Division of General Thoracic Surgery, Catholic University, Rome, Italy.
Ann Thorac Surg. 2010 Jan;89(1):245-52; discussion 252. doi: 10.1016/j.athoracsur.2009.08.074.
The impact of myasthenia gravis on patients with thymoma is still controversial when perioperative and long-term outcomes are analyzed. With the unique opportunity of a 35-year follow-up in a single institution, thymomatous myasthenia gravis cohort, we investigated the influence of early and long-term clinical predictors.
We reviewed a surgical series of 317 (1972 to 2007) patients with thymoma: clinical and pathologic features were analyzed as prognostic factors matched against the short- and long-term survival and recurrence rates.
Male to female ratio was 153:164; median age, 49 years. Myasthenia gravis coexisted in 276 patients (87.1%). Thymomas were classified according to the Masaoka (42.0% stage I, 32.2% stage II, 21.5% stage III, and 4.4% stage IV) and the World Health Organization (3.5% type A, 9.5% type AB, 19.2% type B1, 57.7% type B2, 8.2% type B3, and 1.9% thymic carcinoma) staging systems. The resection was complete in 295 patients (93.1%). Operative mortality and morbidity were respectively 1.6% and 7.6%. No differences were recorded in postoperative outcome stratifying for myasthenia gravis or comorbidities. Mean follow-up was 144.7 +/- 104.4 months. The overall 5-, 10-, 20-, and 30-year survival rates were 89.9%, 84.1%, 73%, and 58.6%, respectively. The completeness of resection (p < 0.001), the Masaoka staging (p = 0.010), and the World Health Organization classification (p < 0.001) all significantly influenced the long-term survival (univariate analysis). Only completeness of resection was significantly correlated with a better prognosis (p < 0.001) in multivariate analysis. Masaoka staging (p < 0.001) and World Health Organization classification (p < 0.001) significantly correlated with the disease-free survival in the univariate and multivariate analyses as significant prognostic factors (Masaoka, p < 0.001; World Health Organization, p = 0.011). Myasthenia gravis patients showed a better prognosis in terms of long-term survival (p = 0.046) and disease-free survival (p = 0.012) in the univariate analysis.
We confirm the evidence that the clinical staging and the histologic classification influence long-term survival. The presence of myasthenia gravis was not significantly related to operative outcome, but prolongs both long-term survival and disease-free survival.
在分析胸腺瘤患者的围手术期和长期预后时，重症肌无力对患者的影响仍存在争议。由于在单一机构进行了长达 35 年的随访，我们调查了胸腺瘤重症肌无力队列中早期和长期临床预测因素的影响。
我们回顾了 317 例（1972 年至 2007 年）胸腺瘤患者的手术系列：分析了临床和病理特征作为预后因素，与短期和长期生存率和复发率相匹配。
男女比例为 153:164；中位年龄为 49 岁。276 例患者合并重症肌无力（87.1%）。胸腺瘤根据 Masaoka（42.0%I 期、32.2%II 期、21.5%III 期和 4.4%IV 期）和世界卫生组织（3.5%A 型、9.5%AB 型、19.2%B1 型、57.7%B2 型、8.2%B3 型和 1.9%胸腺癌）分期系统进行分类。295 例患者（93.1%）行完全切除术。手术死亡率和发病率分别为 1.6%和 7.6%。重症肌无力或合并症分层后，术后结果无差异。平均随访 144.7+/-104.4 个月。总 5 年、10 年、20 年和 30 年生存率分别为 89.9%、84.1%、73%和 58.6%。完全切除（p<0.001）、Masaoka 分期（p=0.010）和世界卫生组织分类（p<0.001）均显著影响长期生存（单因素分析）。只有完全切除与更好的预后显著相关（p<0.001）（多因素分析）。Masaoka 分期（p<0.001）和世界卫生组织分类（p<0.001）在单因素和多因素分析中均与无病生存率显著相关，是重要的预后因素（Masaoka，p<0.001；世界卫生组织，p=0.011）。重症肌无力患者在长期生存（p=0.046）和无病生存（p=0.012）方面的预后明显更好（单因素分析）。
我们证实了临床分期和组织学分类影响长期生存的证据。重症肌无力的存在与手术结果无显著关系，但延长了长期生存和无病生存。
