Zhang Qing, Pan XuanXuan, Bi Zhuajin, Zhan Jiayang, Yang Mengge, Lin Jing, Gui Mengcui, Li Zhijun, Zhang Min, Ma Xue, Bu Bitao
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China.
Ther Adv Neurol Disord. 2025 Jun 20;18:17562864251343573. doi: 10.1177/17562864251343573. eCollection 2025.
Outcomes after thymectomy differ greatly between non-thymomatous and thymomatous myasthenia gravis (MG), meriting an in-depth exploration.
To examine the treatment and prognosis of non-thymomatous and thymomatous MG patients after thymectomy.
A multicenter, retrospective, case-control study focused on MG patients following thymectomy from November 2010 to January 2024. After propensity score matching, 284 patients (142 with non-thymomatous MG and 142 with thymomatous MG) were included, with a median follow-up of 2.94 years.
Four outcomes were examined: minimal manifestations status (MMS) or better at the final visit, sustained clinical response, postoperative myasthenic crisis, and long-term mortality. Kaplan-Meier, logistic regression, cox regression, nomogram, receiver operating characteristic curve, decision curve, and calibration curve analyses were used for assessment.
Non-thymoma patients had a lower proportion of postoperative myasthenic crisis (5.6% vs 13.4%, = 0.026) and long-term mortality (1.4% vs 9.9%, = 0.002) but a higher proportion of sustained clinical response (66.2% vs 52.1%, = 0.016) than thymoma patients. For both non-thymomatous and thymomatous MG, anti-acetylcholine receptor antibody (AChR-Ab) positivity was the independent predictor for MMS or better at the final visit ( = 0.048; = 0.016) and sustained clinical response ( = 0.035; = 0.037). Most severe Myasthenia Gravis Foundation of America (MGFA) classification and high-grade Masaoka histopathology were independent predictors for postoperative myasthenic crisis ( < 0.001; = 0.010) and long-term mortality ( = 0.006; = 0.014) for thymomatous MG. Postoperative prednisone combined with tacrolimus (Pred + TAC) was associated with achieving sustained clinical response ( = 0.026; = 0.030) and prednisone tapering for both groups.
Non-thymomatous MG exhibited a more benign course with better outcomes. AChR-Ab positivity indicated a better prognosis for both groups, while thymomatous MG with severe MGFA classification and high-grade histopathology requires close monitoring and follow-up. Postoperative Pred + TAC could be an effective immunotherapy option for beneficial outcomes.
非胸腺瘤性和胸腺瘤性重症肌无力（MG）患者胸腺切除术后的结局差异很大，值得深入探讨。
研究非胸腺瘤性和胸腺瘤性MG患者胸腺切除术后的治疗及预后情况。
一项多中心、回顾性、病例对照研究，聚焦于2010年11月至2024年1月接受胸腺切除术的MG患者。经过倾向评分匹配后，纳入了284例患者（142例非胸腺瘤性MG患者和142例胸腺瘤性MG患者），中位随访时间为2.94年。
研究了四项结局：末次随访时达到最小表现状态（MMS）或更好、持续临床缓解、术后肌无力危象和长期死亡率。采用Kaplan-Meier法、逻辑回归、Cox回归、列线图、受试者工作特征曲线、决策曲线和校准曲线分析进行评估。
非胸腺瘤患者术后肌无力危象（5.6%对13.4%，P = 0.026）和长期死亡率（1.4%对9.9%，P = 0.002）的比例较低，但持续临床缓解的比例（66.2%对52.1%，P = 0.016）高于胸腺瘤患者。对于非胸腺瘤性和胸腺瘤性MG，抗乙酰胆碱受体抗体（AChR-Ab）阳性是末次随访时达到MMS或更好（P = 0.048；P = 0.016）和持续临床缓解（P = 0.035；P = 0.037）的独立预测因素。美国重症肌无力基金会（MGFA）最严重分级和高级别Masaoka组织病理学是胸腺瘤性MG术后肌无力危象（P < 0.001；P = 0.010）和长期死亡率（P = 0.006；P = 0.014）的独立预测因素。术后泼尼松联合他克莫司（Pred + TAC）与两组实现持续临床缓解（P = 0.026；P = 0.030）及泼尼松减量相关。
非胸腺瘤性MG病程更良性，结局更好。AChR-Ab阳性表明两组预后较好，而MGFA分级严重和组织病理学级别高的胸腺瘤性MG需要密切监测和随访。术后Pred + TAC可能是实现有益结局的有效免疫治疗选择。
