Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
Surg Today. 2024 Jul;54(7):787-794. doi: 10.1007/s00595-024-02806-0. Epub 2024 Feb 28.
Surgical patients with thymoma and myasthenia gravis (MG) must have their MG status and oncological outcomes critically monitored. We aimed to identify clinicopathological predictors of the postoperative MG status.
We conducted a retrospective review of 40 consecutive surgical patients with MG-related thymomas between 2002 and 2020. The quantitative myasthenia gravis score (QMGS) and Myasthenia Gravis Foundation of America post-intervention status (MGFA-PIS) were used to evaluate postoperative MG status.
All patients underwent extended total thymectomy. The most common WHO type was type B2 (32%), while 65% of patients had type B1-B3 and 35% had type A-AB thymomas. Eleven patients (28%) achieved controlled MG status in MGFA-PIS 6 months after surgery. This controlled status was observed more frequently in type A-AB than in B1-B3 (57% vs. 12%, p = 0.007). In a multivariate analysis, WHO type (A-AB or B1-B3) was an independent predictor of worsening episodes of MG based on the QMGS (Type B1-B3, hazard ratio: 3.23, 95% confidence interval: 1.12-9.25). At the last follow-up, 23 patients (58%) achieved controlled MG status. The 5-year overall survival rate of all patients was 93.7%.
The WHO type of thymoma is an informative predictor of postoperative MG status in patients with MG-related thymoma.
患有胸腺瘤和重症肌无力 (MG) 的外科患者必须对其 MG 状况和肿瘤学结果进行严格监测。我们旨在确定术后 MG 状况的临床病理预测因素。
我们对 2002 年至 2020 年间连续 40 例 MG 相关胸腺瘤手术患者进行了回顾性研究。使用定量重症肌无力评分 (QMGS) 和重症肌无力基金会干预后状态 (MGFA-PIS) 评估术后 MG 状况。
所有患者均接受了广泛的全胸腺切除术。最常见的 WHO 类型为 B2 型（32%），而 65%的患者为 B1-B3 型，35%的患者为 A-AB 型胸腺瘤。11 例（28%）患者在术后 6 个月 MGFA-PIS 达到 MG 控制状态。在 A-AB 型患者中，这种控制状态比在 B1-B3 型患者中更为常见（57% vs. 12%，p=0.007）。在多变量分析中，根据 QMGS，WHO 类型（A-AB 或 B1-B3）是 MG 恶化发作的独立预测因素（B1-B3 型，危险比：3.23，95%置信区间：1.12-9.25）。在最后一次随访时，23 例患者（58%）达到了 MG 控制状态。所有患者的 5 年总生存率为 93.7%。
胸腺瘤的 WHO 类型是预测 MG 相关胸腺瘤患者术后 MG 状况的一个信息丰富的预测因素。
