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Lei Yu



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    MA 16 - Mediastinal, Tracheal and Esophageal Tumor: Multimodality Approaches (ID 675)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      MA 16.07 - Appropriate Time to Adjuvant Radiotherapy for Thymoma with MG after Extended Thymectomy (ID 8307)

      15:45 - 17:30  |  Presenting Author(s): Lei Yu

      • Abstract
      • Presentation
      • Slides

      Background:
      The co-existence of MG and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this article is to investigate whether patients with MG and thymoma should receive mediastinal radiation therapy and when after extended thymectomy.

      Method:
      Between 2003 and 2014, 181 patients with MG and thymoma underwent extended thymectomy. According to application of radiation therapy, these patients were divided into 2 groups: Group 1 (n=157), patients having mediastinal radiation therapy after surgery; Group 2, without adjuvant radiation therapy (n = 24). Group 1 was subdivided into 3 subgroups: 1-month subgroup(n = 98); 2-month subgroup(n = 7): and 3-month subgroup(n = 52).

      Result:
      There were no intraoperative deaths and no inoperable cases. 172 patients underwent extended thymectomy by video-assisted thoracoscopic surgery, and 9 undergoing the trans-sternal approach due to thymoma invading great vessels. There was no significant difference in the aspects, such as length of surgery, Operative complications, and ICU stay, between 1-month subgroup, 3-month subgroup and Group 2. The proportions of type A, AB, B1, B2, B3, and thymic carcinoma were 0.6%, 18.2%, 26.5%, 33.7%,21.0%, and 0%, respectively. There were no radiation-related deaths. 159 patients were followed for 15 months to 12 years. Postoperative myasthenic crisis occurred in 40 cases. There was a significant difference in occurrence of postoperative myasthenic crisis between 1-month subgroup and Group 2 (P=0.031). The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group 2, respectively. Overall survival rates of 1-month subgroup, 3-month subgroup, and Group 2 were 88.8%, 83.3%, and 77.3%, respectively. Among 14 recurrences, 11 cases happened in pleural cavity; 2 recurrences in lung; and one patient having metastasis to liver. There was no lymph node metastasis detected. Kaplan-Meier survival curves demonstrate that within 7 years after surgery, there is no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup, 3-month subgroup and Group 2; over 8 years after surgery, disease-free survival rates in 1-month subgroup, 3-month subgroup and Group 2 were 79.4%, 70.6% and 55.3%, respectively.

      Conclusion:
      Adjuvant radiation within one month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR. Whether it might have influence in prognosis of thymoma with MG needs to be further investigated in the future. In recurrences of thymoma patients with MG, no lymph node metastasis was detected

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    P1.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 703)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P1.17-003 - Identification of Differentially Expressed Genes between Thymoma and Paraneoplastic Thymic Tissue (ID 8305)

      09:30 - 16:00  |  Presenting Author(s): Lei Yu

      • Abstract

      Background:
      Our study tries to demonstrate the underlying genetic mechanisms of tumorigenesis of thymoma and understand the related features: association with myasthenia gravis, and histologic variability.

      Method:
      This study uses CapitalBio mRNA microarray analysis of 31 cases of thymoma (including 5 cases of type AB, 6 B1-type cases, 12 B2-type cases, 5 B2B3-type cases, 3 type- B3 cases of; only 6 cases of thymoma were not associated with myasthenia gravis, 25 cases with myasthenia gravis).

      Result:
      Some differentially expressed genes after comparisons between thymoma and the thymus tissue around tumor were identified preliminarily. Among them, 292 genes increased more than 2-fold, 2 genes more than 5-fold; on the other hand, 596 genes were decreased more than 2-fold, 115 genes more than 5-fold, 21 genes more than 10-fold, 6 genes more than 20-fold. Among these genes upregulated or downregulated, 6 driver genes, such as FANCI、NCAPD3、NCAPG、OXCT1、EPHA1 and MCM2, were identified. We selected 2-fold upregulated and 2-fold downregulated genes to generate a supervised clustering heat map. 6 distinct clusters were identified. In cluster 1, two were type B2 tumors; in cluster 6, three were type B2/B3 tumors. KEGG database analysis, utilized for research and education, found that the pathogenesis of thymoma might be associated with several signaling pathways, which provides important information for revealing genetic mechanisms of thymoma; By comparing with genetic differences of thymoma with myasthenia gravis and without, 4 genes (PNISR,NBPF14,PIK3IP1和RTCA)were upregulated more than 2-fold, more than 30 genes were downregulated more than 2-fold, and 2 signaling pathways with more than 2-fold upregulated genes (TGF- beta signaling pathway and HTLV-I signaling pathway)were found.Figure 1



      Conclusion:
      The study would be shed light on the molecular bases for selecting appropriate oncological management, predict prognosis and provide important information on the genetic background of thymoma. But Confirmation of the data will be performed using immunohistochemical and multiplex quantitative RT-PCR methods.