Shen Jianfei, Tie Hongtao, Xu Anyi, Chen Dan, Ma Dehua, Zhang Bo, Zhu Chengchu, Wu Qingchen
Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China.
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
J Thorac Dis. 2018 May;10(5):2981-2990. doi: 10.21037/jtd.2018.05.30.
The aim of study is to analyze the inter-relationship among WHO histology, myasthenia gravis (MG) and Masaoka stage and to assess the feasibility of thoracoscopic surgery in thymoma patients.
Data from 142 consecutive thymoma patients from January 2009 to March 2016 were retrospectively reviewed in our institution. Histological classification and clinical staging were assessed by WHO histology criteria and Masaoka stage. We investigated the clinical characteristics, inter-relationship among WHO histology, MG and Masaoka stage, and compared the feasibility and safety of thoracoscopic thymectomy by comparison of open thymectomy.
Among 142 patients, the incidence of MG was 29.6%. Compared with A and AB-type thymomas, a higher prevalence of advance clinical stage was in B1 to C-type thymomas (37/63 9/43, P<0.001), and there was an increased trend of Masaoka stage from A to C-type thymomas (P<0.001). The incidence of MG was significantly higher in AB, B1 and B2-type thymomas than other type thymomas (23/63 6/44, P=0.009) and in early Masaoka clinical stage than advanced Masaoka clinical stage (29/80 12/59, P=0.042). Thoracoscopic surgery could significantly decrease blood loss in patients with (104.06±137.36 350.91±560.79 mL, P=0.001) or without MG (91.90±77.70 266.32±292.60 mL, P=0.02), with comparable complications. Additionally, thoracoscopic surgery could achieve an equal effect on the remission of MG with open surgery (7/11 10/14, P=1.000), and Masaoka stage was significantly associated with the remission of MG after thymectomy.
Our study suggests that WHO histology, MG, and Masaoka stage interrelate with one another, and Masaoka stage is an important prognostic factor in remission of MG after thymectomy in thymoma patients. Thoracoscopic thymectomy could achieve an equal efficacy to open thymectomy and should be recommended as a routine surgery for patients with early Masaoka stage.
本研究旨在分析世界卫生组织（WHO）组织学类型、重症肌无力（MG）与马萨oka分期之间的相互关系，并评估胸腺瘤患者行胸腔镜手术的可行性。
回顾性分析2009年1月至2016年3月在我院连续收治的142例胸腺瘤患者的数据。根据WHO组织学标准和马萨oka分期评估组织学分类和临床分期。我们调查了临床特征、WHO组织学类型、MG与马萨oka分期之间的相互关系，并通过比较开放性胸腺切除术来比较胸腔镜胸腺切除术的可行性和安全性。
142例患者中，MG的发生率为29.6%。与A和AB型胸腺瘤相比，B1至C型胸腺瘤的临床晚期患病率更高（37/63对9/43，P<0.001），且从A到C型胸腺瘤马萨oka分期有增加趋势（P<0.001）。AB、B1和B2型胸腺瘤中MG的发生率显著高于其他类型胸腺瘤（23/63对6/44，P=0.009），且在马萨oka临床早期高于晚期（29/80对12/59，P=0.042）。胸腔镜手术可显著减少有（104.06±137.36对350.91±560.79 mL，P=0.001）或无MG患者的失血量（91.90±77.70对266.32±292.60 mL，P=0.02）且并发症相当。此外，胸腔镜手术在MG缓解方面与开放性手术效果相当（7/11对10/14，P=1.000），且马萨oka分期与胸腺切除术后MG的缓解显著相关。
我们的研究表明，WHO组织学类型、MG和马萨oka分期相互关联，且马萨oka分期是胸腺瘤患者胸腺切除术后MG缓解的重要预后因素。胸腔镜胸腺切除术与开放性胸腺切除术疗效相当，对于马萨oka分期早期的患者应推荐作为常规手术。
