Clinicopathological predictors of postoperative long-term myasthenic status in resected thymoma with myasthenia gravis.

IF 1.7 4区医学 Q2 SURGERY

Surgery Today Pub Date : 2024-07-01 Epub Date: 2024-02-28 DOI:10.1007/s00595-024-02806-0

Takahiro Suzuki, Tomoyuki Hishida, Shigeaki Suzuki, Yu Okubo, Kyohei Masai, Kaoru Kaseda, Keisuke Asakura, Katsura Emoto, Hisao Asamura

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Abstract

Purpose: 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.

Methods: 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.

Results: 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%.

Conclusion: The WHO type of thymoma is an informative predictor of postoperative MG status in patients with MG-related thymoma.

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切除胸腺瘤合并肌无力症患者术后长期肌无力状态的临床病理预测因素

目的：胸腺瘤合并重症肌无力（MG）的手术患者必须严格监测其 MG 状态和肿瘤预后。我们旨在确定术后 MG 状态的临床病理学预测因素：我们对 2002 年至 2020 年间连续 40 例与 MG 相关的胸腺瘤手术患者进行了回顾性研究。定量肌无力评分（QMGS）和美国肌无力基金会干预后状态（MGFA-PIS）用于评估术后MG状态：所有患者都接受了扩大胸腺全切除术。最常见的WHO类型为B2型（32%），65%的患者为B1-B3型，35%为A-AB型胸腺瘤。有11名患者（28%）在术后6个月达到了MGFA-PIS的MG控制状态。与 B1-B3 型胸腺瘤相比，A-AB 型胸腺瘤患者中出现这种控制状态的比例更高（57% 对 12%，P = 0.007）。在多变量分析中，根据 QMGS，WHO 类型（A-AB 或 B1-B3）是 MG 病情恶化的独立预测因素（B1-B3 型，危险比：3.23，95% 置信区间：1.12-9.25）。在最后一次随访中，23 名患者（58%）的 MG 状况得到控制。所有患者的5年总生存率为93.7%：结论：胸腺瘤的WHO类型是预测MG相关胸腺瘤患者术后MG状态的信息指标。

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来源期刊

Surgery Today 医学-外科

CiteScore

4.90

自引率

4.00%

发文量

208

审稿时长

1 months

期刊介绍： Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it"). The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.