Does myasthenia gravis influence overall survival and cumulative incidence of recurrence in thymoma patients? A Retrospective clinicopathological multicentre analysis on 797 patients

Filosso, Pier Luigi; Evangelista, Andrea; Ruffini, Enrico; Rendina, Erino Angelo; Margaritora, Stefano; Novellis, Pierluigi; Rena, Ottavio; Casadio, Caterina; Andreetti, Claudio; Guerrera, Francesco; Lausi, Paolo Olivo; Diso, Daniele; Mussi, Alfredo; Venuta, Federico; Oliaro, A; Lucchi, Marco

doi:10.1016/j.lungcan.2015.03.007

Cited by 34 publications

(33 citation statements)

References 22 publications

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“…In our study it was found that an advanced Masaoka staging score was a strong predictor of tumour recurrence, in line with the literature data , whereas there was no significant association between thymoma histology and tumour recurrence. This apparent discrepancy is probably related to the high representation, in our patients, of the most commonly MG‐associated B2/B3 stage . The evaluation of incomplete tumour resection as another predictor of thymoma recurrence was unavailable due to the lack of data on residual thymic tissues.…”

Section: Discussionmentioning

confidence: 88%

Acquired neuromyotonia in thymoma‐associated myasthenia gravis: a clinical and serological study

Gastaldi

Rosa

Maestri

et al. 2019

Euro J of Neurology

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Background and purpose Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis ( MG ), but the clinical prognostic significance of such comorbidity is largely unknown. The clinico‐pathological features were investigated along with the occurrence of neuromyotonia as predictors of tumour recurrence in patients with thymoma‐associated myasthenia. Methods A total number of 268 patients with thymomatous MG were studied retrospectively. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell‐surface proteins and cell‐based assays for contactin‐associated protein 2 ( CASPR 2), leucine‐rich glioma inactivated 1 ( LGI 1), glycine receptor and Netrin‐1 receptor antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography abnormalities and/or autoantibodies against LGI 1/ CASPR 2. Results Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, four with typical autoantibodies, including LGI 1 ( n = 1), CASPR 2 ( n = 1) or both ( n = 2). Three patients had Netrin‐1 receptor antibodies, two with neuromyotonia and concomitant CASPR2+ LGI 1 antibodies and one with spontaneous muscle overactivity without electromyography evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than in those without (28/263, 10%, P < 0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy [odds ratio ( OR ) 0.95, 95% confidence interval ( CI ) 0.93–0.97], Masaoka stage ≥ II b ( OR 10.73, 95% CI 2.38–48.36) and neuromyotonia ( OR 41.78, 95% CI 4.71–370.58). Conclusions De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumour recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG .

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Section: Discussionmentioning

confidence: 88%

Acquired neuromyotonia in thymoma‐associated myasthenia gravis: a clinical and serological study

Gastaldi

Rosa

Maestri

et al. 2019

Euro J of Neurology

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“…19 A recent multicenter study from Italy including 375 patients with thymoma showed a slight protective effect of the presence of myasthenia gravis on overall survival, although that was not confirmed in multivariate analysis. 20 These findings suggest that today the outcome of patients with thymoma and myasthenia gravis is at least as good as the outcome of patients with thymoma without myasthenia gravis.…”

Section: Evolution Of the Histomorphologic Classification Of Thymic Ementioning

confidence: 88%

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

Roden¹

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor.Objective.-To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described.Data Sources.-Search of literature database (PubMed) and current (2015) World Health Organization classification.Conclusions.-Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.

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“…Filosso et al detected an association between MG and early Masaoka stage, which was explained by early diagnosis of thymoma as result of MG [23]. Elmacı et al demonstrated that survival rates were markedly higher in cases with myasthenic thymomas diagnosed at early stage, and their recent studies have substantiated this finding [24]. In present study, 87.5% of cases with associated MG were in early stage of the disease (Masaoka stages I and II), while 70.6% of thymoma cases not associated with MG were diagnosed in early stage of the disease.…”

Section: Discussionmentioning

confidence: 99%

The effect of Myasthenia Gravis in thymoma treatment as a prognostic factor

Aydemir¹

2016

North Clin Istanbul

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OBJECTIVE:Thymoma is a standard epithelial tumor. Though it is rare, it constitutes 50% of anterior mediastinal masses. Variety of immunological diseases may accompany thymoma; however, myasthenia gravis (MG) is the most frequently associated paraneoplastic syndrome. Most effective treatment for thymoma is complete surgical resection. In this study, impact of MG on prognosis of thymoma cases was examined.METHODS:Records of 61 patients who underwent surgery with diagnosis of thymoma between January 2003 and September 2016 were retrospectively reviewed. All cases were analyzed for data related to age, gender, complaint, localization of lesion, surgical procedure, histopathological diagnosis, stage, MG, and long-term follow-up results.RESULTS:Total of 58 cases were included in the study. Of those, 37 patients were male and 21 were female. Mean age was 48 years. While 24 cases of thymoma were accompanied by MG, 34 cases were not. Duration of follow-up ranged from 1 month to 155 months.CONCLUSION:It was found that in group with MG, 5-year survival rate was 87.5% while it was 82.4% in group without MG. Despite longer duration of survival in group of thymoma associated with MG, there was no significant statistical difference between groups (p=0.311).

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Does myasthenia gravis influence overall survival and cumulative incidence of recurrence in thymoma patients? A Retrospective clinicopathological multicentre analysis on 797 patients

Cited by 34 publications

References 22 publications

Acquired neuromyotonia in thymoma‐associated myasthenia gravis: a clinical and serological study

Acquired neuromyotonia in thymoma‐associated myasthenia gravis: a clinical and serological study

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

The effect of Myasthenia Gravis in thymoma treatment as a prognostic factor

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