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Predictors of post-thymectomy long-term neurological remission in thymomatous myasthenia gravis: an analysis from a multi-institutional database

Authors
 Kwon Joong Na  ;  Kwanyong Hyun  ;  Chang Hyun Kang  ;  Samina Park  ;  Hyun Joo Lee  ;  In Kyu Park  ;  Young Tae Kim  ;  Geun Dong Lee  ;  Hyeong Ryul Kim  ;  Se Hoon Choi  ;  Yong-Hee Kim  ;  Dong Kwan Kim  ;  Seung-Il Park  ;  Sumin Shin  ;  Jong Ho Cho  ;  Hong Kwan Kim  ;  Yong Soo Choi  ;  Jhingook Kim  ;  Jae Il Zo  ;  Young Mog Shim  ;  Chang Young Lee  ;  Jin Gu Lee  ;  Dae Joon Kim  ;  Hyo Chae Paik  ;  Kyung Young Chung 
Citation
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol.57(5) : 867-873, 2020-05 
Journal Title
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN
 1010-7940 
Issue Date
2020-05
Keywords
Myasthenia gravis ; Survival ; Thymectomy ; Thymoma ; Thymus gland
Abstract
Objectives: Thymectomy is the treatment of choice for thymomatous myasthenia gravis (MG) for both oncological and neurological aspects. However, only a few studies comprising small numbers of patients have investigated post-thymectomy neurological outcomes. We examined post-thymectomy long-term neurological outcomes and predictors of thymomatous MG using a multi-institutional database. Methods: In total, 193 patients (47.3 ± 12.0 years; male:female = 90:103) with surgically resected thymomatous MG between 2000 and 2013 were included. Complete stable remission (CSR) and composite neurological remission (CNR), defined as the achievement of CSR and pharmacological remission after thymectomy, were evaluated. Predictors for CSR and CNR were examined by Cox regression analysis. Results: The median duration between MG and thymectomy was 3.1 months. In addition, 161 patients (83.4%) had symptoms less than Myasthenia Gravis Foundation of America clinical classification III. All patients underwent an extended thymectomy; there were no perioperative deaths. The 10-year cumulative probability of CSR and CNR was 36.9% and 69.1%, respectively. Mild preoperative symptoms were a significant predictor for CSR (P = 0.040), and a large tumour was a predictor for CNR (P < 0.001). Patients with a large tumour were associated with early MG onset and no steroid treatment. Surgical methods, thymoma stage and histological subtypes were not associated with long-term neurological remission. Conclusions: Large tumour size and preoperative mild symptoms were predictors for long-term neurological outcome in thymomatous MG. Considering that patients with early onset of MG and no immunosuppressive treatment tend to have large tumours, early surgical intervention for patients with thymomatous MG having mild symptoms might be beneficial for controlling neurological outcomes.
Full Text
https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezz334
DOI
10.1093/ejcts/ezz334
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Lee, Jin Gu(이진구)
Lee, Chang Young(이창영)
Chung, Kyung Young(정경영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180580
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