合并重症肌无力对胸腺瘤术后患者预后的影响

doi:10.11904/j.issn.1002-3070.2020.04.009

摘要/Abstract

摘要： 目的评价合并重症肌无力(Myasthenia gravis,MG)对胸腺瘤术后患者预后的影响,并对可能影响胸腺瘤术后患者预后的其他相关因素进行分析。方法回顾性分析2002年9月—2018年1月中国人民解放军总医院第八医学中心收治的187例胸腺瘤术后患者的临床资料,其中胸腺瘤合并重症肌无力患者139例(MG组),单纯胸腺瘤患者48例(非MG组)。采用1∶1最邻近匹配法对两组患者行倾向性评分匹配(Propensity score matching,PSM),使组间协变量达到均衡。采用Kaplan-Meier法计算生存率,Log-rank检验比较两组患者生存曲线的差异,采用Cox比例风险回归模型对总体胸腺瘤术后患者进行单因素和多因素分析。结果匹配前,MG组(n=139)与非MG组(n=48)患者的性别(χ²=4.180,P=0.041)、确诊年龄(χ²=8.590,P=0.003)、WHO组织学分型(χ²=4.764,P=0.029)以及是否接受术后辅助化疗(χ²=5.627,P=0.018)均存在统计学差异。两组患者的5年和10年生存率分别为92.4%和69.6%,76.9%和65.2%,两组生存曲线差异有统计学意义(P=0.002)。经PSM法匹配后,两组共44对患者成功匹配,两组患者临床基线资料差异均无统计学意义(P＞0.05)。两组患者的5年和10年生存率分别为90.8%和67.3%,85.6%和62.5%,两组生存曲线差异有统计学意义(P=0.015)。总体胸腺瘤术后患者的单因素分析显示,Masaoka分期(HR=0.237,95% CI:0.111~0.504,P＜0.001)、切除状态(HR=0.250,95% CI:0.096~0.654,P=0.005)、术后辅助化疗(HR=0.367,95% CI:0.179~0.751,P=0.006)以及合并重症肌无力(HR=0.336,95% CI:0.162~0.669,P=0.003)可能与胸腺瘤术后患者的生存预后相关。多因素分析结果显示,Masaoka分期是影响胸腺瘤术后患者生存的独立预后因素(HR=0.317,95% CI:0.140~0.720,P=0.006),合并重症肌无力则为影响胸腺瘤术后患者生存的保护性因素(HR=0.445,95% CI:0.204~0.971,P=0.042)。结论对于可手术的胸腺瘤患者,合并重症肌无力较不伴重症肌无力的患者生存预后更好。Masaoka分期是影响胸腺瘤患者生存的独立预后因素。

关键词: 胸腺瘤, 重症肌无力, 副肿瘤综合征, 预后, 倾向性评分匹配

Abstract: Objective The aim of this study was to evaluate the effect of myasthenia gravis(MG)on the prognosis of patients with thymoma after surgery,and to analyze other related factors affecting the prognosis of patients with thymoma after surgery. Methods The clinical data of 187 thymoma patients in the 8th Medical Center of the Chinese People's Liberation Army from September 2002 to January 2018 were retrospectively analyzed.Among them,139 thymoma patients complicated with myasthenia gravis(MG group)and 48 patients with simple thymoma(non-MG group).The 1∶1 nearest neighbor matching method was used to perform propensity score matching(PSM)for the two groups to achieve equilibrium within covariance.Kaplan-Meier method was used to calculate the survival rate,and log-rank test was preformed to analyze the differences in survival rates between MG and non-MG groups.Cox proportional hazard regression model was used for univariate and multivariate analyses for overall thymoma patients after surgery. Results Before the results were matched,the gender(χ²=4.180,P=0.041),age of diagnosis(χ²=8.590,P=0.003),WHO histological subtype(χ²=4.764,P=0.029)and postoperative adjuvant chemotherapy(χ²=5.627,P=0.018)were significantly different between the MG group(n=139)and the non-MG group(n=48).The 5-year overall survival rates of patients in the MG group and non-MG group were 92.4% and 69.6%,respectively,and the difference was statistically significant(Log-rank test,P=0.002).After matching by the PSM method,a total of 44 of patients were successfully matched in the two groups,and there was no significantly difference in clinical baseline data between the MG and non-MG groups(P＞0.05).The 5-year overall survival rates of patients in the MG group and non-MG group patients were 90.8% and 67.3%,respectively,and the difference was statistically significant(Log-rank test,P=0.015).Univariate analysis for patients with overall thymoma surgery showed that Masaoka stage(HR=0.237,95% CI:0.111~0.504,P＜0.001),resection status(HR=0.250,95% CI:0.096~0.654,P=0.005),postoperative adjuvant chemotherapy(HR=0.367,95% CI:0.179~0.751,P=0.006)and MG(HR=0.336,95% CI:0.162~0.669,P=0.003)might be associated with survival prognosis of thymoma patients after surgery.Cox multivariate analysis showed that Masaoka stage was an independent prognostic factor affecting the survival of thymoma patients after surgery(HR=0.317,95% CI:0.140~0.720,P=0.006),and MG affected protective survival factors of thymoma patients after surgery(HR=0.445,95% CI:0.204~0.971,P=0.042). Conclusion For patients with operable thymoma,thymoma patients with MG have a better prognosis than those without MG.Masaoka stage is an independent prognostic factor that affects the survival of thymoma patients.

Key words: Thymoma, Myasthenia gravis, Paraneoplastic syndrome, Prognosis, Propensity score matching

中图分类号:

R736.3

魏勇, 张玉海, 吕双双, 李月敏. 合并重症肌无力对胸腺瘤术后患者预后的影响[J]. 实用肿瘤学杂志, 2020, 34(4): 341-346.

WEI Yong, ZHANG Yuhai, LV Shuangshuang, LI Yuemin. Effect of myasthenia gravis on prognosis of thymoma patients[J]. Journal of Practical Oncology, 2020, 34(4): 341-346.

0
/ / 推荐

导出引用管理器 EndNote|Reference Manager|ProCite|BibTeX|RefWorks

链接本文: http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/10.11904/j.issn.1002-3070.2020.04.009

http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/Y2020/V34/I4/341

参考文献

1 Scorsetti M,Leo F,Trama A,et al.Thymoma and thymic carcinomas[J].Crit Rev Oncol Hematol,2016,99(6):332-350.
2 Fukuhara M,Higuchi M,Owada Y,et al.Clinical and pathological aspects of microscopic thymoma with myasthenia gravis and review of published reports[J].J Thorac Dis,2017,9(6):1592-1597.
3 Li JF,Hui BG,Li X,et al.Video-assisted thoracic surgery for thymoma:long-term follow-up results and prognostic factors-single-center experience of 150 cases[J].J Thorac Dis,2018,10(1):291-297.
4 Wang GW,Tao T,Li CK,et al.Comparison between thoracoscopic and open approaches in thymoma resection[J].J Thorac Dis,2019,11(10):4159-4168.
5 Qi G,Liu P,Dong H,et al.Metastatic thymoma-associated myasthenia gravis:favorable response to steroid pulse therapy plus immunosuppressive agent[J].Med Sci Monit,2017,23:1217-1223.
6 李月敏,李杨,樊文梅,等.胸腺瘤与自身免疫性疾病的关系[J].解放军医学杂志,2014,39(8):669-672.
7 Hsiao SY,Chang KY,Chang JY,et al.Nephrotic syndrome associated with thymoma[J].Cancer Res Pract,2014,1(3):233-240.
8 Travis WD,Brambilla E,Müller-Hermelink HK,et al.WHO classification of pathology and genetics of tumours of the lung,pleura,thymus and heart,3th edition[J].Lyon:International Agency for Research on Cancer,2004:105-144.
9 Masaoka A,Monden Y,Nakahara K,et al.Follow-up study of thymomas with special reference to their clinical stages[J].Cancer,1981,48(11):2485-2492.
10 Weissferdt A,Moran CA.Staging of thymic epithelial neoplasms:Thymoma and thymic carcinoma[J].Pathol Res Pract,2015,211(1):2-11.
11 Sanders DB,Wolfe GI,Benatar M,et al.International consensus guidance for management of myasthenia gravis:executive summary[J].Neurology,2016,87(4):419-425.
12 Lippner EA,Lewis DB,Robinson WH,et al.Paraneoplastic and therapy-related immune complications in thymic malignancies[J].Curr Treat Options Oncol,2019,20(7):62.
13 袁东风,谷志涛,梁光辉,等.胸腺瘤合并重症肌无力患者预后的临床研究[J].中国肺癌杂志,2018,21(1):1-7.
14 Cacho-Díaz B,Salmerón-Moreno K,Lorenzana-Mendoza NA,et al.Myasthenia gravis as a prognostic marker in patients with thymoma[J].J Thorac Dis,2018,10(5):2842-2848.
15 Aydemir B.The effect of myasthenia gravis as a prognostic factor in thymoma treatment[J].North Clin Istanb,2016,3(3):194-200.
16 Zhang Z,Cui Y,Jia R,et al.Myasthenia gravis in patients with thymoma affects survival rate following extended thymectomy[J].Oncol Lett,2016,11(6):4177-4182.
17 Margaritora S,Cesario A,Cusumano G,et al.Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery[J].Ann Thorac Surg,2010,89(1):245-252.
18 Aydiner A,Toker A,Sen F,et al.Association of clinical and pathological variables with survival in thymoma[J].Med Oncol,2012,29(3):2221-2228.
19 谷鸿秋,王杨,李卫.生存曲线校正方法[J].中华流行病学杂志,2014,35(1):97-99.
20 Kocer B,Kaplan T,Günal N,et al.Long-term survival after R0 resection of thymoma[J].Asian Cardiovasc Thorac Ann,2018,26(6):461-466.
21 Tseng YC,Tseng YH,Kao HL,et al.Long term oncological outcome of thymoma and thymic carcinoma-an analysis of 235 cases from a single institution[J].PLoS One,2017,12(6):e0179527.
22 Zhao Y,Shi J,Fan L,et al.Surgical treatment of thymoma:an 11-year experience with 761 patients[J].Eur J Cardiothorac Surg,2016,49(4):1144-1149.
23 Yuan ZY,Gao SG,Mu JW,et al.Long-term outcomes of 307 patients after complete thymoma resection[J].Chin J Cancer,2017,36(1):1-9.

[1]	谢贤鑫, 韦军, 邱佳鑫, 王聪, 姜大庆. 乳腺癌新辅助化疗残余肿瘤组织病理信息与预后分析[J]. 实用肿瘤学杂志, 2020, 34(3): 225-231.
[2]	王棹, 冯越, 邢丽楠, 张云艳. PLR与恶性肿瘤同步放化疗预后的研究进展[J]. 实用肿瘤学杂志, 2020, 34(3): 271-275.
[3]	苏文佳, 王树叶. 滤泡性淋巴瘤的预后分层和治疗进展[J]. 实用肿瘤学杂志, 2020, 34(2): 189-192.
[4]	廖代祥, 郑博, 张彦斌, 于军辉. RRBP1与RABEX-5蛋白在结直肠癌组织中的表达及与临床病理特征和预后的关系[J]. 实用肿瘤学杂志, 2020, 34(1): 43-48.
[5]	刘耿淳, 申良方. 血清长链非编码RNA MALAT1和AFAP1-AS1与鼻咽癌临床病理特征和预后的关系[J]. 实用肿瘤学杂志, 2019, 33(6): 513-518.
[6]	范晋海, 蒋玉梅, 张静, 白晓静. MAP1A在膀胱癌组织中的表达及其与临床病理特征的关系[J]. 实用肿瘤学杂志, 2019, 33(6): 525-530.
[7]	刘四卫, 崔玥, 孙元元, 胡晶, 张文睿, 曹孟儒. FOXD3在肺癌细胞中的作用[J]. 实用肿瘤学杂志, 2019, 33(5): 390-396.
[8]	夏天一, 张博淼, 姚克非, 崔滨滨. PTPN9表达水平与结直肠癌的临床关系研究[J]. 实用肿瘤学杂志, 2019, 33(5): 415-419.
[9]	徐亭, 严斐斐, 张纯慧, 张艳桥. 胃癌骨转移患者临床病理与预后分析[J]. 实用肿瘤学杂志, 2019, 33(5): 436-441.
[10]	李思维 , 庞达. 长链非编码RNA(lncRNA)在癌症中的作用[J]. 实用肿瘤学杂志, 2019, 33(5): 471-475.
[11]	曲雁飞, 刘超, 王勃军, 方琳, 张艳桥. CSN6基因在肝细胞癌组织中的表达及临床意义[J]. 实用肿瘤学杂志, 2019, 33(4): 328-333.
[12]	刘金涛, 高玲, 周会会. MAGEA4和EB1蛋白在肺癌组织中的表达及其与临床病理特征及预后的相关性分析[J]. 实用肿瘤学杂志, 2019, 33(4): 334-339.
[13]	王晓雅,肖斌,廖扬,唐荣芝,孙朝晖,李林海. CXCR家族蛋白在不同乳腺癌亚型中的表达及临床预后分析[J]. 实用肿瘤学杂志, 2019, 33(3): 206-210.
[14]	冯越,邢丽楠,王棹,张云艳. NLR与肿瘤同步放化疗预后的相关性研究[J]. 实用肿瘤学杂志, 2019, 33(3): 284-288.
[15]	白晓斌, 霍龙伟, 谢万福, 徐高峰, 王茂德. Chk1在胶质母细胞瘤中的表达及其与肿瘤生物学行为和预后生存的关联性[J]. 实用肿瘤学杂志, 2019, 33(2): 122-127.