Long-term efficacy and influencing factors of extended thymectomy for myasthenia gravis with thymic atrophy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Taiming ¹ , ZHANG Xiaohe ² , SHEN Cheng ¹ , ZHAO Shulin ¹ , HE Xiandong ¹ , TAO Shaolin ¹ ,  TAN Qunyou ¹

1. Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;
2. Hebei Provincial Myasthenia Gravis Diagnosis and Treatment Center, Shijiazhuang People Hospital, Shijiazhuang, 050030, P. R. China;

Corresponding author：

TAN Qunyou, Email: tanfriends@163.com

Keywords：

Myasthenia gravis; thymic atrophy; thymectomy; long-term efficacy

DOI：

10.7507/1007-4848.202210028

Video：

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Objective To analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. Methods The clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. Results A total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. Conclusion Early surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.

Citation： ZHANG Taiming, ZHANG Xiaohe, SHEN Cheng, ZHAO Shulin, HE Xiandong, TAO Shaolin, TAN Qunyou. Long-term efficacy and influencing factors of extended thymectomy for myasthenia gravis with thymic atrophy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 848-852. doi: 10.7507/1007-4848.202210028 Copy

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2.	Cooper JD. History of thymectomy for myasthenia gravis. Thorac Surg Clin, 2019, 29(2): 151-158.
3.	Lisak RP, Richman DP. Thymectomy and myasthenia gravis. Proc Natl Acad Sci U S A, 2020, 117(51): 32195-32196.
4.	Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology, 2021, 96(3): 114-122.
5.	Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
6.	Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
7.	Nakahara K, Nakane S, Nakajima M, et al. Effect of thymectomy for thymic atrophy in myasthenia gravis: A retrospective study on 93 patients. J Neuroimmunol, 2017, 305: 182-185.
8.	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.
9.	谭群友, 陶绍霖, 刘宝东, 等. 重症肌无力外科治疗中国临床专家共识. 中国胸心血管外科临床杂志, 2022, 29(5): 529-541.
10.	Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016, 87(4): 419-425.
11.	Gilhus NE, Tzartos S, Evoli A, et al. Myasthenia gravis. Nat Rev Dis Primers, 2019, 5(1): 30.
12.	Bubuioc AM, Kudebayeva A, Turuspekova S, et al. The epidemiology of myasthenia gravis. J Med Life, 2021, 14(1): 7-16.
13.	刘伟, 佟倜, 纪振东, 等. 胸腺病理在重症肌无力胸腺切除手术后远期预后生存分析中的作用. 中国免疫学杂志, 2001, 17(7): 377-379.
14.	Cavallotti C, D'Andrea V, Tonnarini G, et al. Age-related changes in the human thymus studied with scanning electron microscopy. Microsc Res Tech, 2008, 71(8): 573-578.
15.	Koh AS, Miller EL, Buenrostro JD, et al. Rapid chromatin repression by Aire provides precise control of immune tolerance. Nat Immunol, 2018, 19(2): 162-172.
16.	Wang W, Wang L, Ruan L, et al. Extracellular vesicles extracted from young donor serum attenuate inflammaging via partially rejuvenating aged T-cell immunotolerance. FASEB J, 2018, 32(11): fj201800059R.
17.	Hu C, Zhang K, Jiang F, et al. Epigenetic modifications in thymic epithelial cells: An evolutionary perspective for thymus atrophy. Clin Epigenetics, 2021, 13(1): 210.
18.	Gilhus NE, Skeie GO, Romi F, et al. Myasthenia gravis-autoantibody characteristics and their implications for therapy. Nat Rev Neurol, 2016, 12(5): 259-268.
19.	Sanderson NSR. Complement and myasthenia gravis. Mol Immunol, 2022, 151: 11-18.
20.	Huang CS, Hsu HS, Huang BS, et al. Factors influencing the outcome of transsternal thymectomy for myasthenia gravis. Acta Neurol Scand, 2005, 112(2): 108-114.
21.	Ponseti JM, Gamez J, Azem J, et al. Post-thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myasthenia gravis: A non-randomized, non-controlled study. Curr Med Res Opin, 2007, 23(6): 1269-1278.
22.	Roxanis I, Micklem K, McConville J, et al. Thymic myoid cells and germinal center formation in myasthenia gravis; possible roles in pathogenesis. J Neuroimmunol, 2002, 125(1-2): 185-197.
23.	Koneczny I, Herbst R. Myasthenia gravis: Pathogenic effects of autoantibodies on neuromuscular architecture. Cells, 2019, 8(7): 671.

1. Marx A, Pfister F, Schalke B, et al. The different roles of the thymus in the pathogenesis of the various myasthenia gravis subtypes. Autoimmun Rev, 2013, 12(9): 875-884.
2. Cooper JD. History of thymectomy for myasthenia gravis. Thorac Surg Clin, 2019, 29(2): 151-158.
3. Lisak RP, Richman DP. Thymectomy and myasthenia gravis. Proc Natl Acad Sci U S A, 2020, 117(51): 32195-32196.
4. Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology, 2021, 96(3): 114-122.
5. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
6. Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
7. Nakahara K, Nakane S, Nakajima M, et al. Effect of thymectomy for thymic atrophy in myasthenia gravis: A retrospective study on 93 patients. J Neuroimmunol, 2017, 305: 182-185.
8. 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.
9. 谭群友, 陶绍霖, 刘宝东, 等. 重症肌无力外科治疗中国临床专家共识. 中国胸心血管外科临床杂志, 2022, 29(5): 529-541.
10. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016, 87(4): 419-425.
11. Gilhus NE, Tzartos S, Evoli A, et al. Myasthenia gravis. Nat Rev Dis Primers, 2019, 5(1): 30.
12. Bubuioc AM, Kudebayeva A, Turuspekova S, et al. The epidemiology of myasthenia gravis. J Med Life, 2021, 14(1): 7-16.
13. 刘伟, 佟倜, 纪振东, 等. 胸腺病理在重症肌无力胸腺切除手术后远期预后生存分析中的作用. 中国免疫学杂志, 2001, 17(7): 377-379.
14. Cavallotti C, D'Andrea V, Tonnarini G, et al. Age-related changes in the human thymus studied with scanning electron microscopy. Microsc Res Tech, 2008, 71(8): 573-578.
15. Koh AS, Miller EL, Buenrostro JD, et al. Rapid chromatin repression by Aire provides precise control of immune tolerance. Nat Immunol, 2018, 19(2): 162-172.
16. Wang W, Wang L, Ruan L, et al. Extracellular vesicles extracted from young donor serum attenuate inflammaging via partially rejuvenating aged T-cell immunotolerance. FASEB J, 2018, 32(11): fj201800059R.
17. Hu C, Zhang K, Jiang F, et al. Epigenetic modifications in thymic epithelial cells: An evolutionary perspective for thymus atrophy. Clin Epigenetics, 2021, 13(1): 210.
18. Gilhus NE, Skeie GO, Romi F, et al. Myasthenia gravis-autoantibody characteristics and their implications for therapy. Nat Rev Neurol, 2016, 12(5): 259-268.
19. Sanderson NSR. Complement and myasthenia gravis. Mol Immunol, 2022, 151: 11-18.
20. Huang CS, Hsu HS, Huang BS, et al. Factors influencing the outcome of transsternal thymectomy for myasthenia gravis. Acta Neurol Scand, 2005, 112(2): 108-114.
21. Ponseti JM, Gamez J, Azem J, et al. Post-thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myasthenia gravis: A non-randomized, non-controlled study. Curr Med Res Opin, 2007, 23(6): 1269-1278.
22. Roxanis I, Micklem K, McConville J, et al. Thymic myoid cells and germinal center formation in myasthenia gravis; possible roles in pathogenesis. J Neuroimmunol, 2002, 125(1-2): 185-197.
23. Koneczny I, Herbst R. Myasthenia gravis: Pathogenic effects of autoantibodies on neuromuscular architecture. Cells, 2019, 8(7): 671.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term efficacy and influencing factors of extended thymectomy for myasthenia gravis with thymic atrophy

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