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ABSTRACT
Purpose: Thymectomy is the first-line therapy for thymomatous myasthenia gravis patients. The aim of this study is to explore the clinical outcome and predictors of postoperative myasthenic crisis (POMC) in these patients.
Method: Clinical data of 173 thymomatous myasthenia gravis patients undergoing thymectomy from January 2000 to March 2013 were, retrospectively reviewed. Variables potentially affecting the occurrence of POMC were evaluated using binary logistic regression analysis. The difference in survival was determined by the log-rank test.
Result: Fifty-one patients experienced POMC. Univariate analysis revealed that events significantly associated with increased risk of POMC include symptom duration before operation >2.75months, preoperative bulbar symptoms, incomplete resection, operation time ≥122.5 min and advanced stages (stage III or IV). Multivariate logistic regression analysis showed that preoperative bulbar symptoms (OR = 3.207 [1.413–7.278]; P = 0.005) and incomplete resection (OR = 4.182 [1.332–13.135]; P = 0.014) were independent risk factors for POMC. Twenty-eight patients (16.9%) died during the follow-up. The log-rank test revealed survival for patients with POMC was significantly worse than that for patients without POMC (P = 0.042).
Conclusion: The important risk factors for developing POMC in thymomatous myasthenia gravis patients include the preoperative bulbar symptoms and incomplete resection of thymoma. Moreover, the patients with POMC had a worse prognosis compared with patients without POMC. Our study highlights the need of appropriate preoperative management of thymomatous myasthenia gravis patients to prevent the occurrence of POMC.
Acknowledgments
This work was supported by grants from the China National Natural Sciences Foundation (30870850, 81071002, 81371386) and the Clinical study of 5010 plan of Sun Yat-sen University (2010003). Yan Li and Haiyan Wang both contribute equally to this study. The work is also attributed to the Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases (2014B030301035), National Key Clinical Department, National Key Discipline, Guangzhou 510080, China.
Disclosure statement
There are no conflicts of interest.
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Notes on contributors
Yan Li
Dr Yan Li is a third-year resident at the First Affiliated Hospital of Sun Yat-sen University. She received a bachelor's degree in clinical medicine from Nanhua University and a doctor's degree in neurology from Sun Yat-sen University. Her major research interests include several autoimmune neurological disease such as myasthenia gravis.
Haiyan Wang
Dr Haiyan Wang is a chief resident at the First Affiliated Hospital of Sun Yat-sen University. She received a bachelor's degree in clinical medicine from Xinxiang University and a doctor's degree in neurology from Sun Yat-sen University. She is interested in autoimmune neurological disease such as myasthenia gravis.
Pei Chen
Dr Pei Chen is a first-year resident at the First Affiliated Hospital of Sun Yat-sen University. He earned a bachelor's degree in clinical medicine and his PhD degree in neurology at Sun Yat-sen University. He is specifically interested in studying the immune response that occurs in myasthenia gravis.
Zhenguang Chen
Dr Zhenguang Chen is a professor of cardiothoracic surgery at the First Affiliated Hospital of Sun Yat-sen University. He earned PhD degree in surgery from the Sun Yat-sen University in Guangzhou. His current field placement is with the European Society For Medical Oncology and he also reviews the papers for several SCI journals including Medicine, Thoracic Cancer. His major research interests include molecular pathogenesis and treatment of lung cancer, and the treatment outcome of thymectomy for myasthenia gravis.
Chunhua Su
Dr Chunhua Su is an associate professor of Department of Thoracic Surgery at the First Affiliated Hospital of Sun Yat-sen University. She earned a bachelor degree of clinical medicine and her PhD degree in surgery at Sun Yat-sen University. Areas of her special research interests include lung cancer, oesophageal cancer and myasthenia gravis.
Chuanming Luo
Dr Chuanming Luo was a teacher at the second clinical college, Guangdong Medical College. Now he is an attending physician of Department of Neurology at the Seventh Affiliated Hospital of Sun Yat-sen University. He received a bachelor's degree in preventive medicine from Guangxi Medical University and a doctor's degree in neurology from Sun Yat-sen University. He is specifically interested in studying the immune pathogenesis of myasthenia gravis and cerebrovascular disease.
Huiyu Feng
Dr Huiyu Feng is an associate professor of neurology at the First Affiliated Hospital of Sun Yat-sen University. She earned a bachelor degree of clinical medicine and her PhD degree in neurology at Sun Yat-sen University. Her current field placement is with the Neuroimmunology Diseases Institute of Guangdong Provincial Medical Association. She is interested in autoimmunity disease including multiple sclerosis, neuromyelitis optica and myasthenia gravis.
Weibin Liu
Dr Weibin Liu is a professor of neurology at the First Affiliated Hospital of Sun Yat-sen University. She received a bachelor's degree in clinical medicine from XinXiang University and a doctor's degree in neurology from Sun Yat-sen University. Her major research was focused on how immune imbalance leads to the development of myasthenia gravis. She is also the principal investigator of several clinical research of myasthenia gravis in China and the member of a task force of the Medical Scientific Advisory Board (MSAB) of the Myasthenia Gravis Foundation of America (MGFA).