Eight-year follow-up of patients with myasthenia gravis after thymectomy

Yu, Shenghui; Li, F.; Chen, Biao; Lin, Jing; Yang, Mengjiao; Fu, Xiangning; Li, J.; Bu, Bitao

doi:10.1111/ane.12289

Cited by 27 publications

(21 citation statements)

References 33 publications

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“…We showed that the MG patients with nonthymomatous pathology were 2.17 times more likely to achieve remission compared with the patients with thymomatous pathology. This result is consistent with results from previous studies that included large numbers (>100) of patients . However, other studies have found that nonthymomatous pathology is not a prognostic factor .…”

Section: Discussionsupporting

confidence: 91%

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Factors predicting remission in thymectomized patients with acetylcholine receptor antibody‐positive myasthenia gravis

et al. 2018

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Section: Discussionsupporting

confidence: 91%

“…This result is consistent with results from previous studies that included large numbers (>100) of patients. 4,6,15 However, other studies have found that nonthymomatous pathology is not a prognostic factor. 5,[16][17][18] This discrepancy may be a result of differences in participants, followup times, or sample sizes.…”

Section: Discussionmentioning

confidence: 98%

Factors predicting remission in thymectomized patients with acetylcholine receptor antibody‐positive myasthenia gravis

et al. 2018

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“…The prevalence of MG was significantly different in type B2 thymoma compared with that in other types of thymoma. In the 38 patients that had thymoma with MG, muscle weakness relief following surgery was 77.8%, which is similar to the 81.1% reported by Yu et al (29). However, 1 out of 66 (1.5%) patients without preoperative MG developed postoperative MG in the present study.…”

Section: Discussionsupporting

confidence: 89%

Myasthenia gravis in patients with thymoma affects survival rate following extended thymectomy

et al. 2016

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Abstract. Thymomas are the most common adult tumors in the anterior mediastinal compartment, and a significant amount of thymomas are complicated by myasthenia gravis (MG). Extended thymectomy (ET) is the primary treatment method for thymomas and is used to completely resect possible ectopic thymus to avoid recurrence. Studies on the effect of MG in thymoma patients following ET are limited. The aim of the present study was to determine whether the presence of MG affects the prognosis of patients with thymoma. The present study consisted of 104 patients with thymoma that underwent ET; 61 men (58.7%) and 43 women (41.3%) (mean age, 54.6 years). In total, 38 patients had MG (36.5%). MG was most frequently observed in World Health Organization (WHO) classification type B2 thymoma compared with other types of thymoma. During the 5-year follow-up period, 11 patients succumbed to a recurrence of thymoma or respiratory failure due to MG. The overall 5-year survival rate in patients without MG or with MG was 89.1 and 76.0%, respectively. The overall survival (OS) rate in patients with Masaoka stages I + II and III + IV was 90.0 and 68.0%, respectively. The OS rate in patients with WHO type A + AB + B1 and type B2 + B3 was 96.9 and 76.8%, respectively. The patients with MG (P=0.026), Masaoka stages III + IV (P= 0.008) and WHO type B2 + B3 (P=0.032) had a poorer prognosis compared with patients without these characteristics. Furthermore, multivariate analysis by Cox regression revealed that age [P=0.032; relative risk (RR)=1.097; 95% confidence interval (CI)=1. 097-1.192] and MG (P= 0.042; RR= 0.167; 95% CI= 0.037-0.940) significantly affected OS rate. In summary, ET is a reliable method for the treatment of thymoma. Long-term survival is expected for patients at early Masaoka stages, and for patients without MG. The prognosis of patients with thymomas with MG is poorer compared with patients without MG. The present findings provide useful information for the future management of patients with thymomas. IntroductionThymoma is a tumor originating from the epithelial cells of the thymus and is a relatively rare neoplasm with an incidence of 0.13 cases per 100,000 individuals per year (1,2). The prognosis of patients with thymoma largely depends on the Masaoka stage of disease and prognosis is poorer for patients with stage III or IV compared with patients with stage I and II tumors (3). The 10-year survival rates are 90, 70, 55 and 35% for stages I, II, III, and IV thymoma, respectively (4). Surgical resection is the primary treatment method for thymoma and a sternotomy is the optimal surgical procedure for thymoma, since it may not be possible to perform a complete thymectomy via thoracotomy on locally advanced lesions, particularly those that are stage III-IV (5,6). Normally, thymoma is a slow-growing tumor, but 40% of thymomas exhibit a locally invasive growth pattern. In addition, thymomas often result in the development of pleural dissemination and distant metastasis (7,8). Therefore, complete resection should be th...

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“…However, the risk of generalization from OMG to generalized MG (GMG) do exist for part of patients, and certain treatment might delay or prevent the onset of GMG (1). Besides, the presence of OMG before operation was one of the favorable factors according to a large sample retrospective study (34). Therefore, 8 cases of MGFA classes I were enrolled in our study, among which 5 cases achieved CSR and all of the 8 patients achieved significant improvement till the last follow up.…”

Section: Discussionmentioning

confidence: 99%

Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience

Yin

Huang²,

Han

et al. 2018

J. Thorac. Dis.

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Background: Robotic thymectomy has been suggested a feasible and safe approach for myasthenia gravis (MG). Few investigations have revealed the independent effect of robotic thymectomy without the confounding impact of immunosuppressive (IM) therapy. Results: Data of 37 cases was available for analysis. The mean follow-up was 70.0±13.3 months. The median age was 40 years. Twelve (32.4%) patients kept free of IM therapy, and 25 (67.6%) patients accepted postoperatively. The overall 5-year complete stable remission (CSR) rate was 40.6% and improvement rate was 81.6%. The young (age ≤40) displayed a significant better CSR rate (P=0.015) and a trend of better improvement rate (P=0.050) compared to the old (age >40). Patients without usage of IM therapy showed significant higher CSR rate (P=0.014) and improvement rate (P=0.024) compared to those with usage of IM therapy. Patients with Myasthenia Gravis Foundation of America (MGFA) classes I showed a trend of higher remission rate by multivariate analysis. No significant differences were found for the remission rate according to gender, pathology, and the duration of symptoms. Conclusions:The mono-therapy of robotic thymectomy may bring with a satisfactory long-term result for part of MG patients. Precision selection and individualized therapy are of the most importance. J Thorac Dis 2018;10(1):321-329 jtd.amegroups.com improvement clinical outcomes by thymectomy for patients with nonthymomatous MG. It was a great stride for surgical treatment of MG, but there still remains several questions with regards to the candidates, the optimal surgical approach, the timing and the extent of resection (4,5).Representing the newest minimal invasive technique, robotic thymectomy has been increasing rapidly worldwide in recent years, as it provides with multiple advantages with less trauma comparing to the open procedure (6-8). The long-term results of robotic thymectomy for MG have also been published by several investigators (9-11). Whereas, immunotherapy as the mainstay of treatment for MG, it is frequently given to thymectomized patients to maintain pharmacologic remission (PR) nowadays (12-15). The usage of immunosuppressants would certainly play a role in the overall remission rate of thymectomized MG patients (16). However, few investigations of robotic thymectomy for MG has separated the confounding influence of immunotherapy when analyze the long-term results. Thus, the actual independent effect of robotic thymectomy for MG patients is unclear.The present report introduces our observation of the relatively independent long-term results after robotic thymectomy for MG. MethodsA retrospectively study was performed for patients who diagnosed as MG and underwent robotic extended thymectomy with da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, CA, USA) in department of thoracic surgery of PLA Rocket Force General Hospital between May 2009 and December 2012. The study was approved by the medical ethics committee of PLA Rocket Force General Hospital (approval number ...

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Eight-year follow-up of patients with myasthenia gravis after thymectomy

Cited by 27 publications

References 33 publications

Factors predicting remission in thymectomized patients with acetylcholine receptor antibody‐positive myasthenia gravis

Factors predicting remission in thymectomized patients with acetylcholine receptor antibody‐positive myasthenia gravis

Myasthenia gravis in patients with thymoma affects survival rate following extended thymectomy

Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience

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