Clinical characteristics and outcomes of thymoma-associated myasthenia gravis.
Eur J Neurol
; 28(6): 2083-2091, 2021 06.
Article
em En
| MEDLINE
| ID: mdl-33721382
ABSTRACT
BACKGROUND AND PURPOSE:
Prognosis of myasthenia gravis (MG) in patients with thymoma is not well established. Moreover, it is not clear whether thymoma recurrence or unresectable lesions entail a worse prognosis of MG.METHODS:
This multicenter study was based on dataâ¯fromâ¯aâ¯Spanish neurologist-drivenâ¯MG registry. All patients were aged >18 yearsâ¯atâ¯onsetâ¯and had anti-acetylcholine receptor antibodies.â¯We compared the clinical data of thymomatous and nonthymomatous patients.â¯Prognosis of patients with recurrent or nonresectable thymomas was assessed.RESULTS:
We included 964 patients from 15 hospitals; 148 (15.4%) had thymoma-associated MG. Median follow-up time was 4.6 years. At onset, thymoma-associated MG patients were younger (52.0 vs. 60.4 years, p < 0.001), had more generalized symptoms (odds ratio [OR] 3.02, 95% confidence interval [CI] 1.95-4.68, p < 0.001) and more severe clinical forms according to the Myasthenia Gravis Foundation of America (MGFA) scale (OR 1.6, 95% CI 1.15-2.21, p = 0.005). Disease severity based on MGFA postintervention status (MGFA-PIS) was higher in thymomatous patients at 1 year, 5 years, and the end of follow-up. Treatment refractoriness and mortality were also higher (OR 2.28, 95% CI 1.43-3.63, p = 0.001; hazard ratio 2.46, 95% CI 1.47-4.14, p = 0.001). Myasthenic symptoms worsened in 13 of 27 patients with recurrences, but differences in long-term severity were not significant. Fifteen thymomatous patients had nonresectable thymomas with worse MGFA-PIS and higher mortality at the end of follow-up.CONCLUSIONS:
Thymoma-associated MG patients had more severe myasthenic symptoms and worse prognosis. Thymoma recurrence was frequently associated with transient worsening of MG, but long-term prognosis did not differ from nonrecurrent thymoma. Patients with nonresectable thymoma tended to present severe forms of MG.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Timoma
/
Neoplasias do Timo
/
Miastenia Gravis
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article