Does Myasthenia Gravis Affect Long-Term Survival in Thymic Carcinomas? An ESTS Database Analysis (original) (raw)
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Lung Cancer, 2015
Objective: Aim of this study is to evaluate whether Myasthenia Gravis (MG) might influence Overall Survival (OS) and Cumulative Incidence of Recurrence (CIR) in thymoma patients. Methods: this is a multicenter retrospective study of patients operated in 6 high-volume Italian Institutions between 1990 and 2012. OS was estimated by the Kaplan-Meier method and CIR by considering death from any cause as a competing event. Crude and adjusted comparisons by MG for OS and CIR were performed using Cox and Fine&Gray models. Adjusted models included MG, age, gender, stage, histology, induction therapy, completeness of resection, adjuvant therapy. Results: Seven hundred ninety-seven patients were included: 375 (47%) had MG. MG patients were younger and more frequently female, with a B2-B3 thymoma. At the end of the study, 129 patients (54 with MG) developed a recurrence and 165 (66 with MG) died. At univariate analysis, MG showed a slight protective effect on OS, not confirmed by the multivariate model. Age, incomplete resection, advanced stages and thymic carcinoma were negative prognostic variables. Univariate analyses showed no evidence of MG protective effect on CIR. Advanced stages and induction therapy were significant negative predictors. Conclusion: our study showed that MG was significantly associated with female, lower age and B2-B3 thymoma; it demonstrated a slight protective effect on OS at the univariate analysis which was not confirmed in multivariate as well as no impact on CIR. Advanced tumor stages and thymic carcinoma histology for OS and induction therapy and advanced stages for CIR were negative prognostic variables.
World Journal of Surgery, 2009
Thymic epithelial tumors are characterized by slow growth and variable malignant behavior. We present our experience on the surgical management of these tumors. We conducted a retrospective analysis of patients with thymomas undergoing modified maximal thymectomy over a period of 16 years. Evaluated parameters included gender, age, Masaoka stage, WHO histology, R0 resection, myasthenia gravis, and adjuvant radiotherapy. In thymoma-associated myasthenia gravis, further analysis was made according the Osserman stage, the time from myasthenia diagnosis to thymectomy, and the steroid treatment. End points were survival for the total study group and achievement of complete stable remission (CSR) in patients with myasthenia gravis. The study group consisted of 15 male and 24 female patients. There was no perioperative mortality. Overall survival was 91.6% and 75.1% at 5 and 10 years. Univariate analysis identified the following predictors of survival: myasthenia (P < 0.001), Masaoka stage (P < 0.001), R0 resection (P < 0.001), and WHO histology (P = 0.007). Only the WHO histology was an independent predictor of survival in multivariate analysis (P = 0.003). Myasthenia patients had CSR prediction of 51.9% and 75.9% at 10 and 15 years. Preoperative steroid treatment (P = 0.007) and WHO histology (P = 0.021) were independent predictors of CSR on multivariate analysis. Modified maximal thymectomy is safe and efficient in the treatment of thymomas. WHO histology is the prime determinant of tumor aggressiveness and patient survival. Paraneoplastic myasthenia gravis and its outcome after thymectomy is significantly correlated with the WHO classification subtypes; however, lower CSR rates are not necessarily associated with more aggressive histological subgroups.
ecancermedicalscience, 2021
Thymic epithelial tumours are rare and highly heterogeneous. Reports from the United States suggest an overall incidence of 0.15 per 100,000/year. In contrast, the incidence of these tumours in Latin America is largely unknown and reports are scarce, somewhat limited to case reports. Herein, we report a series of 38 thymic tumours from a single institution, retrospectively incorporated into this study. Patient characteristics and outcomes including age, sex, stage, paraneoplastic syndromes, treatment regimens and the date of decease were obtained from medical records. Most cases in our series were females and young age (<50 years old) and early stage by Masaoka-Koga or the Moran staging systems. Also, a 34% of patients had myasthenia gravis (MG). Next, we analysed overall survival rates in our series and found that the quality of surgery (R0, R1 or R2), MG status and staging (Masaoka-Koga, Moran or TNM) were prognostic factors. Finally, we compared our data to larger thymic tumou...
2020
Background: Thymic epithelial tumors are rare and highly heterogeneous. Reports from the United States suggest an overall incidence of 0.15 per 100,000/year. In contrast, the incidence of these tumors in Latin America is largely unknown and reports are scarce, somewhat limited to case reports. Methods: Herein, we report a series of 38 thymic tumors from a single institution, retrospectively incorporated into this study. Patient characteristics and outcomes including age, sex, stage, paraneoplastic syndromes, treatment regimens and the date of decease were obtained from medical records. Results: Most cases in our series were females and young age (<50 years-old) and early stage by Masaoka-Koga or the Moran staging systems. Also, a 34% of patients had myasthenia gravis (MG). Next, we analyzed overall survival (OS) rates in our series and found that the quality of surgery (R0, R1 or R2), MG status, and staging (Masaoka-Koga or Moran) were prognostic factors. Finally, we compared our data to larger thymic tumor series. Conclusions: Overall, our study confirms complete surgical resection as the standard, most effective treatment for thymic epithelial tumors. Also, the Masaoka-Koga staging system remains as a reliable prognostic factor but also the Moran staging system should be considered for thymomas.
Myasthenia Gravis Related to Thymic Carcinoma: A Case Study
The Thoracic and Cardiovascular Surgeon Reports, 2020
Myasthenia gravis and thymoma are often presented in association with ∼10% of myasthenic cases having concomitant thymoma. Thymic carcinoma is one of the rarest/aggressive human epithelial tumors and has no correlation with myasthenia gravis hitherto. Here is provided a clinical case and review of literature on a very rare association of thymic carcinoma (with no sign of thymoma) and myasthenia gravis (antiacetylcholine receptor antibody positive). Two years after thymectomy, clinical evolution was satisfactory. This clinical case elicits hypothesis that thymic carcinoma may be related with myasthenia gravis, what may have good prognostic from oncologic and neurologic perspectives.
Clinical and pathologic predictors of outcome in Thymoma-Associated myasthenia gravis
The Annals of Thoracic Surgery, 2003
gravis Clinical and pathologic predictors of outcome in Thymoma-Associated myasthenia http://ats.ctsnetjournals.org/cgi/content/full/76/5/1643 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association.
Prognostic Factors of Thymectomy in Patients with Myasthenia gravis: A Cohort of 132 Patients
Objective: To identify the response to thymectomy and the factors associated with a poor response, a nested case-control study was performed on 132 patients with an established diagnosis of myasthenia gravis who had had a thymectomy between 1987 and 1997 and had been followed up for at least 3 years. Methods: In order to assess the response to thymectomy, the following two points were taken into account: (a) the dose of pyridos-tigmine and other drugs (steroids, azathioprine) that the patient took before and after thymectomy, and (b) the Osserman classification before and after thymectomy. The patients were divided into 4 groups: (1) patients in remission; (2) patients with improvement; (3) patients with no change, and (4) patients who were worse. Results: 91 patients had a good response (69%) and 41 patients had a poor response (31%). The response by groups was as follows: 50 patients were found to be in remission; 41 patients had improved; 34 patients had no changes, and 7 got worse. Being more than 60 years old was associated with a poor prognosis (odds ratio 4.6, CI 1.11–20.32, p 0.01). The patients who had the disease for more than 3 years (odds ratio 2.97, CI 0.79–5.39, p 0.09) had a tendency towards a bad prognosis even though there was no statistical significance, and for those who had it for more than 4 years (odds ratio 2.58, CI 0.89–0.96, p 0.02) the bad prognosis was statistically significant. The patients who had the disease for more than 3 years between diagnosis and thymectomy (odds ratio 2.02, CI 0.69–5.90, p 0.15) and those with it for more than 4 years (odds ratio 2.53, CI 0.83–7.7, p 0.06) had a tendency towards a poor prognosis even though there was no statistical significance. In addition, having Osserman I was associated with a bad prognosis. Referring to the pathological findings, patients with thymoma (odds ratio 3.51, CI 0.43–31.5, p 0.15) and those with thymic atrophy (odds ratio 2.19, CI 0.93–5.16, p 0.04) had a poor prognosis. Finally, the use of steroids before thymectomy (odds ratio 2.26, CI 0.99–5.18, p 0.03) was associated with a worse prognosis. Conclusions: The response to thymec
Thymoma and myasthenia gravis: clinical aspects and prognosis
Asian Cardiovascular and Thoracic Annals, 2012
Myasthenia gravis is present in a significant proportion of patients with thymoma. We investigated particular features of the clinical behavior of thymoma and its relationship to myasthenia in a retrospective study of 79 patients who underwent thymectomy for thymoma during the last 20 years. The presence of myasthenia gravis, Masaoka stage, World Health Organization histotype, myasthenia response, and survival were analyzed. The mean age of the patients was 56.1 AE12.4 years, and 39 had myasthenia gravis. A significantly higher proportion of patients with myasthenia was found in B2 and B3 histotypes compared to A, AB, and B1. Among myasthenic patients, 33.3% had no response, 50% had a partial response, and 16.7% achieved complete remission. During the follow-up period, 16 (21.1%) patients died. Mean survival was 4.8 AE 1.4 years for patients with no myasthenia response, whereas those with a partial or complete myasthenia response had significantly better survival.
Predictors of Outcome for Myasthenia Gravis after Thymectomy
The aim of this study was to assess the clinical outcome of patients with myasthenia gravis treated with maximal thymectomy and to identify prognostic variables that predict the outcome. Over 15 years, from 1986 to 2001, we collected data on 100 patients with myasthenia gravis who underwent maximal thymectomy and retrospectively reviewed their outcome. Women comprised 63% and the median age was 25 years (range, 4 to 61). The median duration of the disease was 26 months (range, 1 to 240). According to the Osserman classification, there were seven patients in class I, 31 in class II, 47 in class III, and 15 in class IV. In non thymomatous patients (93 patients), complete remission rate progressively increased from 37.4% to 58.2% and 75% at 3, 10 and 15 years of follow-up respectively. These findings suggest that the complete remission rate is prone to increase with time after maximal thymectomy. The total benefit rate achieved was estimated to be 86% while 14% did not improve at a mean follow-up period of 7.6 years (range, 8 to 180 months). Univariate analysis ( p < 0.05) showed that age, thymic histology and ectopic thymic tissue are significant prognostic factors for outcome.
Journal of Neuroimmunology, 2008
We studied 197 patients with thymoma-associated myasthenia gravis (T-MG) to identify variables that can influence the natural history of the disease and the therapeutical approaches. Multivariate analysis showed that neither clinical nor pathological variables were associated with a better chance to reach complete stable remission. The video-assisted thoracoscopic extended thymectomy (VATET) was not significantly correlated with a lower chance of achieving complete stable remission compared with the classical transsternal approach (T-3b) (p = 0.1090). Thymoma recurrence was not correlated with surgery by VATET or T-3b. VATET was safe and reliable for removal of thymoma. The low chance of achieving remission (9.64%) in T-MG underlines the importance of an early diagnosis as well as the need for more aggressive therapeutic strategies.