Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Thorac Cancer. 2020 May;11(5):1288-1296. doi: 10.1111/1759-7714.13396. Epub 2020 Mar 19.
To evaluate the surgical effect and prognostic factors of extended thymectomy for myasthenia gravis (MG) patients with thymomas.
Patients with MG with thymomas who underwent extended thymectomy at Peking University People's Hospital and Beijing Hospital between January 2010 and December 2018 were retrospectively enrolled. Patients were followed up by telephone or outpatient record review . Statistical analyses were performed using SPSS version 19.0.
A total of 194 patients were included in this study. According to the Osserman classification, there were 56 type I, 52 type IIa, 67 type IIb, 14 type III, and five type IV. Video-assisted thoracoscopic surgery (VATS) thymectomies were performed in 137 patients, and transthymectomies in 57 patients. The average operation time was 136.6 ± 46.5 minutes, average blood loss was 129.3 ± 287.4 mL, and average postoperative stay was 8.3 ± 7.4 days. A total of 170 patients (87.6%) were successfully followed up. The median follow-up period was 45 months, and the five-year overall survival (OS) rate was 81.9%. Cox regression analysis demonstrated that age, Masaoka stage, and recurrence were prognostic factors of OS. Tumor recurrence tended to occur in patients with Masaoka stage III + IV, and age was a protective factor. A total of 20 patients experienced postoperative myasthenic crisis (POMC). Univariate analysis indicated that presence of bulbar symptoms, surgical procedure, and blood loss were risk factors for POMC, but multivariate analysis only indicated the presence of bulbar symptoms as an independent risk factor. A total of 162 patients were evaluated for post intervention MG status. A total of 55 patients achieved complete stable remission; the overall effective rate was 84.5%. Older patients and those with B-type thymomas had a lower probability of achieving complete stable remission. Efficacy was similar in patients who underwent VATS or the transsternal procedure.
Age, Masaoka stage, and recurrence were prognostic factors of OS. Presence of bulbar symptoms was an independent risk factor for POMC. Age and World Health Organization classification influence the postoperative effect of MG.
Significant findings of the study Age, Masaoka stage, and recurrence were prognostic factors of OS for MG with thymomas. The presence of bulbar symptoms was an independent risk factor for POMC. Age and World Health Organization classification may influence the postoperative effect of MG. What this study adds Our study had a relatively large sample size of MG patients with thymomas only. We emphasize the analysis of the postoperative effect of MG and overall survival for these patients, which is a complement to previous studies.
评估胸腺瘤合并重症肌无力（MG）患者行胸腺扩大切除术的手术效果和预后因素。
回顾性分析 2010 年 1 月至 2018 年 12 月在北京大学人民医院和北京医院行胸腺扩大切除术的胸腺瘤合并 MG 患者的临床资料，通过电话或门诊记录进行随访。采用 SPSS 19.0 统计软件进行数据分析。
共纳入 194 例患者，Osserman 分型：Ⅰ型 56 例，Ⅱa 型 52 例，Ⅱb 型 67 例，Ⅲ型 14 例，Ⅳ型 5 例。其中 137 例行胸腔镜下胸腺切除术，57 例行经胸骨正中胸腺切除术。手术时间平均 136.6±46.5 分钟，术中出血量平均 129.3±287.4ml，术后住院时间平均 8.3±7.4 天。170 例（87.6%）患者获得随访，中位随访时间 45 个月，5 年总生存率为 81.9%。Cox 回归分析显示，年龄、Masaoka 分期、复发是影响总生存的预后因素。肿瘤复发倾向于发生在 Masaoka 分期Ⅲ+Ⅳ期患者，而年龄是保护因素。术后发生肌无力危象（POMC）20 例。单因素分析显示，球部症状、手术方式、术中出血量是 POMC 的危险因素，多因素分析仅显示球部症状是独立的危险因素。162 例患者评估术后 MG 状态，完全稳定缓解 55 例，总有效率为 84.5%。高龄和 B 型胸腺瘤患者完全稳定缓解率较低。胸腔镜下手术和经胸骨正中手术的疗效相似。
年龄、Masaoka 分期、复发是影响胸腺瘤合并 MG 患者总生存的预后因素。球部症状是 POMC 的独立危险因素。年龄和世界卫生组织（WHO）分型影响 MG 的术后效果。
本研究的重要发现年龄、Masaoka 分期和复发是胸腺瘤合并重症肌无力（MG）患者总生存的预后因素。球部症状是肌无力危象（POMC）的独立危险因素。年龄和世界卫生组织（WHO）分型可能影响 MG 的术后效果。本研究的补充说明本研究为仅包含胸腺瘤合并 MG 患者的大样本量研究。我们强调对这些患者术后 MG 及总生存的分析，这是对既往研究的补充。
