Abstract
BackgroundThe length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction.MethodsThe records of patients with thymomatous MG who underwent extended thymectomy from January 2005 to December 2018 were retrospectively reviewed. The primary end point was a reduction of 3 points of QMGs and the secondary end point was another reduction of 3 points of QMGs.ResultsA total of 481 patients were included in the analysis, the mean age of the patients was 41.63 ± 8.55 years, and approximately 60% were male. The median time to achieve a 3 point decrease in QMGS was 6 months, and the median time to achieve another 3 point decrease was 30 months. Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively). Likewise, multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a second 3 point decrease in QMGS (HR = 0.53 and 0.53, respectively).ConclusionsIn patients with thymomatous MG who receive thymectomy, age ≥ 42 years and Masaoka-Koga stage > I are associated with a worse prognosis and failure to achieve a 3 point decrease in QMGS.
Highlights
Thymoma is a rare tumor of thymic epithelial cells [1]
Univariate results indicate that age ≥ 42 years, higher Myasthenia Gravis Foundation of America (MGFA) class (IIB-V), and Masaoka-Koga stage > I were associated with a lower probability of an initial 3 point decrease of Quantitative Myasthenia Gravis Score (QMGS)
Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively)
Summary
Thymoma is a rare tumor of thymic epithelial cells [1]. Notably, 15–20% of patients with a thymoma present with myasthenia gravis (MG; thymomatous MG), a neuromuscular disease [2]. The clinical characteristics and neurological prognosis of thymomatous MG are different than those of MG not associated with thymoma (non-thymomatous MG) [6]. Thymectomy has been shown to improve neurological outcomes in patients with thymomatous MG [1, 7]. The authors concluded that neurologic outcomes of the two groups were similar, but earlier thymectomy may result in a better prognosis by shortening the disease period. The length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction
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