AB023. Thymic epithelial tumors and immune system: a particular relationship still to be clarified
Original Research

AB023. Thymic epithelial tumors and immune system: a particular relationship still to be clarified

Emanuele Voulaz1,2, Simone Balin3,4, Emanuela Re Cecconi1,2, Laura Russo5, Matteo Perrino6, Nadia Cordua6, Silvia Della Bella3,4, Giorgio Da Rin2,5, Domenico Mavilio3,4, Giuseppe Marulli1,2, Paolo Zucali2,6

1Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy; 2Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; 3Unit of Clinical and Experimental Immunology, Department of Medical Biotechnologies and Translational Medicine, University of Milan, Segrate, Italy; 4Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy; 5Clinical Laboratory, IRCCS Humanitas Research Hospital, Rozzano, Italy; 6Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Italy

Correspondence to: Emanuele Voulaz, MD. Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milano, 20089, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy. Email: emanuele.voulaz@humanitas.it.

Background: Thymic epithelial tumors (TETs) are rare cancers of the thymus, frequently associated with autoimmune diseases (ADs), including myasthenia gravis (24.5–44%). The correlation between TETs and autoimmunity still remains unknown. We aim to evaluate the autoantibody profile of patients affected by TETs before surgery in order to assess the presence of differences in patients with or without ADs, even in a subclinical setting.

Methods: We have prospectively enrolled patients affected by TETs and thymic hyperplasia (TH), including age- and sex-matched healthy donors (HDs) as control group. The tests performed were: antinuclear antibodies (ANA), extractable nuclear antigens (ENA), rheumatoid factor (RF), anti-acetylcholine receptor (AchR) and anti-muscle specific kinase (MuSK) immunoglobulin G (IgG), anti-SSA antibodies, anti-SSB, anti-Smith (Sm), anti-ribonucleoprotein (RNP), anti-topoisomerase (Scl-70) and anti-Jo1 anti-cyclic-citrullinated peptide (CCP), anti-neutrophil cytoplasmic antibodies (ANCA) and anti-myeloperoxidase and proteinase 3 (MPO-PR3) antibodies, dsDNA antibodies, thyroglobulin antibodies (TGAb), anti-thyroid peroxidase antibodies (TPOAb) and anti-TSH receptor (TRAb).

Results: From 2020 to date, a total of 171 patients (100 thymomas, 14 thymic carcinomas, 27 THs, and 30 HDs) were enrolled. Among 141 patients with TETs and TH, 28 patients (19.8%) had an overt AD at time of surgery, including myasthenia gravis in 17 patients (60.7%). Notably, the presence of at least one autoantibody positivity was also detected in 69 patients without overt ADs (61.4%) at much higher frequency compared with 30 HDs (23.3%). In patients without overt AD we found AchR positivity in 22 patients (19.4%), TGAb positivity in 12 (11.1%), and TPOAb positivity in 18 (16.2%). Moreover, in the absence of an overt AD, the highest percentage of positivity for autoantibody tested was observed in patients with Thymoma B1 (57%) and B2 (55%).

Conclusions: The pathophysiological links between TETs and autoimmunity still remains unclear. Indeed, while a pre-existing autoimmune condition does not constitute a risk for AD relapse after surgery, the impact of surgical resection on AD flares is unpredictable. In our series we observed several autoantibody positivities despite the absence of overt ADs, suggesting a higher percentage of patients potentially carrying an autoimmune disorder clinically unrecognized when affected by TETs and TH.

Keywords: Thymic tumors; autoimmune diseases (ADs); surgery

Acknowledgments

None.

Footnote

Funding: This work was supported by Associazione Italiana per la Ricerca sul Cancro (AIRC) (IG 27520) (for P.Z. and M.P.).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab023/coif). M.P. gets payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, support for attending meetings from Astellas, Johnson & Johnson, Ipsen, Bristol Meyer Squibb and Bayer. He also participation on a Data Safety Monitoring Board or Advisory Board of Astellas, Johnson&Johnson, Ipsen, Bristol Meyer Squibb and Bayer. P.Z. gets payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, support for attending meetings from Merck Sharp and Dohme, Astellas, Janssen, Sanofi, Ipsen, Pfizer, Novartis, Bristol Meyer Squibb, Amgen, AstraZeneca, Roche, and Bayer. He also participation on a Data Safety Monitoring Board or Advisory Board of Merck Sharp and Dohme, Astellas, Janssen, Sanofi, Ipsen, Pfizer, Novartis, Bristol Meyer Squibb, Amgen, AstraZeneca, Roche, and Bayer. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional ethics committee board of IRCCS Humanitas Research Hospital (No. ONC/OSS-01/2020) and informed consent was obtained from all individual participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/med-25-ab023
Cite this abstract as: Voulaz E, Balin S, Re Cecconi E, Russo L, Perrino M, Cordua N, Della Bella S, Da Rin G, Mavilio D, Marulli G, Zucali P. AB023. Thymic epithelial tumors and immune system: a particular relationship still to be clarified. Mediastinum 2025;9:AB023.

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