Yamamoto Yoko, Iwahori Kota, Shintani Yasushi
Department of General Thoracic Surgery, Sakai City Medical Center, Osaka, Japan.
Department of General Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Mediastinum. 2024 Oct 11;8:47. doi: 10.21037/med-24-24. eCollection 2024.
Thymic epithelial tumors (TETs) are the most common neoplasm of the prevascular mediastinal compartment and are characterized by their rarity and variable clinical presentation. The present study aimed to explore the current management of patients with TET with a special focus on immunotherapy for advanced disease.
Relevant studies published between 1981 and 2024 were searched in PubMed using search terms "Thymoma", "Thymic cancer", "Myasthenia gravis", "Radiation therapy", "Surgery", and "Immunotherapy".
The International Thymic Malignancy Interest Group and the International Association for the Study of Lung Cancer established the tumor-node-metastasis (TNM) staging system for TET based on an overall survival (OS) analysis of a retrospective international database. While complete surgical resection is the mainstay for resectable TET, there are currently no clear guidelines on systemic treatments for advanced TET because of the complexity, rarity, and heterogeneity of this disease and the lack of and models. With the development of immunotherapy, the application of the anti-programmed cell death-1 (anti-PD-1) antibody is expanding and includes TET. Clinical trials on immune checkpoint inhibitors (ICIs) are ongoing, and the acceptable clinical efficacy of the anti-PD-1 antibody for TET has been reported. On the other hand, there have been reports of a heightened frequency of severe immune-related adverse events (irAEs) in TET.
ICIs have the potential for patients with TET. The benefit-toxicity ratio of ICI treatment needs to be carefully evaluated for those patients.
胸腺上皮肿瘤（TETs）是血管前纵隔最常见的肿瘤，其特点是罕见且临床表现多样。本研究旨在探讨TET患者的当前治疗方法，特别关注晚期疾病的免疫治疗。
在PubMed中检索1981年至2024年发表的相关研究，检索词为“胸腺瘤”、“胸腺癌”、“重症肌无力”、“放射治疗”、“手术”和“免疫治疗”。
国际胸腺恶性肿瘤兴趣小组和国际肺癌研究协会基于对一个回顾性国际数据库的总生存（OS）分析，为TET建立了肿瘤-淋巴结-转移（TNM）分期系统。虽然完整的手术切除是可切除TET的主要治疗方法，但由于该疾病的复杂性、罕见性和异质性以及缺乏合适的模型，目前对于晚期TET的全身治疗尚无明确指南。随着免疫治疗的发展，抗程序性细胞死亡蛋白1（anti-PD-1）抗体的应用正在扩大，包括TET。免疫检查点抑制剂（ICIs）的临床试验正在进行，并且已经报道了anti-PD-1抗体对TET具有可接受的临床疗效。另一方面，有报道称TET中严重免疫相关不良事件（irAEs）的发生率有所增加。
ICIs对TET患者具有潜在作用。对于这些患者，需要仔细评估ICI治疗的利弊比。
