Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac210.
Thymic epithelial tumours (TETs) are relatively rare indolent malignancies in the mediastinum. Lymph node metastasis (LNM) is an important prognostic indicator for TETs; however, the pattern of LNM involved in TETs has yet to be elucidated.
Patients diagnosed with histologically confirmed thymoma (A-B3), thymic carcinomas and thymic neuroendocrine tumours, between 1988 and 2016 were identified from the Surveillance, Epidemiology, and End Results database. Univariable and multivariable logistic regression analyses were applied to identify the predictors for LNM. The predictive nomogram was built from the independent risk factors and measured using the concordance statistic.
The overall proportion of TETs with LNM was 18.5% (200/1048). The rate of LNM in thymoma, thymic carcinomas and thymic neuroendocrine tumours was 6.8% (42/622), 30.2% (100/331) and 61.1% (58/95), respectively. According to the logistic regression analysis, histology type and T stage were independent factors correlated with LNM. A predictive nomogram model was developed with a concordance statistic of 0.807 (95% confidence interval: 0.773-0.841), which was significantly better than the T stage (P < 0.001) while had limited benefit to the histology type (P = 0.047). The calibration curve for the nomogram comparing the predicted and actual probabilities after bias correction showed good agreement.
Nodal involvement was not uncommon in TETs. Main factors related to LNM in TETs were histology type and T stage. The probability of LNM could be well calculated using the predictive model.
胸腺瘤（TET）是纵隔内相对罕见的惰性恶性肿瘤。淋巴结转移（LNM）是 TET 的一个重要预后指标；然而，TET 中 LNM 的模式尚未阐明。
从监测、流行病学和最终结果数据库中确定了 1988 年至 2016 年间经组织学证实的胸腺瘤（A-B3）、胸腺癌和胸内神经内分泌肿瘤患者。应用单变量和多变量逻辑回归分析来确定 LNM 的预测因素。从独立风险因素构建预测列线图，并使用一致性统计量进行测量。
总体而言，TET 中 LNM 的比例为 18.5%（200/1048）。胸腺瘤、胸腺癌和胸内神经内分泌肿瘤的 LNM 发生率分别为 6.8%（42/622）、30.2%（100/331）和 61.1%（58/95）。根据逻辑回归分析，组织学类型和 T 分期是与 LNM 相关的独立因素。建立了一个预测列线图模型，其一致性统计量为 0.807（95%置信区间：0.773-0.841），明显优于 T 分期（P < 0.001），而对组织学类型的改善有限（P = 0.047）。经过偏差校正后，列线图预测概率与实际概率的校准曲线显示出良好的一致性。
TET 中淋巴结受累并不少见。TET 中与 LNM 相关的主要因素是组织学类型和 T 分期。使用预测模型可以很好地计算 LNM 的概率。
