合并重症肌无力的胸腺瘤患者术后生存的初步分析——ChART数据库回顾性结果

BACKGROUND AND OBJECTIVE: It is so far not clear that how myasthenia gravis (MG) affected the prognosis of thymoma patients. The aim of this assay is to compare the postoperative survival between patients with thymoma only and those with both thymoma and MG. METHODS: The Chinese Alliance for Research in Thymomas (ChART) registry recruited patients with thymoma from 18 centers over the country on an intention to treat basis from 1992 to 2012. Two groups were formed according to whether the patient complicated MG. Demographic and clinical data were reviewed, Patients were followed and their survival status were analyzed. RESULTS: There were 1, 850 patients included in this study, including 421 with and 1, 429 without MG. Complete thymectomy were done in 91.2% patients in MG group and 71.0% in non-MG group (P < 0.05). There were more percentage of patients with the histology of thymoma AB, B1, or B2 (P < 0.05) in MG group, and more percentage of patients with MG were in Masaoka stage Ⅰ and Ⅱ. The 5 year and 10 year OS rates were both higher in MG group (93% vs 88%; 83% vs 81%, P=0.034) respectively. The survival rate was significantly higher in patients with MG when the Masaoka staging was Ⅲ/Ⅳ (P=0.003). Among patients with advanced stage thymoma (stage Ⅲ, Ⅳa, Ⅳb), the constituent ratios of Ⅲ, Ⅳa, Ⅳb were similar between MG and Non-MG group. Histologically, however, there were significantly more proportion of AB/B1/B2/B3 in the MG group while there were more C in the non-MG group (P=0.000). Univariate analyses for all patients showed that MG, WHO classification, Masaoka stage, surgical approach, chemotherapy and radiotherapy and resectability were significant factors, and multivariate analysis showed WHO Classification, Masaoka stage, and resectability were strong independent prognostic indicators. CONCLUSION: Although MG is not an independent prognostic factor, the survival of patients with thymoma was superior when MG was present, especially in late Masaoka stage patients. Possible reasons included early diagnosis of the tumor, better histologic types, an overall higher R0 resection and less recurrence.