Predictors of outcome in thymectomy for myasthenia gravis

Ann Thorac Surg. 2001 Jul;72(1):197-202. doi: 10.1016/s0003-4975(01)02678-9.

Abstract

Background: Factors determining predictability of response to thymectomy for myasthenia gravis (MG) vary in the literature.

Methods: A 25-year retrospective review (1974 to 1999) of all thymectomies performed at a single institution was undertaken.

Results: In 113 consecutive thymectomies for MG, women comprised 79% (89 of 113 patients), and mean age was 40+/-15 years. Complications occurred in 14% of patients (16 of 113). In-hospital mortality was 0, but 90-day hospital mortality was 0.88% (1 of 113 patients). Follow-up was obtained in 81% (92 of 113 patients) at a mean of 51+/-59 months postoperatively. Complete remission was achieved in 21% of patients (19 of 92), and marked improvement of MG in 54% (50 of 92), for a total benefit rate of 75%. Fourteen percent (13 of 92) were unchanged, and 11% (10 of 92) were worse. Using univariate analysis, sex, age, and pathology correlated significantly with outcome (p < 0.05): 80% of women (57 of 70) benefited from the procedure, versus 57% of men (12 of 21). Eighty percent (57 of 70) of patients less than 51 years of age were improved or in remission, versus 57% (12 of 22) older than 50. Twenty-three percent (5 of 22) of patients with thymoma deteriorated, versus 7.1% (5 of 70) without thymoma. Sex did not significantly correlate in the multivariate model.

Conclusions: Sex, age, and thymic pathology are potential predictors of outcome in thymectomy for MG, and may shape treatment decisions and target higher-risk patients.

MeSH terms

  • Adult
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myasthenia Gravis / diagnosis
  • Myasthenia Gravis / mortality
  • Myasthenia Gravis / surgery*
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / mortality
  • Retrospective Studies
  • Survival Rate
  • Thymectomy*
  • Thymoma / diagnosis
  • Thymoma / mortality
  • Thymoma / surgery*
  • Thymus Neoplasms / diagnosis
  • Thymus Neoplasms / mortality
  • Thymus Neoplasms / surgery*
  • Treatment Outcome