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ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 5  |  Page : 115-117

Risk factors for developing postthymectomy myasthenic crisis in Thymoma Patients


1 Department of Intensive Care Unit, The People's Hospital of Lishui, Lishui 323000; Department of Emergency, The People's Hospital of Lishui, Lishui 323000, PR China
2 Department of Intensive Care Unit, The People's Hospital of Lishui, Lishui 323000, PR China

Date of Web Publication31-Aug-2015

Correspondence Address:
Dr. Yipeng Chen
Department of Intensive Care Unit, The People's Hospital of Lishui, Lishui 323000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.163863

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 > Abstract 

Objective: The objective of this study is to investigate the risk factors for developing postthymectomy myasthenic crisis in thymoma patients.
Patients and Methods: Patients with thymoma received thymectomy from January 2001 to December 2014 were reviewed and included in this retrospective study in Lishui People's Hospital. Seventy-seven patients were included in this study. For the 77 cases, 66 patients not developing postthymectomy myasthenic crisis were considered as a control group, and other 11 subjects developing postthymectomy myasthenic were considered as the case group. The potential risk factors such age, gender, Osseman stage, Masaoka, pyridostigmine bromide, and et al. were compared between case and control group firstly by Chi-square test or Student's t-test and then by logistic regression test.
Results: Eleven patients developed postthymectomy myasthenic with the incidence of 14.3%; logistic regression analysis indicates that pyridostigmine bromide >360 mg/day administration (OR = 21.2, P < 0.05), postsurgery pulmonary infection (OR = 8.3, P < 0.05) and myasthenic crisis prior surgery (OR = 3.2, P < 0.05) were the independent risk factors for developing postthymectomy myasthenic crisis in thymoma patients.
Conclusion: Thymoma patients with a large dosage of pyridostigmine bromide administration, postsurgery pulmonary infection and myasthenic crisis prior surgery were easy to have postthymectomy myasthenic crisis.

Keywords: Logistic regression, postthymectomy myasthenic crisis, risk factors, thymoma


How to cite this article:
Wu Y, Chen Y, Liu H, Zou S. Risk factors for developing postthymectomy myasthenic crisis in Thymoma Patients. J Can Res Ther 2015;11, Suppl S1:115-7

How to cite this URL:
Wu Y, Chen Y, Liu H, Zou S. Risk factors for developing postthymectomy myasthenic crisis in Thymoma Patients. J Can Res Ther [serial online] 2015 [cited 2019 Sep 17];11:115-7. Available from: http://www.cancerjournal.net/text.asp?2015/11/5/115/163863


 > Introduction Top


A thymoma is the most common primary tumor in the anterior mediastinum with the incidence of 1.5 cases/million. [1],[2] Thymoma usually occur in adults with the age range from 40 to 70 which was the relative rate in children and adolescent. Most of the symptom for thymoma is chest pain, cough, and dyspnea. It was reported that about 30-50% of the thymoma patients have myasthenia gravis (MG). [3],[4],[5] And about 10-27% the MG patients had thymoma. [6],[7] Surgery in the import treatment method for thymoma with relative good prognosis. Surgery is recommended for all resectable thymoma in patients who can affordable for the operation. For these resectable patients, the 10 years survival is 70-90%. [8] And postthymectomy myasthenic crisis in a life-threatening complication of MG with a high mortality rate in patients with thymoma. Thus, evaluation the risk factors for postthymectomy myasthenic crisis is useful for health providers to deal with the problem. In this study, we retrospectively analyzed 77 cases with thymoma who underwent the thymectomy and analyzed the independent risk factors for postthymectomy myasthenic crisis by logistic regression.


 > Patients and Methods Top


Patients with thymoma received thymectomy from January 2001 to December 2014 were reviewed and included in this retrospective study in Lishui People's Hospital. Seventy-seven patients were included in this study. For the 77 cases, 66 patients not developing postthymectomy myasthenic crisis were considered as a control group and other 11 subjects developing postthymectomy myasthenic were considered as the case group. The clinical characteristics and treatment methods were recorded from each of the included patients. The clinical characteristic and treatment methods including age, sex, stages, APACHE II score, pyridostigmine bromide administration dosage myasthenic crisis prior surgery, postsurgery pulmonary infection, postsurgery immunoglobulin usage, and postsurgery plasmapheresis.

Statistics

Statistical analysis was performed using Stata11.0 software (Stata Corporation, College Station, TX, USA). The measurement data is expressed as mean ± standard deviation. The numeration data are expressed by n (%).The Chi-square test and the Student's t-test were used to evaluate the differences in case and control groups. Logistic regression analysis and its 95% confidence interval were used to evaluate the independent risk factors for developing postthymectomy myasthenic crisis. P < 0.05 for two tails was considered significant.


 > Results Top


General characteristics of the 77 cases

From January 2001 to December 2014 in our hospital database, we included 77 thymoma patients who received thymectomy. Of the 77 cases, 11 were developed postthymectomy myasthenic crisis with the incidence of 14.3%. The mean age of 77 patients were 47.6 ± 10.9 with 34 male and 43 female patients.

Single factor analysis for postoperative myasthenic crisis

The potential risk factors for postoperative myasthenic crisis were evaluated by Chi-square test and the Student's t-test. We find that the patients developing with postthymectomy myasthenic crisis had a larger dosage of pyridostigmine bromide administration (P < 0.05) and lower APACHE II score (P < 0.05) compared with control group. The postsurgery pulmonary infection rate and postsurgery immunoglobulin usage rate were higher in the case group compared with control group (P < 0.05). However, no statistical difference of Osseman stage, Masaoka stage and gender were observed between the two groups (P > 0.05) [Table 1].
Table 1: Single factor analysis for postoperative myasthenic crisis


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Independent risk factors for postoperative myasthenic crisis

The potential risk factors of age, pyridostigmine bromide >360 mg/day, myasthenic crisis prior surgery, APACHE II score, postsurgery pulmonary infection, postsurgery immunoglobulin usage, and postsurgery plasmapheresis were further analyzed by logistic regression. Pyridostigmine bromide >360 mg/day administration (OR = 21.2, P < 0.05), postsurgery pulmonary infection (OR = 8.3, P < 0.05) and myasthenic crisis prior surgery (OR = 3.2, P < 0.05) were found to be the independent risk factors for developing postthymectomy myasthenic crisis in thymoma patients, [Table 2].
Table 2: Independent risk factors for postoperative myasthenic crisis by logistic regression analysis


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 > Discussion Top


It was reported that about 65% of young patients will have thymic hyperplasia, and about 15% of all patients may have thymoma. [9] Surgery is recommended for patients with thymoma. Thymectomy is usually carried out after symptom stabilization with plasmapheresis, which is considered to improve outcome from thymic surgery in myasthenic patients. Moreover, it is reported that thymectomy is the only intervention in MG, which offers the realistic prospect of complete remission. [9]

Myasthenic crisis is a life-threatening condition, which is defined as weakness from acquired MG that is severe enough to necessitate intubation or to delay extubation following surgery. Myasthenic crisis is always happened after thymectomy. Several articles have discussed the risk factors for postthymectomy myasthenic crisis. Preoperative history of myasthenic crisis and presence of bulbar symptoms are risk factors associated with postoperative myasthenic crisis after thymectomy. [10] In our study, we find that myasthenic crisis prior surgery is an independent risk factors for postthymectomy myasthenic crisis. Patients with a preoperative history of the myasthenic crisis are 3.2 times higher with postthymectomy myasthenic crisis than patients without a preoperative history of the myasthenic crisis. This result is consistent with Watanabe's study. It is also believed that higher daily dose of pyridostigmine and body mass index predicted worse outcome after surgery. [11] In our retrospective study, we also found that patients administered pyridostigmine bromide >360 mg/day is also related with the postthymectomy myasthenic crisis.


 > Conclusion Top


Thymoma patients with a large dosage of pyridostigmine bromide administration, postsurgery pulmonary infection and myasthenic crisis prior surgery were easy to have postthymectomy myasthenic crisis. The health provider should pay much attention to this kind of patients in order to make early diagnosis and treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Engels EA, Pfeiffer RM. Malignant thymoma in the United States: Demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 2003;105:546-51.  Back to cited text no. 1
    
2.
Joly C, Deblock M, Desandes E, Geoffrois L. Primary mediastinal germs cells tumors: A twenty years experience in a comprehensive cancer center. Bull Cancer 2014;101:1067-73.  Back to cited text no. 2
    
3.
Marx A, Porubsky S, Belharazem D, Saruhan-Direskeneli G, Schalke B, Ströbel P, et al. Thymoma related myasthenia gravis in humans and potential animal models. Exp Neurol 2015;270:55-65.  Back to cited text no. 3
    
4.
Beydoun SR, Gong H, Ashikian N, Rison RA. Myasthenia gravis associated with invasive malignant thymoma: Two case reports and a review of the literature. J Med Case Rep 2014 13;8:340.  Back to cited text no. 4
    
5.
Fujii Y. Thymus, thymoma and myasthenia gravis. Surg Today 2013;43:461-6.  Back to cited text no. 5
    
6.
Lee BW, Ihm SH, Shin HS, Yoo HJ. Malignant thymoma associated with myasthenia gravis, Graves′ disease, and SIADH. Intern Med 2008;47:1009-12.  Back to cited text no. 6
    
7.
Tormoehlen LM, Pascuzzi RM. Thymoma, myasthenia gravis, and other paraneoplastic syndromes. Hematol Oncol Clin North Am 2008;22:509-26.  Back to cited text no. 7
    
8.
Detterbeck FC, Parsons AM. Management of stage I and II thymoma. Thorac Surg Clin 2011;21:59-67, vi-vii.  Back to cited text no. 8
    
9.
Chaudhuri A, Behan PO. Myasthenic crisis. QJM 2009;102:97-107.  Back to cited text no. 9
    
10.
Watanabe A, Watanabe T, Obama T, Mawatari T, Ohsawa H, Ichimiya Y, et al. Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis. J Thorac Cardiovasc Surg 2004;127:868-76.  Back to cited text no. 10
    
11.
Toker A, Tanju S, Sungur Z, Parman Y, Senturk M, Serdaroglu P, et al. Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: Results of 90 patients. Surg Endosc 2008;22:912-6.  Back to cited text no. 11
    



 
 
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