Wang Fangrui, Pang Liewen, Fu Jianhua, Shen Yi, Wei Yucheng, Tan Lijie, Zhang Peng, Han Yongtao, Chen Chun, Zhang Renquan, Li Yin, Chen Ke-Neng, Chen Hezhong, Liu Yongyu, Cui Youbing, Wang Yun, Yu Zhentao, Zhou Xinming, Liu Yangchun, Liu Yuan, Gu Zhitao, Fang Wentao
Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China.
Zhongguo Fei Ai Za Zhi. 2016 Jul 20;19(7):418-24. doi: 10.3779/j.issn.1009-3419.2016.07.03.
It is so far not clear that how myasthenia gravis (MG) affected the prognosis of thymoma patients. The aim of this assay is to compare the postoperative survival between patients with thymoma only and those with both thymoma and MG.
The Chinese Alliance for Research in Thymomas (ChART) registry recruited patients with thymoma from 18 centers over the country on an intention to treat basis from 1992 to 2012. Two groups were formed according to whether the patient complicated MG. Demographic and clinical data were reviewed, Patients were followed and their survival status were analyzed.
There were 1,850 patients included in this study, including 421 with and 1,429 without MG. Complete thymectomy were done in 91.2% patients in MG group and 71.0% in non-MG group (P<0.05). There were more percentage of patients with the histology of thymoma AB, B1, or B2 (P<0.05) in MG group, and more percentage of patients with MG were in Masaoka stage I and II. The 5 year and 10 year OS rates were both higher in MG group (93% vs 88%; 83% vs 81%, P=0.034) respectively. The survival rate was significantly higher in patients with MG when the Masaoka staging was III/IV (P=0.003). Among patients with advanced stage thymoma (stage III, IVa, IVb), the constituent ratios of III, IVa, IVb were similar between MG and Non-MG group. Histologically, however, there were significantly more proportion of AB/B1/B2/B3 in the MG group while there were more C in the non-MG group (P=0.000). Univariate analyses for all patients showed that MG, WHO classification, Masaoka stage, surgical approach, chemotherapy and radiotherapy and resectability were significant factors, and multivariate analysis showed WHO Classification, Masaoka stage, and resectability were strong independent prognostic indicators.
CONCLUSIONS: Although MG is not an independent prognostic factor, the survival of patients with thymoma was superior when MG was present, especially in late Masaoka stage patients. Possible reasons included early diagnosis of the tumor, better histologic types, an overall higher R0 resection and less recurrence. .
重症肌无力（MG）如何影响胸腺瘤患者的预后目前尚不清楚。本研究的目的是比较单纯胸腺瘤患者与合并胸腺瘤和MG患者的术后生存率。
中国胸腺瘤研究联盟（ChART）登记处从1992年至2012年在全国18个中心招募胸腺瘤患者，采用意向性治疗原则。根据患者是否合并MG分为两组。回顾人口统计学和临床数据，对患者进行随访并分析其生存状况。
本研究共纳入1850例患者，其中合并MG的患者421例，未合并MG的患者1429例。MG组91.2%的患者和非MG组71.0%的患者接受了完整胸腺切除术（P<0.05）。MG组中胸腺瘤AB、B1或B2组织学类型的患者比例更高（P<0.05），MG患者中处于Masaoka I期和II期的比例更高。MG组的5年和10年总生存率均更高（分别为93%对88%；83%对81%，P=0.034）。当Masaoka分期为III/IV期时，合并MG患者的生存率显著更高（P=0.003）。在晚期胸腺瘤（III期、IVa期、IVb期）患者中，MG组和非MG组III期、IVa期、IVb期的构成比相似。然而，在组织学上，MG组中AB/B1/B2/B3的比例显著更高，而非MG组中C型的比例更高（P=0.000）。对所有患者的单因素分析显示，MG、WHO分类、Masaoka分期、手术方式、化疗、放疗和可切除性是显著因素，多因素分析显示WHO分类、Masaoka分期和可切除性是强有力的独立预后指标。
虽然MG不是一个独立的预后因素，但合并MG时胸腺瘤患者的生存率更高，尤其是在Masaoka晚期患者中。可能的原因包括肿瘤的早期诊断、更好的组织学类型、总体更高的R0切除率和更少的复发。
