Surgical Result for Patients Who Simultaneously Presented With Myasthenia Gravis and Thymoma.

IF 2.6 3区医学 Q3 ONCOLOGY

Thoracic Cancer Pub Date : 2026-07-01 DOI:10.1111/1759-7714.70350

Po-Chun Chang, Ping-Chung Tsai, Ching-Feng Wu, Yau-Lin Tseng, En-Kuei Tang, Tzu-Ping Chen, Yi-Ting Yen, Ching-Yang Wu

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Abstract

Background: Patients who present concurrently with thymoma and myasthenia gravis (MG) constitute a unique clinical population in whom both oncologic control and stabilization of MG symptoms are essential treatment goals. Although extended thymectomy is traditionally recommended, the necessity of radical thymic tissue removal in this subgroup remains uncertain. This study compared surgical outcomes between thymomectomy and extended thymectomy in this specific population.

Methods: We retrospectively analyzed 145 patients with concurrent thymoma and MG treated across four tertiary centers between 2013 and 2023. Clinical characteristics, surgical approaches, postoperative complications, MG medication adjustments, and plasmapheresis requirements were compared between patients undergoing thymomectomy (n = 37) and extended thymectomy (n = 108). A 1:1 propensity score matching (PSM) was performed to balance age (n = 37 per group). Freedom from recurrence (FFR) and overall survival (OS) were compared between patients undergoing thymomectomy and extended thymectomy.

Results: Patients undergoing thymomectomy were older with higher anesthesia risk. Despite a higher rate of R1 resections, thymomectomy achieved FFR and OS comparable to extended thymectomy across the entire cohort and within different Masaoka stages. No significant differences were observed in MG medication reduction, plasmapheresis rates, or postoperative MG crisis. Thymomectomy was associated with shorter operative times and avoided the risks related to thymic vein division, a major source of hemorrhagic complications in extended thymectomy.

Conclusion: Thymomectomy provides oncologic and neurologic outcomes comparable to extended thymectomy in patients with thymoma-associated MG while reducing operative risks. These findings challenge the necessity of routine extended thymectomy and support thymomectomy as an effective, less invasive alternative in appropriately selected patients.

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重症肌无力合并胸腺瘤的手术效果分析。

背景：同时患有胸腺瘤和重症肌无力（MG）的患者构成了一个独特的临床人群，在这些人群中，肿瘤控制和MG症状的稳定是必不可少的治疗目标。虽然传统上推荐扩大胸腺切除术，但在这一亚群中是否需要根治性胸腺组织切除仍不确定。本研究比较了胸腺瘤切除术和扩大胸腺切除术在这一特定人群中的手术效果。方法：我们回顾性分析了2013年至2023年间在四个三级中心治疗的145例胸腺瘤合并MG患者。比较胸腺瘤切除术（n = 37）和扩大胸腺切除术（n = 108）患者的临床特征、手术入路、术后并发症、MG药物调整和血浆置换要求。采用1:1倾向评分匹配（PSM）来平衡年龄（每组n = 37）。比较胸腺瘤切除术和扩展胸腺切除术患者的复发自由度（FFR）和总生存期（OS）。结果：胸腺瘤切除术患者年龄较大，麻醉风险较高。尽管R1切除率更高，但在整个队列和不同的Masaoka分期中，胸腺瘤切除术获得的FFR和OS与扩展胸腺切除术相当。在MG药物减量、血浆置换率或术后MG危象方面没有观察到显著差异。胸腺瘤切除术与较短的手术时间有关，并避免了胸腺静脉分裂的风险，胸腺静脉分裂是延长胸腺切除术出血并发症的主要来源。结论：胸腺瘤切除术在降低手术风险的同时，为胸腺瘤相关MG患者提供了与扩大胸腺切除术相当的肿瘤和神经预后。这些发现对常规胸腺切除术的必要性提出了挑战，并支持胸腺瘤切除术作为一种有效的、侵入性较小的选择，适用于适当选择的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thoracic Cancer ONCOLOGY-RESPIRATORY SYSTEM

CiteScore

5.20

自引率

3.40%

发文量

439

审稿时长

2 months

期刊介绍： Thoracic Cancer aims to facilitate international collaboration and exchange of comprehensive and cutting-edge information on basic, translational, and applied clinical research in lung cancer, esophageal cancer, mediastinal cancer, breast cancer and other thoracic malignancies. Prevention, treatment and research relevant to Asia-Pacific is a focus area, but submissions from all regions are welcomed. The editors encourage contributions relevant to prevention, general thoracic surgery, medical oncology, radiology, radiation medicine, pathology, basic cancer research, as well as epidemiological and translational studies in thoracic cancer. Thoracic Cancer is the official publication of the Chinese Society of Lung Cancer, International Chinese Society of Thoracic Surgery and is endorsed by the Korean Association for the Study of Lung Cancer and the Hong Kong Cancer Therapy Society. The Journal publishes a range of article types including: Editorials, Invited Reviews, Mini Reviews, Original Articles, Clinical Guidelines, Technological Notes, Imaging in thoracic cancer, Meeting Reports, Case Reports, Letters to the Editor, Commentaries, and Brief Reports.