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背景与目的重症肌无力(myasthenia gravis,MG)对胸腺瘤患者预后的影响至今尚不明确,本文旨在比较单纯胸腺瘤与合并肌无力胸腺瘤患者的手术预后。方法 1992年至2012年中国胸腺协作组(Chinese Alliance for Research in Thymomas,ChART)数据库录入的18个胸外科中心诊断胸腺瘤并接受相关手术的患者分为合并重症肌无力组(合并组)和单纯胸腺瘤组(对照组)。收集两组患者的人口学资料及临床资料,比较两组患者生存率。结果共1,850例患者纳入研究,其中合并肌无力组及单纯胸腺瘤组分别421人和1429人,行胸腺全切的比例分别是91.2%和71.0%(P<0.05);肌无力组患者的WHO病理类型多分布于AB、B1和B2型,优于单纯胸腺瘤组(P<0.05);合并肌无力组的Masaoka分期较早(I和Ⅱ期)的比例高于单纯胸腺瘤组。5年和10年的总体生存率在MG组和非MG组中分别为93%和88%;83%和81%(P=0.034);在Masaoka III、IVa和IVb期胸腺瘤患者中,合并肌无力患者的生存曲线高于单纯胸腺瘤患者(P=0.003)。在进展型胸腺瘤患者中,MG组和非MG组患者的Masaoka III、IVa、IVb的构成比相似,组织学结果中,MG组的AB/B1/B2/B3型的比例高于C型比例更高的非MG组(P<0.001)。整体的单因素分析结果提示,MG、WHO分型、Masaoka分期、手术方式、化疗、放疗和临床切除状况均为预后的影响因素。而在多因素分析中,WHO分型、Masaoka分期和临床切除状况是独立的预后预测指标。结论虽然重症肌无力不是独立的预后影响因素,但是在胸腺瘤患者中,合并MG的患者预后较优,尤其是Masaoka分期晚期的患者,可能与疾病的早期发现、病理类型分布相对较好、整体R0切除率较高以及复发率较低有关。
BACKGROUND & OBJECTIVE: The effect of myasthenia gravis (MG) on the prognosis of patients with thymoma has not been elucidated yet. This article aims to compare the prognosis of patients with thymoma and thymoma with myasthenia gravis. METHODS: From 1992 to 2012, 18 thoracic centers diagnosed with thymoma in the Chinese Alliance for Research in Thymomas (ChART) database were included in the study. Patients with myasthenia gravis (combined group) and simple Thymoma group (control group). The demographic data and clinical data of two groups were collected and the survival rates of the two groups were compared. Results A total of 1,850 patients were enrolled in the study, of which 421 and 1429 were myasthenia gravis and 4129 patients respectively. The total thyroidectomy rates were 91.2% and 71.0%, respectively (P <0.05) The pathological types were more distributed in AB, B1 and B2 than in simple thymoma group (P <0.05). The Masaoka staging in early stage (stage I and II) was higher than that in thymoma alone group. Overall 5-year and 10-year overall survival rates were 93% and 88% in the MG and non-MG groups respectively; 83% and 81% (P = 0.034); in Masaoka III, IVa and IVb thymoma patients, The patients with myasthenia gravis had higher survival curves than those with simple thymoma (P = 0.003). In patients with advanced thymoma, the compositional ratios of Masaoka III, IVa and IVb were similar in MG patients and non-MG patients. The histological results showed that the proportion of AB / B1 / B2 / B3 in MG group was higher than that in C type Higher non MG group (P <0.001). The overall univariate analysis suggested that MG, WHO classification, Masaoka staging, surgical modality, chemotherapy, radiotherapy and clinical resection were the prognostic factors. In the multivariate analysis, WHO classification, Masaoka staging and clinical resection status were independent predictors of prognosis. Conclusions Although myasthenia gravis is not an independent prognostic factor, the prognosis of patients with thymoma is superior to that of patients with MG, especially in patients with late stage Masaoka, which may be related to the early detection of the disease and the distribution of pathological types. The whole R0 high resection rate and the relapse rate is low.