Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Chin Med J (Engl). 2018 Apr 20;131(8):927-932. doi: 10.4103/0366-6999.229894.
The co-existence of myasthenia gravis (MG) and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.
A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery (Group A); whereas the other 24 patients did not receive radiation therapy (Group B). According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups (1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52). We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission (CSR) rate as the primary endpoints.
There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B (χ = 4.631, P = 0.031). The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.
Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.
重症肌无力（MG）与胸腺瘤并存使手术治疗更加复杂，辅助放疗更具争议。本研究旨在探讨扩大胸腺切除术治疗伴 MG 的胸腺瘤的辅助放疗。
2003 年至 2014 年，中国同仁医院共收治 181 例 MG 合并胸腺瘤患者。所有患者中，157 例术后接受放疗（A 组）；另 24 例未接受放疗（B 组）。根据患者开始纵隔放疗的时间，我们将 A 组中的 157 例患者进一步分为亚组（1 个月亚组，n=98；2 个月亚组，n=7；3 个月亚组，n=52）。然后，我们将以生存率、术后肌无力危象发生率和完全稳定缓解（CSR）率作为主要终点，比较各组纵隔放疗的效果。
1 个月亚组与 B 组术后肌无力危象发生率有显著差异（χ=4.631，P=0.031）。1 个月亚组、3 个月亚组和 B 组的 CSR 发生率分别为 32.6%、25%和 22.7%。1 个月亚组、3 个月亚组和 B 组的总生存率分别为 88.8%、83.3%和 77.3%。Kaplan-Meier 生存曲线分析显示，术后 8 年内，1 个月亚组与 B 组、3 个月亚组与 B 组的总生存和无病生存无显著差异；术后 8 年以上，1 个月亚组、3 个月亚组和 B 组的无病生存率分别为 79.4%、70.6%和 55.3%。
扩大胸腺切除术后 1 个月内进行辅助放疗可能有助于控制术后 MG，如降低术后肌无力危象的可能性，并提高达到 CSR 的累积概率。
