Comparison of extended thymectomy and medicine for myasthenia gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Xiaoru , QIAN Kun , WANG Ruotian , SU Lei ,  ZHANG Yi

Department of Thoracic Surgery, Multidisciplinary Center for Myasthenia Gravis and Thymus Disease, Xuanwu Hospital, Capital Medical University (CMU), Beijing, 100053, P.R.China;

Corresponding author：

ZHANG Yi, Email: steven9130@sina.com

Keywords：

Non-thymomatous myasthenia gravis; extended thymectomy; medicine-alone treatment; conservative treatment; efficacy

DOI：

10.7507/1007-4848.201710051

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Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients. Methods We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.

Citation： TIAN Xiaoru, QIAN Kun, WANG Ruotian, SU Lei, ZHANG Yi. Comparison of extended thymectomy and medicine for myasthenia gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 772-776. doi: 10.7507/1007-4848.201710051 Copy

1.	中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组. 重症肌无力诊断和治疗中国专家共识. 中国神经免疫学和神经病学杂志, 2012, 19(6): 401-408.
2.	Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016, 87(4): 419-425.
3.	Hughes T. The early history of myasthenia gravis. Neuromuscul Disord, 2005, 15(12): 878-886.
4.	中华医学会神经病学分会, 神经免疫学组中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南2015. 中华神经科杂志, 2015, 48(11): 934-940.
5.	Jaretzki A 3rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
6.	蒋雷. 胸腺切除术治疗非胸腺瘤重症肌无力的研究进展. 中国胸心血管外科临床杂志, 2013, 20(4): 463-466.
7.	Lucchi M, Van Schil P, Schmid R, et al. Thymectomy for thymoma and myasthenia gravis. A survey of current surgical practice in thymic disease amongst EACTS members. Interact Cardiovasc Thorac Surg, 2012, 14(6): 765-770.
8.	Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
9.	Miller RG, Filler-Katz A, Kiprov D, et al. Repeat thymectomy in chronic refractory myasthenia gravis. Neurology, 1991, 41(6): 923-924.
10.	Masaoka A, Monden Y, Seike Y, et al. Reoperation after transcervical thymectomy for myasthenia gravis. Neurology, 1982, 32(1): 83-85.
11.	Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
12.	Aydin Y, Ulas AB, Mutlu V, et al. Thymectomy in myasthenia gravis. Eurasian J Med, 2017, 49(1): 48-52.
13.	Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
14.	Bachmann K, Burkhardt D, Schreiter I, et al. Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement. Surgery, 2009, 145(4): 392-398.
15.	Spillane J, Hayward M, Hirsch NP, et al. Thymectomy: role in the treatment of myasthenia gravis. J Neurol, 2013, 260(7): 1798-1801.
16.	Bachmann K, Burkhardt D, Schreiter I, et al. Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients. Surg Endosc, 2008, 22(11): 2470-2477.
17.	Kerty E, Elsais A, Argov Z, et al. EFNS/ENS Guidelines for the treatment of ocular myasthenia. Eur J Neurol, 2014, 21(5): 687-693.
18.	Roberts PF, Venuta F, Rendina E, et al. Thymectomy in the treatment of ocular myasthenia gravis. J Thorac Cardiovasc Surg, 2001, 122(3): 562-568.
19.	Mineo TC, Ambrogi V. Outcomes after thymectomy in class Ⅰ myasthenia gravis. J Thorac Cardiovasc Surg, 2013, 145(5): 1319-1324.
20.	邓艳, 张旭. 胸腺切除术治疗眼肌型重症肌无力的疗效观察及影响因素分析. 中国神经免疫学和神经病学杂志, 2009, 16(2): 86-89.
21.	Zhu K, Li J, Huang X, et al. Thymectomy is a beneficial therapy for patients with non-thymomatous ocular myasthenia gravis: a systematic review and meta-analysis. Neurol Sci, 2017, 38(10): 1753-1760.

1. 中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组. 重症肌无力诊断和治疗中国专家共识. 中国神经免疫学和神经病学杂志, 2012, 19(6): 401-408.
2. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016, 87(4): 419-425.
3. Hughes T. The early history of myasthenia gravis. Neuromuscul Disord, 2005, 15(12): 878-886.
4. 中华医学会神经病学分会, 神经免疫学组中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南2015. 中华神经科杂志, 2015, 48(11): 934-940.
5. Jaretzki A 3rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
6. 蒋雷. 胸腺切除术治疗非胸腺瘤重症肌无力的研究进展. 中国胸心血管外科临床杂志, 2013, 20(4): 463-466.
7. Lucchi M, Van Schil P, Schmid R, et al. Thymectomy for thymoma and myasthenia gravis. A survey of current surgical practice in thymic disease amongst EACTS members. Interact Cardiovasc Thorac Surg, 2012, 14(6): 765-770.
8. Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
9. Miller RG, Filler-Katz A, Kiprov D, et al. Repeat thymectomy in chronic refractory myasthenia gravis. Neurology, 1991, 41(6): 923-924.
10. Masaoka A, Monden Y, Seike Y, et al. Reoperation after transcervical thymectomy for myasthenia gravis. Neurology, 1982, 32(1): 83-85.
11. Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
12. Aydin Y, Ulas AB, Mutlu V, et al. Thymectomy in myasthenia gravis. Eurasian J Med, 2017, 49(1): 48-52.
13. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
14. Bachmann K, Burkhardt D, Schreiter I, et al. Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement. Surgery, 2009, 145(4): 392-398.
15. Spillane J, Hayward M, Hirsch NP, et al. Thymectomy: role in the treatment of myasthenia gravis. J Neurol, 2013, 260(7): 1798-1801.
16. Bachmann K, Burkhardt D, Schreiter I, et al. Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients. Surg Endosc, 2008, 22(11): 2470-2477.
17. Kerty E, Elsais A, Argov Z, et al. EFNS/ENS Guidelines for the treatment of ocular myasthenia. Eur J Neurol, 2014, 21(5): 687-693.
18. Roberts PF, Venuta F, Rendina E, et al. Thymectomy in the treatment of ocular myasthenia gravis. J Thorac Cardiovasc Surg, 2001, 122(3): 562-568.
19. Mineo TC, Ambrogi V. Outcomes after thymectomy in class Ⅰ myasthenia gravis. J Thorac Cardiovasc Surg, 2013, 145(5): 1319-1324.
20. 邓艳, 张旭. 胸腺切除术治疗眼肌型重症肌无力的疗效观察及影响因素分析. 中国神经免疫学和神经病学杂志, 2009, 16(2): 86-89.
21. Zhu K, Li J, Huang X, et al. Thymectomy is a beneficial therapy for patients with non-thymomatous ocular myasthenia gravis: a systematic review and meta-analysis. Neurol Sci, 2017, 38(10): 1753-1760.

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