The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 40-45, July 2009

Recurrent intrathoracic thymomas: Potential prognostic importance of cell-cycle protein expression

  • Tommaso C. Mineo, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
    • Corresponding Author InformationAddress for reprints: Tommaso C. Mineo, MD, Cattedra di Chirurgia Toracica, Università Tor Vergata, Policlinico Tor Vergata, Via Oxford, 81, 00133 Rome, Italy.
    • ,
  • Vincenzo Ambrogi, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Alfonso Baldi, MD

      Affiliations

    • Department of Biochemistry and Biophysic “F. Cedrangolo,” Section of Anatomic Pathology, Second University, Naples, Italy
    • ,
  • Eugenio Pompeo, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Davide Mineo, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy

Received 2 June 2008; received in revised form 22 September 2008; accepted 27 November 2008. published online 06 February 2009.

Objective

Recurrent intrathoracic thymomas may have an unpredictable behavior. Cell-cycle protein expression has proven useful in predicting outcome in a variety of neoplasms. We investigated its potential prognostic importance in recurrent intrathoracic thymomas.

Methods

We reviewed the case histories of 25 consecutive patients operated on between 1987 and 2004 for intrathoracic recurrence (7 mediastinal, 18 nonmediastinal) after radical thymomectomy. Complete resection was performed in 14 patients. In the other 11 patients incomplete resection was followed by chemotherapy and radiotherapy. Expression of cell-cycle proteins (p53, p21, and p27) was assessed by immunohistochemistry in specimens retrieved from both initial and recurrent thymomas. Univariate and multivariate analysis for prognostic factors present at the time of the recurrence was performed.

Results

Eight of 14 patients who underwent complete resection had a second recurrence after a mean free interval of 20 ± 9 months, and a new complete resection was reperformed in 4. After incomplete resection, chemotherapy and radiotherapy allowed total remission in 4 subjects and only 1 of these had a second recurrence. Survival after surgery of the recurrence was negatively influenced by incomplete recurrence resection (P = .03), first disease-free interval less than 24 months (P = .03), high p53 (P = .04), low p21 (P = .02), low p27 (P = .003) expressions, and combination of these proteins (p53 high, p21 low, p27 low expression) (P = .0001). Multivariate analysis selected the triple combination of cell-cycle protein expression as the most significant prognostic variable (P = .02, odds ratio = 11.96, 95% confidence interval = 1.39–102.63).

Conclusions

Cell-cycle protein expression, and namely the combination of high p53, low p21, and low p27 expression, may have a potential prognostic importance in recurrent intrathoracic thymomas.

CTSNet classification: 13

Abbreviation and Acronym: WHO, World Health Organization

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 This research was granted by the grant 60% 2005 from the Tor Vergata University and from the Italian Health Ministry according to the project “Profilo genetico associato al fenotipo metastatico e alla prognosi nei tumori polmonari.”

 This study has been carried out within the Research Fellowship Program “Tecnologie e Terapie Avanzate in Chirurgia,” awarded by TOR Vergata University.

PII: S0022-5223(08)02054-0

doi:10.1016/j.jtcvs.2008.11.048

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 40-45, July 2009

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