Diagnostic and prognostic relevance of inflammatory and immune-related markers in thymic epithelial tumors
Megyesfalvi Evelyn Katalin
KÁROLY RÁCZ CONSERVATIVE MEDICINE PROGRAM
Dr. Fekete Andrea
Országos Onkológiai Intézet, 1122 Budapest, Ráth György utca 7-9, 3. épület fsz. Aula Előadóterem
2026-09-21 13:00:00
Pulmonology
Dr. Losonczy György
Dr. Döme Balázs
Dr. Piros László
Dr. Csoma Zsuzsanna
Dr. Tamási Lilla
Dr. Lázár Zsófia
Dr. Buzás András
Thymic epithelial tumors (TETs) are rare thoracic malignancies characterized by pronounced biological and clinical heterogeneity, resulting in divergent outcomes even among patients with similar stage or histology. Therefore, complementary prognostic markers are needed to aid patient stratification and determine the most appropriate follow-up strategies. Our goal was to investigate the diagnostic and prognostic relevance of inflammatory and immune-related markers in TETs. First, we evaluated the clinical significance of preoperative blood-based inflammatory parameters in a large multicenter cohort of surgically treated patients. Next, taking into account the unique immunological role of the thymus, we characterized the tissue-level expression patterns and clinical relevance of immune-related markers with potential biological and therapeutic relevance in surgically resected TETs. The first study included 743 patients who underwent surgical resection in four European medical centers across Hungary, Austria, and Germany. Preoperative laboratory parameters and inflammatory ratios were collected from routine blood cell counts prior to surgery. Meanwhile, the second study assessed the expression of TIM3, OX40L, GTF2I, XPO1, and GITR by immunohistochemistry (IHC) in both the epithelial and lymphocytic tumor compartments of 137 surgically resected TETs. The laboratory and IHC data were subsequently correlated with clinicopathological characteristics and survival outcomes, including overall survival (OS) and cause-specific survival (CSS). Elevated preoperative CRP levels were significantly associated with larger tumor size, whereas increased neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values were characteristic of thymic carcinomas (vs. thymomas). High PLR and fibrinogen levels proved to be independent negative prognosticators for OS and CSS. TIM3, GTF2I, and XPO1 showed high and consistent epithelial expression across different TET histological subtypes, while OX40L expression was significantly increased in patients with myasthenia gravis. Importantly, the combined immune marker expression profiles identified four distinct TET subgroups with widely different survival outcomes. The subgroup characterized by elevated epithelial GTF2I, XPO1, and TIM3 expression showed the worst survival in our multivariate model. Our findings demonstrate that systemic inflammatory markers and ratios, as well as tissue-based immune marker expression patterns, provide clinically relevant information beyond conventional prognostic systems and may contribute to more accurate risk assessment, refined patient stratification, and the development of personalized follow-up protocols in thymoma and thymic carcinoma.
