Risk factors for myasthenia gravis after resection of thymoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIAN Kunjie , SUN Qingchao , ZHANG Haiping , LI Desheng , YOU Zhaolei ,  ZHANG Liwei

Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R.China;

Corresponding author：

ZHANG Liwei, Email: zhangliwei@medmail.com.cn

Keywords：

Thymoma; myasthenia gravis; risk factors

DOI：

10.7507/1007-4848.201506036

Video：

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Objective To evaluate the risk factors of the patients with myasthenia gravis (MG) after resection of thymoma. Methods We retrospectively analyzed the clinical data of 126 thymoma patients without preoperative MG who underwent a thymectomy in our hospital from June 2002 through May 2015. There were 51 males and 75 females at age of 51.71±14.06 years. The risk factors for MG after resection of thymoma were evaluated. Results MG occurred in nine patients after resection of thymoma (7.1%). Incomplete resection (P=0.024), A and AB type of WHO classification (P=0.048), concomitant autoimmune diseases (P=0.024), postoperative pulmonary infection (P=0.036) were the risk factors for the MG after resection of thymoma. Postoperative radiotherapy and chemotherapy (P=0.011) reduced the risk for the patients with incomplete resection or invasive thymoma. Conclusion Incomplete resection, A and AB type of WHO classification, concomitant autoimmune diseases, postoperative pulmonary infection are considered as the risk factors for MG after resection of thymoma, and postoperative radiotherapy and chemotherapy should be performed for the patients with incomplete resection or invasive thymoma.

Citation： QIANKunjie, SUNQingchao, ZHANGHaiping, LIDesheng, YOUZhaolei, ZHANGLiwei. Risk factors for myasthenia gravis after resection of thymoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 20-24. doi: 10.7507/1007-4848.201506036 Copy

1.	Nakajima J, Murakawa T, Fukami T, et al. Postthymectomy myasthenia gravis: relationship with thymoma and antiacetylcholine receptor antibody. Ann Thorac Surg, 2008, 86(3): 941-945.
2.	Ito M, Fujimura S, Monden Y, et al. A retrospective group study on post-thymectomy myasthenia gravis. Nihon Kyobu Geka Gakkai Zasshi, 1992, 40(2): 189-193.
3.	Kondo K, Monden Y. Myasthenia gravis appearing after thymectomy for thymoma. Eur J Cardiothorac Surg, 2005, 28(1): 22-25.
4.	Rosai J, Sobin LH. Histological typing of tumours of the thymus. World Health Organization international histological classification of tumours, New York: Springer, 1999.
5.	Obata S, Yamaguchi Y, Sakio H, et al. Myasthenia gravis developed after extirpation of thymoma. Rinsho Kyobu Geka, 1983(3): 729-733.
6.	Namba T, Grunner NG, Grob D. Myasthenia gravis in patients with thymoma, with particular reference to onset after thymectomy. Medicine, 1978, 57(5): 411-433.
7.	李鉴, 张德超, 汪良骏, 等. 胸腺瘤切除术后重症肌无力的临床分析. 中华外科杂志, 2004, 42(9): 540-542.
8.	Kokubo M, Shirohashi Y, Inaba K, et al. A case of pure red cell aplasia with hypogammaglobulinemia appearing after thymothymectomy. Kyobu Geka, 1999, 52(6): 505-507.
9.	Michalska T, Rowinska-Marcinska K, Ryniewicz B, et al. Is there true remission in myasthenia gravis: long-term clinical and electrophysiological studies. Neurol Neurochir Pol, 1998, 32(6): 1357-1367.
10.	Sun XG, Wang YL, Liu YH, et al. Myasthenia gravis appearing after thymectomy. J Clin Neurosci, 2011, 18(1): 57-60.
11.	管宇宙, 崔丽英, 郭慧琴, 等. 胸腺瘤切除术后重症肌无力患者 11 例的临床特点. 中华神经外科杂志, 2006, 39(4): 262-263.
12.	Ruffini E, Filosso PL, Mossetti C, et al. Thymoma: inter-relationships among World Health Organization histology, Masaoka staging and myasthenia gravis and their independent prognostic significance: a single centre experience. Eur J Cardiothorac Surg, 2011, 40(1): 146-153.
13.	Berrih-Aknin S, Le Panse R. Myasthenia gravis: A comprehensive review of immune dysregulation and etiological mechanisms. J Autoimmun, 2014, 52: 90-100.
14.	Chen J, Yang Y, Zhu D, et al. Thymoma with pure red cell aplasia and Good’s syndrome. Ann Thorac Surg, 2011, 91(5): 1620-1622.
15.	Sanders DB, Evoli A. Immunosuppressive therapies in myasthenia gravis. Autoimmunity, 2010, 43(56): 428-435.
16.	Werneck LC, Omha FM, Scola RII. Myasthenia gravis: a retrospective study comparing thymectomy to conservative treatment. Acta Ncuroi Scan, 2000, 101(1): 41-46.
17.	昊涛, 涂来慧, 张仁琴. 胸腺瘤术后重症肌无力六例报告. 中华神经外科杂志, 2001, 34(4): 256.
18.	Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys, 2010, 76(2): 440-445.
19.	Masaoks A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
20.	Yoshito Y, Shigetoshi Y, Takekazu I, et al. Risk factors for developing postthymectomy myasthenia gravs in thymoma patients. Ann Thorac Surg, 2015, 99(3): 1013-1019.

1. Nakajima J, Murakawa T, Fukami T, et al. Postthymectomy myasthenia gravis: relationship with thymoma and antiacetylcholine receptor antibody. Ann Thorac Surg, 2008, 86(3): 941-945.
2. Ito M, Fujimura S, Monden Y, et al. A retrospective group study on post-thymectomy myasthenia gravis. Nihon Kyobu Geka Gakkai Zasshi, 1992, 40(2): 189-193.
3. Kondo K, Monden Y. Myasthenia gravis appearing after thymectomy for thymoma. Eur J Cardiothorac Surg, 2005, 28(1): 22-25.
4. Rosai J, Sobin LH. Histological typing of tumours of the thymus. World Health Organization international histological classification of tumours, New York: Springer, 1999.
5. Obata S, Yamaguchi Y, Sakio H, et al. Myasthenia gravis developed after extirpation of thymoma. Rinsho Kyobu Geka, 1983(3): 729-733.
6. Namba T, Grunner NG, Grob D. Myasthenia gravis in patients with thymoma, with particular reference to onset after thymectomy. Medicine, 1978, 57(5): 411-433.
7. 李鉴, 张德超, 汪良骏, 等. 胸腺瘤切除术后重症肌无力的临床分析. 中华外科杂志, 2004, 42(9): 540-542.
8. Kokubo M, Shirohashi Y, Inaba K, et al. A case of pure red cell aplasia with hypogammaglobulinemia appearing after thymothymectomy. Kyobu Geka, 1999, 52(6): 505-507.
9. Michalska T, Rowinska-Marcinska K, Ryniewicz B, et al. Is there true remission in myasthenia gravis: long-term clinical and electrophysiological studies. Neurol Neurochir Pol, 1998, 32(6): 1357-1367.
10. Sun XG, Wang YL, Liu YH, et al. Myasthenia gravis appearing after thymectomy. J Clin Neurosci, 2011, 18(1): 57-60.
11. 管宇宙, 崔丽英, 郭慧琴, 等. 胸腺瘤切除术后重症肌无力患者 11 例的临床特点. 中华神经外科杂志, 2006, 39(4): 262-263.
12. Ruffini E, Filosso PL, Mossetti C, et al. Thymoma: inter-relationships among World Health Organization histology, Masaoka staging and myasthenia gravis and their independent prognostic significance: a single centre experience. Eur J Cardiothorac Surg, 2011, 40(1): 146-153.
13. Berrih-Aknin S, Le Panse R. Myasthenia gravis: A comprehensive review of immune dysregulation and etiological mechanisms. J Autoimmun, 2014, 52: 90-100.
14. Chen J, Yang Y, Zhu D, et al. Thymoma with pure red cell aplasia and Good’s syndrome. Ann Thorac Surg, 2011, 91(5): 1620-1622.
15. Sanders DB, Evoli A. Immunosuppressive therapies in myasthenia gravis. Autoimmunity, 2010, 43(56): 428-435.
16. Werneck LC, Omha FM, Scola RII. Myasthenia gravis: a retrospective study comparing thymectomy to conservative treatment. Acta Ncuroi Scan, 2000, 101(1): 41-46.
17. 昊涛, 涂来慧, 张仁琴. 胸腺瘤术后重症肌无力六例报告. 中华神经外科杂志, 2001, 34(4): 256.
18. Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys, 2010, 76(2): 440-445.
19. Masaoks A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
20. Yoshito Y, Shigetoshi Y, Takekazu I, et al. Risk factors for developing postthymectomy myasthenia gravs in thymoma patients. Ann Thorac Surg, 2015, 99(3): 1013-1019.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for myasthenia gravis after resection of thymoma

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