Long-term Efficacy and Influencing Factors of Thymectomy for Thymoma Patients Associated with Myasthenia Gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIANKun-jie , SUNQing-chao , LIDe-sheng , YOUZhao-lei , ZHANGFa-wang , JULAITIAiniwaer ,  ZHANGLi-wei

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

Corresponding author：

ZHANGLi-wei, Email: zhangliwei@medmail.com.cn

Keywords：

Thymoma associated with myasthenia gravis; Extended thymectomy; Long-term effect; Multivariate analysis

DOI：

10.7507/1007-4848.20160167

Video：

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Objective To investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis. Methods We retrospectively analyzed the clinical and follow-up data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result:sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35(5-96) months. During follow-up period, 12 patients (19%) achieved complete remission, 39 patients (62%) achieved partial remission, 7 patients (11%) kept stable, 5 patients (8%) deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease (P=0.027), history of critical illness on myasthenia gravis (P=0.035) and Osserman classification (P=0.018) were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease (P=0.001) and Osserman classification (P=0.012) were the independent risk factors for incomplete remission. Conclusion Extended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at Ⅱ_B, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.

Citation： QIANKun-jie, SUNQing-chao, LIDe-sheng, YOUZhao-lei, ZHANGFa-wang, JULAITIAiniwaer, ZHANGLi-wei. Long-term Efficacy and Influencing Factors of Thymectomy for Thymoma Patients Associated with Myasthenia Gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 698-701. doi: 10.7507/1007-4848.20160167 Copy

1.	Nakajima J, Murakawa T, Fukami T, et al. Postthymectomy myas-theniagravis:relationship with thymoma and antiacetylcholine receptor antibody. Ann Thorac Surg, 2008, 86(3):941-945.
2.	Raica M, Cimpean AM, Ribatti D. Myasthenia gravis and the thymus gland:A historical review. Clin Exp Med, 2008, 8(2):61-64.
3.	Rosai J, Sobin LH, Chief eclitor. Histological typing of tumours of the thymus. World Health Organization international histological classification of tumours, New York:Springer, 1999.25-127.
4.	Grob D, Brunner N, Namba T, et al. Lifetime course of myasthenia gravis. Muscle Nerve, 2008, 37(2):141-149.
5.	De Filippi V, Richman D, Ferguson M. Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1994, 5 7(1):194-197.
6.	Roth T, Ackemann R, Stein R, et al. Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term result predict long-term outcome. Eur J CaIdiothorac Surg, 2002, 21(4):664-670.
7.	Lopez-Cano M, Ponseti-Bosch JM, Espin-Basany E, et al. Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis. Ann Thorac Surg, 2003, 76(5):1643-1649.
8.	Jaretzki A Ⅲ, Wolff M. Maximal thymectomy for myasthenia gravis. Surgical anatomy and operative technique. J Thorac Cardiovasc Surg, 1988, 96(5):711-716.
9.	Masaoka A, Nagaoka Y, Kotake Y. Distribution of thymic tissue at the anterior mediastinum:current procedures in thymectomy. J Thorac Cardiovasc Surg, 1975, 70(4):747-754.
10.	Ashour M. Prevalence of ectopic thymic tissue in myasthenia gravis and its clinical significance. J Thorac Cardiovasc Surg, 1995, 109 (4):632-635.
11.	Nieto IP, Robledo JP, Pajuelo MC, et al. Prognostic factors for mya-sthenia gravis treated by thymectomy:review of 61 cases. Ann Thorac Surg, 1999, 67(6):1568-1571.
12.	Kumar N, Verma AK, Mishra A, et al. Factors predicting surgical outcome of thymectomy in myasthenia gravis:A 16-year experience. Ann Indian Acad Neurol, 2011, 14(4):267-271.
13.	Lucchi M, Ricciardi R, Melfi F, et al. Association of thymoma and myasthenia gravis:oncological and neurological results of the surgical treatment. Eur J Cardiothorac Surg, 2009, 35(5):812-816.
14.	Papatestas AE, Genkins G, Kornfeld P, et al. Effects of thymectomy in myathenia gravis. Ann Surg, 1987, 206(1):79-88.
15.	Mineo TC, Ambrogi V. Outcomes after thymectomy in class I myas-thenia gravis. J Thorac Cardiovasc Surg, 2013, 145(5):1319-1324.
16.	Kerty E, Elsais A, Argov Z, et al. EFNS/ENS Guidelines for the treatment of ocular myast-henia. Eur J Neurol, 2014, 21(5):687-693.
17.	Nakamura H, Taniguchi Y, Suzuki Y, et al. Delayed remission after thymectomy for myasthenia gravis of the purely ocular type. J Thorac Cardiovasc Surg, 1996, 112(2):371-375.
18.	朱豫, 朱健, 刘勇, 等. 胸腺瘤Masaoka分期及WHO分型与重症肌无力关系的临床意义. 国际外科杂志, 2014, 41(6):394-396.
19.	Kondo K, Monden Y. Thymoma and myasthenia gravis:a clinical study of 1,089 patients from Japan. Ann Thorac Surg, 2005, 79(1):219-224.
20.	叶挺, 王群, 蒋伟, 等. 经右胸胸腔镜下全胸腺切除术附38例报道. 复旦学报(医学版), 2009, 36(5):618-620.

1. Nakajima J, Murakawa T, Fukami T, et al. Postthymectomy myas-theniagravis:relationship with thymoma and antiacetylcholine receptor antibody. Ann Thorac Surg, 2008, 86(3):941-945.
2. Raica M, Cimpean AM, Ribatti D. Myasthenia gravis and the thymus gland:A historical review. Clin Exp Med, 2008, 8(2):61-64.
3. Rosai J, Sobin LH, Chief eclitor. Histological typing of tumours of the thymus. World Health Organization international histological classification of tumours, New York:Springer, 1999.25-127.
4. Grob D, Brunner N, Namba T, et al. Lifetime course of myasthenia gravis. Muscle Nerve, 2008, 37(2):141-149.
5. De Filippi V, Richman D, Ferguson M. Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1994, 5 7(1):194-197.
6. Roth T, Ackemann R, Stein R, et al. Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term result predict long-term outcome. Eur J CaIdiothorac Surg, 2002, 21(4):664-670.
7. Lopez-Cano M, Ponseti-Bosch JM, Espin-Basany E, et al. Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis. Ann Thorac Surg, 2003, 76(5):1643-1649.
8. Jaretzki A Ⅲ, Wolff M. Maximal thymectomy for myasthenia gravis. Surgical anatomy and operative technique. J Thorac Cardiovasc Surg, 1988, 96(5):711-716.
9. Masaoka A, Nagaoka Y, Kotake Y. Distribution of thymic tissue at the anterior mediastinum:current procedures in thymectomy. J Thorac Cardiovasc Surg, 1975, 70(4):747-754.
10. Ashour M. Prevalence of ectopic thymic tissue in myasthenia gravis and its clinical significance. J Thorac Cardiovasc Surg, 1995, 109 (4):632-635.
11. Nieto IP, Robledo JP, Pajuelo MC, et al. Prognostic factors for mya-sthenia gravis treated by thymectomy:review of 61 cases. Ann Thorac Surg, 1999, 67(6):1568-1571.
12. Kumar N, Verma AK, Mishra A, et al. Factors predicting surgical outcome of thymectomy in myasthenia gravis:A 16-year experience. Ann Indian Acad Neurol, 2011, 14(4):267-271.
13. Lucchi M, Ricciardi R, Melfi F, et al. Association of thymoma and myasthenia gravis:oncological and neurological results of the surgical treatment. Eur J Cardiothorac Surg, 2009, 35(5):812-816.
14. Papatestas AE, Genkins G, Kornfeld P, et al. Effects of thymectomy in myathenia gravis. Ann Surg, 1987, 206(1):79-88.
15. Mineo TC, Ambrogi V. Outcomes after thymectomy in class I myas-thenia gravis. J Thorac Cardiovasc Surg, 2013, 145(5):1319-1324.
16. Kerty E, Elsais A, Argov Z, et al. EFNS/ENS Guidelines for the treatment of ocular myast-henia. Eur J Neurol, 2014, 21(5):687-693.
17. Nakamura H, Taniguchi Y, Suzuki Y, et al. Delayed remission after thymectomy for myasthenia gravis of the purely ocular type. J Thorac Cardiovasc Surg, 1996, 112(2):371-375.
18. 朱豫, 朱健, 刘勇, 等. 胸腺瘤Masaoka分期及WHO分型与重症肌无力关系的临床意义. 国际外科杂志, 2014, 41(6):394-396.
19. Kondo K, Monden Y. Thymoma and myasthenia gravis:a clinical study of 1,089 patients from Japan. Ann Thorac Surg, 2005, 79(1):219-224.
20. 叶挺, 王群, 蒋伟, 等. 经右胸胸腔镜下全胸腺切除术附38例报道. 复旦学报(医学版), 2009, 36(5):618-620.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term Efficacy and Influencing Factors of Thymectomy for Thymoma Patients Associated with Myasthenia Gravis

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