Ann Thorac Surg 2012;93:888-889. doi:10.1016/j.athoracsur.2011.06.046
© 2012 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited Commentary
Pierre-Emmanuel Falcoz, MD, PhD
Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
(Email: pierre-emmanuel.falcoz{at}wanadoo.fr).
The current issue of The Annals of Thoracic Surgery publishes the remarkable work of Weksler and associates [1] which contributes to a deeper understanding of the lifetime risk and incidence of extrathymic neoplasia, diagnosed either before or after thymoma, in patients with thymoma. For this purpose, they used the Surveillance, Epidemiology, and End Results (SEER) cancer database. Of the 2,171 patients in the SEER database with thymoma, 306 (14.1%) had 350 extrathymic primary cancers. Extrathymic neoplasms were diagnosed before the diagnosis of thymoma in 88 patients, and after the diagnosis of thymoma in 206 patients. The age-adjusted incidence of cancer in patients diagnosed with thymoma was 8224.9 per 100,000 compared with 459.2 per 100,000 in the SEER population (p < 0.001), an incidence 18 times greater. In addition, the age-adjusted incidence of cancer before thymoma diagnosis in patients who were subsequently diagnosed with thymoma was 3,388.6 per 100,000 persons, a 7 times increased incidence. When using standardized incidence ratios, the authors found that patients with thymoma had an overall increased risk of 47% of developing extrathymic malignancies. Finally, they concluded that the incidence of extrathymic neoplasia was significantly higher in patients with thymoma than in the general population and that the higher incidence of extrathymic cancers occurs both before and after the diagnosis of thymoma.
Few studies in the past 10 years have sought to address the very interesting but seldom debated question of the association between thymoma and extrathymic cancer, and they have, for the most part, been single institutions series or database reports focusing on this clinical occurrence, which is gaining notoriety. This stimulating article helps to clarify some of the controversies and its main findings may well have a relevant impact on the follow-up of these patients in the near future. Indeed, very little was known before this study about extrathymic neoplasm (eg, lymphoma, breast cancer, prostate cancer, and colorectal cancer) diagnosed before thymoma. According to the article's results, a lifetime follow-up and a vigilant screening to allow early detection of any malignancies would be highly indicated for this group of patients!
Dr Weksler and colleagues [1] emphasize in their work the importance of the burgeoning field of immunology in the spectrum of thymic gland disorders. Current scientific evidence suggests that malignancies linked to thymoma include the loss of self-tolerance and the presence of autoimmunity, highlighting, therefore, the great importance of autoimmune regulator [2,3]. Exploring immune abnormality in patients with thymoma will therefore be the clue not only to assess the central place of the thymus in autoimmunity and cancer immunosurveillance, but also, going one step further, to shed light on the role of the immune system in the framework of diseases related to thymoma. For this purpose, the mission of the International Thymic Malignancy Interest Group (http://www.ITMIG.org/), promoting the advancement of clinical and basic science pertaining to thymoma biology and thymic malignancies, is of major importance.
In the meantime, Dr Weksler and associates are to be congratulated on their investigations in this area. From the standpoint of medical care, their results will certainly prove to be most beneficial to the thoracic surgery community.
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References
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- Weksler B, Nason KS, Mackey D, Gallagher A, Pennathur A. Thymomas and extrathymic cancers Ann Thorac Surg 2012;93:884-889.[Abstract/Free Full Text]
- Marx A, Hohenberger P, Hoffmann H, et al. The autoimmune regulator AIRE in thymoma biology: autoimmunity and beyond J Thorac Oncol 2010;5:S266-S272.[Medline]
- Shelly S, Agmon-Levin N, Altman A, Shoenfeld Y. Thymoma and autoimmunity Cell Mol Immunol 2011;8:199-202.[Medline]
Related Article
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Thymomas and Extrathymic Cancers
- Benny Weksler, Katie S. Nason, Daniel Mackey, Angela Gallagher, and Arjun Pennathur
Ann. Thorac. Surg. 2012 93: 884-888.
[Abstract]
[Full Text]
[PDF]
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References