Preoperative steroid pulse therapy for invasive thymoma - Clinical experience and mechanism of action
Preoperative steroid pulse therapy for invasive thymoma - Clinical experience and mechanism of action
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DOI：
10.1002/cncr.21875
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发表时间：
2006-05-01
期刊：
影响因子：
6.2
通讯作者：
Kawano, O
中科院分区：
文献类型：
--
作者：
Kobayashi, Y;Fujii, Y;Kawano, O
背景：糖皮质激素用于胸腺瘤。本研究的目的是评价静脉注射高密度糖皮质激素(类固醇脉冲)治疗未经治疗的晚期胸腺瘤的疗效。方法：17名未接受化疗或放射治疗的侵袭性胸腺瘤患者纳入研究。所有患者术前均接受2个疗程的糖皮质激素治疗。激素冲击治疗1周后，通过计算机断层扫描(CT)评估肿瘤反应。分析胸腺瘤相关淋巴细胞的CD4/CD8表型和糖皮质激素受体(GR)。结果激素冲击治疗总有效率为47.1%(8/17)。131型胸腺瘤的肿瘤体积缩小最为明显；AB型胸腺瘤与B1型胸腺瘤(P=0.0234)以及B1型与B3型胸腺瘤(P=0.0068)之间有显著差异。肿瘤体积缩小的同时，表达较高水平糖皮质激素受体的CD4+8+双阳性未成熟胸腺细胞显著减少。结论：激素冲击治疗131型胸腺瘤的疗效最为显著，这可能与激素对富含GR的CD4+8+双阳性幼稚淋巴细胞的特异性作用有关。
BACKGROUND, Glucocorticoid was used in thymomas. The purpose of the study was to evaluate the efficacy of intravenous high-close glucocorticoid (steroid Pulse) therapy in patients with previously untreated advanced thymoma. Causes were also sought for a possible underlying mechanism of the effect of steroid on thymoma.METHODS. Seventeen patients with invasive thymoma who had not received previous chemotherapy or radiation therapy were enrolled in the study. All cases were treated with 2 courses of glucocorticoid therapy before surgery. Tumor response was assessed by Computed tomography (CT) scan I week after the steroid pulse therapy. Lymphocytes associated with thymoma were analyzed for their CD4/CD8 phenotype and glucocorticoid receptor (GR). TdT-mediated dUTP-biotin nick-end labeling (TUNEL) staining was used to analyze the apoptotic lymphocytes and epithelial cells.RESULTS. The overall response rate to the steroid pulse therapy was 47.1% (8 of 17). The reduction in tumor size was most prominent in type 131 thymomas; there were significant differences between type AB and type B1 thymomas (P = .0234) and type B1 and type B3 thymomas (P = .0068). The reduction in tumor size was accompanied with a marked reduction in the CD4+8+ double-positive immature thymocytes that expressed higher levels of glucocorticoid receptor. Apoptotic changes were observed in both neoplastic epithelial cell and lymphocyte components after glucocorticoid therapy.CONCLUSIONS. The efficiency of preoperative steroid pulse therapy in type 131 thymoma was most prominent, which is probably related to the specific effect on GR-rich CD4+8+ double-positive immature lymphocytes, which are abundant in this type of thymoma.