胸腺瘤伴与不伴重症肌无力的不同特征。

Different characteristics of thymomas with and without myasthenia gravis.

机构信息

Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

出版信息

Ann Surg Oncol. 2012 Jan;19(1):94-8. doi: 10.1245/s10434-011-1896-8. Epub 2011 Aug 31.

DOI:10.1245/s10434-011-1896-8

PMID:21879277

Abstract

BACKGROUND

The objective of this study was to evaluate the different pathological and clinical characteristics of thymomas with and without myasthenia gravis (MG) and to determine whether the presence of MG influences the prognosis in thymoma patients.

METHODS

We retrospectively studied data from 228 consecutive patients operated on from 1992 to 2007 in Beijing Tongren Hospital. These thymoma patients have been subdivided into two groups: group A with MG (n = 125) and group B without MG (n = 103).

RESULTS

There were no perioperative deaths. There were 19 inoperable cases (6 in the group with MG, 13 without MG, P = 0.035). The proportions of types A, AB, B1, B2, B3, and C thymoma in this data were 0, 22.4, 26.4, 30.4, 20.8, and 0%, respectively, in the group with MG, and 10.5, 13.4, 23.6, 24.5, 16.4, and 11.6%, respectively in the group without MG. There was a significant difference between hyperplastic paraneoplastic thymus coexisting in 28.8% patients with MG and only 5.8% in patients without MG. Microthymoma was identified in the paraneoplastic thymus of three patients with MG. There were 198 patients followed up. There was no recurrence in patients with type A, and a few patients with types AB, B1, B2, B3, and C recurred. The actuarial 5- and 10-year survival rates were 89.3 and 81.2% for patients with MG, respectively, and 90 and 78.9% for patients without MG, respectively. Within 5 years postoperatively, 6 of 9 patients with MG died of myasthenia crisis, while 6 of 7 deaths in patients without MG were attributable to inoperable tumors (stage IV) and type C thymoma.

CONCLUSIONS

MG seldom occurs in types A and C thymoma. MG of some thymoma patients was not caused by thymoma, but by the paraneoplastic thymus. The prognosis of thymomas with MG is similar to that without MG. The main cause of death is myasthenia crisis for thymoma patients with MG and stage IV and/or type C for thymoma patients without MG.

摘要

背景

本研究旨在评估合并和不合并重症肌无力（MG）的胸腺瘤的不同病理和临床特征，并确定 MG 的存在是否影响胸腺瘤患者的预后。

方法

我们回顾性研究了 1992 年至 2007 年在北京同仁医院接受手术的 228 例连续胸腺瘤患者的数据。这些胸腺瘤患者分为两组：A 组伴 MG（n=125）和 B 组不伴 MG（n=103）。

结果

无围手术期死亡。19 例为不可手术（MG 组 6 例，MG 组 13 例，P=0.035）。MG 组的胸腺瘤 A、AB、B1、B2、B3 和 C 型比例分别为 0、22.4%、26.4%、30.4%、20.8%和 0%，B 组分别为 10.5%、13.4%、23.6%、24.5%、16.4%和 11.6%。MG 组中 28.8%的患者伴有增生性副瘤胸腺，而无 MG 组中仅有 5.8%。在 3 例伴有 MG 的副瘤胸腺中发现微小胸腺瘤。198 例患者得到随访。A 型患者无复发，少数 AB、B1、B2、B3 和 C 型患者复发。MG 患者的 5 年和 10 年生存率分别为 89.3%和 81.2%，无 MG 患者分别为 90%和 78.9%。术后 5 年内，MG 组 9 例患者中有 6 例死于肌无力危象，而无 MG 组 7 例死亡中有 6 例归因于不可手术肿瘤（IV 期）和 C 型胸腺瘤。