Prognostic factors of thymectomy in patients with myasthenia gravis: a cohort of 132 patients.
OBJECTIVE
To identify the response to thymectomy and the factors associated with a poor response, a nested case-control study was performed on 132 patients with an established diagnosis of myasthenia gravis who had had a thymectomy between 1987 and 1997 and had been followed up for at least 3 years.


METHODS
In order to assess the response to thymectomy, the following two points were taken into account: (a) the dose of pyridostigmine and other drugs (steroids, azathioprine) that the patient took before and after thymectomy, and (b) the Osserman classification before and after thymectomy. The patients were divided into 4 groups: (1) patients in remission; (2) patients with improvement; (3) patients with no change, and (4) patients who were worse.


RESULTS
91 patients had a good response (69%) and 41 patients had a poor response (31%). The response by groups was as follows: 50 patients were found to be in remission; 41 patients had improved; 34 patients had no changes, and 7 got worse. Being more than 60 years old was associated with a poor prognosis (odds ratio 4.6, CI 1.11-20.32, p 0.01). The patients who had the disease for more than 3 years (odds ratio 2.97, CI 0.79-5.39, p 0.09) had a tendency towards a bad prognosis even though there was no statistical significance, and for those who had it for more than 4 years (odds ratio 2.58, CI 0.89-0.96, p 0.02) the bad prognosis was statistically significant. The patients who had the disease for more than 3 years between diagnosis and thymectomy (odds ratio 2.02, CI 0.69-5.90, p 0.15) and those with it for more than 4 years (odds ratio 2.53, CI 0.83-7.7, p 0.06) had a tendency towards a poor prognosis even though there was no statistical significance. In addition, having Osserman I was associated with a bad prognosis. Referring to the pathological findings, patients with thymoma (odds ratio 3.51, CI 0.43-31.5, p 0.15) and those with thymic atrophy (odds ratio 2.19, CI 0.93-5.16, p 0.04) had a poor prognosis. Finally, the use of steroids before thymectomy (odds ratio 2.26, CI 0.99-5.18, p 0.03) was associated with a worse prognosis.


CONCLUSIONS
The response to thymectomy was high (69%). The variables that had the most prognostic importance were age and the Osserman stage. Other variables of poor prognosis were: high doses of pyridostigmine and use of steroids before surgery; the total duration of the disease and the duration of the disease between diagnosis and the surgical procedure; history of previous thymectomy; use of plasmapheresis after surgery, and the discovery of thymic atrophy and thymoma in the histopathological result.
Téllez-Zenteno
J F
JF
Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico. jftellez@yahoo.com
Remes-Troche
J M
JM
García-Ramos
G
G
Estañol
B
B
Garduño-Espinoza
J
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination / Q000187:drug effects; D011379:Prognosis; D011729:Pyridostigmine Bromide / Q000008:administration & dosage; D013934:Thymectomy; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D011729:Pyridostigmine Bromide; D001379:Azathioprine