow-up, respectively.Main prognostic factors are the histologic type and subtype and the clinical stage (p < 0.001). Conclusions: In PNLTT early diagnosis is crucial in order to administer a correct treatment beforethe clinical stage is more advanced. Main prognostic factors are the histologic type andsubtype and the clinical stage.
Background and objective: Primary non-lymphoid thymus tumors (PNLTT) are an uncommonthough quite varied pathology. Our objective was to identify the clinical, therapeutic and histologicvariables with a prognostic value in these neoplasms. Patients and method: We studied 58 PNLTT cases, corresponding to 52 epithelial neoplams(PTEN), 4 thymolipomas (7%) and 2 neuroendocrine tumors (3%). Commonest clinical manifestationswere myasthenia gravis (41%) and dyspnea (21%). Three patients were symptomfree(24%). We used Kaplan-Meier survival curves and Cox regression model. Results: All patients underwent surgery which consisted of thymectomy. Four patients underwenta biopsy procedure alone. Perioperative mortality was 3% (n = 2) and morbidity was 31%(n = 18), mainly because of respiratory and wound problems. 24 patients with PTEN, Masaokadegrees III and IV, and a patient with a lymphoepithelial carcinoma received adjuvant chemotherapyand/or radiotherapy. With a follow-up of 13 + 5 years, 12 PTEN patients and one patientwith a neuroendrocrine tumor died as a consequence of the evolution of the disease. Cumulativesurvival was 80% at 5 years, 71% at 7 years and 63% at 10 years. There arecurrently two local relapses in two PTEN cases after 9 and 8 years of follow-up, respectively.Main prognostic factors are the histologic type and subtype and the clinical stage (p < 0.001). Conclusions: In PNLTT early diagnosis is crucial in order to administer a correct treatment beforethe clinical stage is more advanced. Main prognostic factors are the histologic type andsubtype and the clinical stage.
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Citation
Med Clin (Barc) 2004 122(17):664-7
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