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Surgery Today

28-02-2024 | Myasthenia Gravis | Original Article

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

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

Published in: Surgery Today

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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.
Literature
1.
Chan JKC, Lanyuejoul S, Marx A (eds). Tumours of the thymus in WHO classification of tumours editorial board. In: Thoracic tumours. 5th ed. International Agency for Research on Cancer; 2021; pp. 319–44.
2.
Marx A, Willcox N, Leite MI, Chuang WY, Schalke B, Nix W, et al. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity. 2010;43:413–27.CrossRefPubMed
3.
Wang F, Pang L, Fu J, Shen Y, Wei Y, Tan L, et al. Postoperative survival for patients with thymoma complicating myasthenia gravis-preliminary retrospective results of the ChART database. J Thorac Dis. 2016;8:711–7.CrossRefPubMedPubMedCentral
4.
Nakajima J, Okumura M, Yano M, Date H, Onuki T, Haniuda M, et al. Myasthenia gravis with thymic epithelial tumour: a retrospective analysis of a Japanese database. Eur J Cardiothorac Surg. 2016;49:1510–5.CrossRefPubMed
5.
Ruffini E, Detterbeck F, Van Raemdonck D, Rocco G, Thomas P, Weder W, et al. Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg. 2014;46:361–8.CrossRefPubMedPubMedCentral
6.
Menon D, Katzberg H, Barnett C, Pal P, Bezjak A, Keshavjee S, et al. Thymoma pathology and myasthenia gravis outcomes. Muscle Nerve. 2021;63:868–73.CrossRefPubMed
7.
Weis CA, Yao X, Deng Y, Detterbeck FC, Marino M, Nicholson AG, et al. The impact of Thymoma Histotype on prognosis in a worldwide database. J Thorac Oncol. 2015;10:367–72.CrossRefPubMedPubMedCentral
8.
Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology. 2021;96:114–22.CrossRefPubMedPubMedCentral
9.
Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med. 2016;375:511–22.CrossRefPubMedPubMedCentral
10.
Asamura H. Lung, pleural, and thymic tumours. In: Brierley J, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumours. 8th ed. UK: Wiley; 2017. p. 105–17.
11.
Detterbeck FC, Stratton K, Giroux D, Asamura H, Crowley J, Falkson C, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9:S65-72.CrossRefPubMed
12.
13.
Skeie GO, Apostolski S, Evoli A, Gilhus NE, Illa I, Harms L, et al. European Federation of Neurological Societies. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol. 2010;17(7):893–902.CrossRefPubMed
14.
Chaurasia A, Harel O. Using AIC in multiple linear regression framework with multiply imputed data. Health Serv Outcomes Res Methodol. 2012;12(2–3):219–33.CrossRefPubMedPubMedCentral
15.
Masaoka A, Yamakawa Y, Niwa H, Fukai I, Kondo S, Kobayashi M, et al. Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg. 1996;62:853–9.CrossRefPubMed
16.
López-Cano M, Ponseti-Bosch JM, Espin-Basany E, Sánchez-García JL, Armengol-Carrasco M. Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis. Ann Thorac Surg. 2003;76:1643–9.CrossRefPubMed
17.
Tian W, Li X, Tong H, Weng W, Yang F, Jiang G, et al. Surgical effect and prognostic factors of myasthenia gravis with thymomas. Thorac Cancer. 2020;11:1288–96.CrossRefPubMedPubMedCentral
18.
Okumura M, Miyoshi S, Fujii Y, Takeuchi Y, Shiono H, Inoue M, et al. Clinical and functional significance of WHO classification on human thymic epithelial neoplasms. A study of 146 consecutive tumors. Am J Surg Pathol. 2001;25:103–10.CrossRefPubMed
19.
Suzuki S, Utsugisawa K, Suzuki N. Overlooked non-motor symptoms in myasthenia gravis. J Neurol Neurosurg Psychiatry. 2013;84:989–94.CrossRefPubMed
20.
Ströbel P, Helmreich M, Menioudakis G, Lewin SR, Rüdiger T, Bauer A, et al. Paraneoplastic myasthenia gravis correlates with generation of mature naive CD4 (+) T cells in thymomas. Blood. 2002;100:159–66.CrossRefPubMed
21.
Yamada Y, Weis CA, Thelen J, Sticht C, Schalke B, Ströbel P, et al. Thymoma Associated Myasthenia Gravis (TAMG): differential expression of functional pathways in relation to MG status in different thymoma histotypes. Front Immunol. 2020;11:664.CrossRefPubMedPubMedCentral
22.
Leuzzi G, Meacci E, Cusumano G, Cesario A, Chiappetta M, Dall’armi V, et al. Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis. Eur J Cardiothorac Surg. 2014;45:e76-88.CrossRefPubMed
23.
Yu S, Lin J, Fu X, Li J, Li Y, Chen B, et al. Risk factors of myasthenic crisis after thymectomy in 178 generalized myasthenia gravis patients in a five-year follow-up study. Int J Neurosci. 2014;124:792–8.CrossRefPubMed
Metadata
Title
Clinicopathological predictors of postoperative long-term myasthenic status in resected thymoma with myasthenia gravis
Authors
Takahiro Suzuki
Tomoyuki Hishida
Shigeaki Suzuki
Yu Okubo
Kyohei Masai
Kaoru Kaseda
Keisuke Asakura
Katsura Emoto
Hisao Asamura
Publication date
28-02-2024
Publisher
Springer Nature Singapore
Published in
Surgery Today
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-024-02806-0