Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis(MG) surgically treated ...Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis(MG) surgically treated in our department from 1978 to 2003 were studied retrospectively. The clinical characteristics, complication, remissions and survival rates were compared between MG with and without thymoma. Results: The patients of MG with thymoma were significantly older (P<0.01), had shorter duration of symptom(P<0.01), and higher myasthenia crisis rates after operation(P<0.01) than those without thymoma. No difference of Osserman classification was found between the 2 groups. The complete remission rates and partial remission rates of MG with thymoma were significantly lower than those without thymoma at 1 and 3 years(P=0.049, P=0.000, P=0.015, P=0.010), but no differences at 5 years(P=0.457, P=0.699). The survival rates were lower in MG with thymoma than without thymoma(Log rank=18.58,P=0.000). Conclusion: The clinical characteristics are different between MG with and without thymoma. The remission of symptom of MG with thymoma is worse than that of MG without thymoma in the near future, but similar in the long future. In a long-term, the death rate of MG with thymoma is significantly higher than that of MG without thymoma.展开更多
Background Thymectomy is an established treatment for myasthenia gravis （MG）, and video-assisted thoracoscopic surgery （VATS） thymectomy has become an acceptable surgical procedure. This study aimed to compare the...Background Thymectomy is an established treatment for myasthenia gravis （MG）, and video-assisted thoracoscopic surgery （VATS） thymectomy has become an acceptable surgical procedure. This study aimed to compare the results of VATS thymectomy and open thymectomy and to identify the prognostic factors after thymectomy. Methods The clinical data of 187 consecutive thymectomies performed between July 2000 and December 2009 were retrospectively reviewed; 75 open thymectomies and 112 VATS thymectomies. Clinical efficacy and variables influencing outcome were assessed by Kaplan-Meier survival curves and Cox proportional hazards regression analysis. Results The operative blood loss in the VATS group was significantly less than that in the open group （（62.14＋55.43） ml vs. （137.87＋165.25） ml, P 〈0.05）. The postoperative crisis rate increased with the severity of preoperative MG and the prescription dose of anticholinesterase. Complete follow-up information of patients more than 12 months after the thymectomy was obtained on 151 cases, 89 cases from the VATS group and 62 cases from the open group, with a mean follow-up period of 59.3 months, range from 12 to 117 months. Complete stable remission （CSR） was the end point for evaluation of the treatment results. The overall five-year CSR rate was 57.5%. Two good prognostic factors were identified; preoperative prescription of anticholinesterase alone （P=0.035） and non-thymomatous MG （P=0.003）. The five-year CSR rate of the ocular type of MG reached a high level of 67.4%. Conclusions Thymectomy can achieve good long-term CSR in MG, and VATS is an ideal alternative method. High-dose prescription of anticholinesterase and the advanced stage by Myasthenia Gravis Foundation of America （MGFA） classification have higher risks of postoperative crisis. Preoperative prescription of anticholinesterase alone and non-thymomatous MG are good prognostic factors. Thymectomy should also be considered for the ocular tvioe of MG.展开更多
Background：The co-existence of myasthenia gravis （MG） and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiother...Background：The co-existence of myasthenia gravis （MG） and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.Methods：A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery （Group A）; whereas the other 24 patients did not receive radiation therapy （Group B）. According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups （1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52）. We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission （CSR） rate as the primary endpoints.Results：There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B （χ2 = 4.631, P = 0.031）. The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.Conclusions：Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.展开更多
Objective To determine whether the clinical and pathologic characteristics and prognoses of myasthenia gravis (MG) patients below 15 years differ from those patients over 50 years after thymectomy. Methods We reviewed...Objective To determine whether the clinical and pathologic characteristics and prognoses of myasthenia gravis (MG) patients below 15 years differ from those patients over 50 years after thymectomy. Methods We reviewed the registry material of 30 pediatric and 32 elderly MG patients after thymectomy,including their age,sex,clinical classification,pathological types,and prognoses. The Chi-square test or Wilcoxon’s rank-sum test was used to determine the statistical differences between the children and elderly groups.Results No significant difference was seen in sex distribution between the two groups (Chi-square test, P =0.625),but there were differences in clinical classification: more type Ⅰ was observed in the pediatric group than in the elderly group,but more type Ⅱor Ⅲ was seen in the elderly group (Wilcoxon's rank-sum test,P <0.001). As to pathological types,the pediatric group was also significantly different from the elderly group (Chi-square test,P <0.01). All of the patients (100%) in the pediatric group had thymus hyperplasia,but in the elderly group more than half (56.26%) were found to have thymoma (benign or malignant). The prognoses after thymectomy were better in the pediatric group than in the elderly group (Wilcoxon's rank-sum test,P <0.001). Conclusions Because the prognoses are generally better than those of the elderly patients,we should be careful when operating on pediatric patients of ocular type. The elderly patients tend to receive more aggressive treatment because of more severe generalized types often associated with thymoma and poor prognoses. Both pediatric and elderly patients are seldom associated with other autoimmune disease.展开更多
背景与目的胸腺瘤常伴发重症肌无力(myasthenia gravis,MG),但是这些患者行胸腺切除的预后与MG的关系尚不明确。本研究旨在探讨影响胸腺瘤合并MG患者预后的因素。方法回顾性分析中国胸腺瘤协作组(Chinese Alliance for Research of Thym...背景与目的胸腺瘤常伴发重症肌无力(myasthenia gravis,MG),但是这些患者行胸腺切除的预后与MG的关系尚不明确。本研究旨在探讨影响胸腺瘤合并MG患者预后的因素。方法回顾性分析中国胸腺瘤协作组(Chinese Alliance for Research of Thymoma,ChART)数据库1992年-2012年875例随访20年资料完整的胸腺瘤病例,分析世界卫生组织(World Health Organization,WHO)组织学分型、Masaoka分期、术后辅助治疗与MG及预后的关系。结果胸腺瘤WHO组织学分型与MG有相关性,差异有统计学意义(χ~2=24.908,P<0.001)。MG发生率为22.7%,其中B2型(58/178,32.58%)>B3型(65/239,27.20%)>B1型(27/132,20.45%)>AB型(43/267,16.10%)>A型(6/59,10.17%),Masaoka分期与MG无相关性(χ~2=1.365,P=0.714)。生存分析表明WHO分型、Masaoka分期与预后有关(P<0.05),而是否合并MG(χ~2=0.113,P=0.736)、是否行胸腺扩大切除(χ~2=1.548,P=0.213)、术后辅助放疗(χ~2=0.380,P=0.538)与预后无相关,术后辅助化疗与差的预后相关(χ~2=14.417,P<0.001)。是否行胸腺扩大切除与MG的疗效有相关性(χ~2=24.695,P<0.001)。结论胸腺瘤患者是否合并MG和是否行胸腺扩大切除与预后无相关性,胸腺扩大切除可改善MG患者的疗效。展开更多
文摘Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis(MG) surgically treated in our department from 1978 to 2003 were studied retrospectively. The clinical characteristics, complication, remissions and survival rates were compared between MG with and without thymoma. Results: The patients of MG with thymoma were significantly older (P<0.01), had shorter duration of symptom(P<0.01), and higher myasthenia crisis rates after operation(P<0.01) than those without thymoma. No difference of Osserman classification was found between the 2 groups. The complete remission rates and partial remission rates of MG with thymoma were significantly lower than those without thymoma at 1 and 3 years(P=0.049, P=0.000, P=0.015, P=0.010), but no differences at 5 years(P=0.457, P=0.699). The survival rates were lower in MG with thymoma than without thymoma(Log rank=18.58,P=0.000). Conclusion: The clinical characteristics are different between MG with and without thymoma. The remission of symptom of MG with thymoma is worse than that of MG without thymoma in the near future, but similar in the long future. In a long-term, the death rate of MG with thymoma is significantly higher than that of MG without thymoma.
文摘Background Thymectomy is an established treatment for myasthenia gravis （MG）, and video-assisted thoracoscopic surgery （VATS） thymectomy has become an acceptable surgical procedure. This study aimed to compare the results of VATS thymectomy and open thymectomy and to identify the prognostic factors after thymectomy. Methods The clinical data of 187 consecutive thymectomies performed between July 2000 and December 2009 were retrospectively reviewed; 75 open thymectomies and 112 VATS thymectomies. Clinical efficacy and variables influencing outcome were assessed by Kaplan-Meier survival curves and Cox proportional hazards regression analysis. Results The operative blood loss in the VATS group was significantly less than that in the open group （（62.14＋55.43） ml vs. （137.87＋165.25） ml, P 〈0.05）. The postoperative crisis rate increased with the severity of preoperative MG and the prescription dose of anticholinesterase. Complete follow-up information of patients more than 12 months after the thymectomy was obtained on 151 cases, 89 cases from the VATS group and 62 cases from the open group, with a mean follow-up period of 59.3 months, range from 12 to 117 months. Complete stable remission （CSR） was the end point for evaluation of the treatment results. The overall five-year CSR rate was 57.5%. Two good prognostic factors were identified; preoperative prescription of anticholinesterase alone （P=0.035） and non-thymomatous MG （P=0.003）. The five-year CSR rate of the ocular type of MG reached a high level of 67.4%. Conclusions Thymectomy can achieve good long-term CSR in MG, and VATS is an ideal alternative method. High-dose prescription of anticholinesterase and the advanced stage by Myasthenia Gravis Foundation of America （MGFA） classification have higher risks of postoperative crisis. Preoperative prescription of anticholinesterase alone and non-thymomatous MG are good prognostic factors. Thymectomy should also be considered for the ocular tvioe of MG.
文摘Background：The co-existence of myasthenia gravis （MG） and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.Methods：A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery （Group A）; whereas the other 24 patients did not receive radiation therapy （Group B）. According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups （1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52）. We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission （CSR） rate as the primary endpoints.Results：There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B （χ2 = 4.631, P = 0.031）. The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.Conclusions：Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.
文摘Objective To determine whether the clinical and pathologic characteristics and prognoses of myasthenia gravis (MG) patients below 15 years differ from those patients over 50 years after thymectomy. Methods We reviewed the registry material of 30 pediatric and 32 elderly MG patients after thymectomy,including their age,sex,clinical classification,pathological types,and prognoses. The Chi-square test or Wilcoxon’s rank-sum test was used to determine the statistical differences between the children and elderly groups.Results No significant difference was seen in sex distribution between the two groups (Chi-square test, P =0.625),but there were differences in clinical classification: more type Ⅰ was observed in the pediatric group than in the elderly group,but more type Ⅱor Ⅲ was seen in the elderly group (Wilcoxon's rank-sum test,P <0.001). As to pathological types,the pediatric group was also significantly different from the elderly group (Chi-square test,P <0.01). All of the patients (100%) in the pediatric group had thymus hyperplasia,but in the elderly group more than half (56.26%) were found to have thymoma (benign or malignant). The prognoses after thymectomy were better in the pediatric group than in the elderly group (Wilcoxon's rank-sum test,P <0.001). Conclusions Because the prognoses are generally better than those of the elderly patients,we should be careful when operating on pediatric patients of ocular type. The elderly patients tend to receive more aggressive treatment because of more severe generalized types often associated with thymoma and poor prognoses. Both pediatric and elderly patients are seldom associated with other autoimmune disease.
文摘背景与目的胸腺瘤常伴发重症肌无力(myasthenia gravis,MG),但是这些患者行胸腺切除的预后与MG的关系尚不明确。本研究旨在探讨影响胸腺瘤合并MG患者预后的因素。方法回顾性分析中国胸腺瘤协作组(Chinese Alliance for Research of Thymoma,ChART)数据库1992年-2012年875例随访20年资料完整的胸腺瘤病例,分析世界卫生组织(World Health Organization,WHO)组织学分型、Masaoka分期、术后辅助治疗与MG及预后的关系。结果胸腺瘤WHO组织学分型与MG有相关性,差异有统计学意义(χ~2=24.908,P<0.001)。MG发生率为22.7%,其中B2型(58/178,32.58%)>B3型(65/239,27.20%)>B1型(27/132,20.45%)>AB型(43/267,16.10%)>A型(6/59,10.17%),Masaoka分期与MG无相关性(χ~2=1.365,P=0.714)。生存分析表明WHO分型、Masaoka分期与预后有关(P<0.05),而是否合并MG(χ~2=0.113,P=0.736)、是否行胸腺扩大切除(χ~2=1.548,P=0.213)、术后辅助放疗(χ~2=0.380,P=0.538)与预后无相关,术后辅助化疗与差的预后相关(χ~2=14.417,P<0.001)。是否行胸腺扩大切除与MG的疗效有相关性(χ~2=24.695,P<0.001)。结论胸腺瘤患者是否合并MG和是否行胸腺扩大切除与预后无相关性,胸腺扩大切除可改善MG患者的疗效。
