Abstract
ObjectiveThe association between the prognosis of thymoma and MG remains controversial. Differences in clinical characteristics and treatments between patients with and without MG may affect the findings of those studies. We designed this propensity score matching trial to investigate whether MG is an independent prognostic predictor in thymoma.MethodsPatients with pathologically diagnosed thymoma and MG were enrolled in the MG group. Moreover, the propensity score matching method was used to select patients who were diagnosed with thymoma without MG from the database of two participating centers. Matched factors included sex, age, Masaoka stage, pathological subtypes, and treatments. Matched patients were enrolled in the non-MG group. Chi-squared test was used to compare the characteristics of the two groups. Overall survival, local-regional relapse-free survival, distant metastasis-free survival, progression-free survival, and cancer-specific survival were calculated from the diagnosis of thymoma using the Kaplan–Meier method.ResultsBetween April 1992 and October 2018, 235 patients each were enrolled in the MG and non-MG groups (1:1 ratio). The median ages of patients in the MG and non-MG groups were 46 years old. The World Health Organization pathological subtypes were well balanced between the two groups (B2 + B3: MG vs. non-MG group, 63.0 vs. 63.4%, p = 0.924). Most patients in both groups had Masaoka stages I–III (MG vs. non-MG group, 90.2 vs. 91.5%, p = 0.631). R0 resections were performed in 86.8 and 90.2% of the MG and non-MG groups, respectively (p = 0.247). The median follow-up time of the two groups was 70.00 months (MG vs. non-MG group, 73.63 months vs. 68.00 months). Five-year overall survivals were 92.5 and 90.3%, 8-year overall survivals were 84.2 and 84.2%, and 10-year overall survivals were 80.2 and 81.4% (p = 0.632) in the MG and non-MG groups, respectively. No differences were found in the progression-free survival, distant metastasis-free survival, and local-regional relapse-free survival between the two groups.ConclusionMG is not an independent or direct prognostic factor of thymoma, although it might be helpful in diagnosis thymoma at an early stage, leading indirectly to better prognosis.
Highlights
Thymic epithelia neoplasm, including thymoma and thymic carcinoma, accounts for 0.2–1.5% of malignancies and is a rare disease with an incidence of 0.013–1.5 per million people [1, 2]
Thymoma, which accounts for 20% of mediastinal neoplasm, is the most frequent primary malignancy
myasthenia gravis (MG) is deemed as a special characteristic of thymoma compared with other thoracic malignancies [1, 4, 8]
Summary
Thymic epithelia neoplasm, including thymoma and thymic carcinoma, accounts for 0.2–1.5% of malignancies and is a rare disease with an incidence of 0.013–1.5 per million people [1, 2]. Paraneoplastic syndrome is relatively common in patients with thymoma. Occurring in approximately 30–50% of patients with thymoma, MG is deemed a special characteristic [3, 4]. The occurrence of MG is much lower in thymic carcinoma, at only 0–30%, probably because of the lack of thymus-like features compared with thymoma [5, 6]. From a clinical point of view, this controversy is important. We designed this trial to investigate whether MG is an independent prognostic predictor in thymoma and used the propensity score matching method to eliminate the bias from other variables
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