title: Does myasthenia gravis influence overall survival and cumulative incidence of recurrence in thymoma patients? A Retrospective clinicopathological multicentre analysis on 797 patients.
abstract: OBJECTIVE
  Aim of this study is to evaluate whether Myasthenia Gravis (MG) might influence Overall Survival (OS) and Cumulative Incidence of Recurrence (CIR) in thymoma patients.
  
  
  METHODS
  this is a multicenter retrospective study of patients operated in 6 high-volume Italian Institutions between 1990 and 2012. OS was estimated by the Kaplan-Meier method and CIR by considering death from any cause as a competing event. Crude and adjusted comparisons by MG for OS and CIR were performed using Cox and Fine&Gray models. Adjusted models included MG, age, gender, stage, histology, induction therapy, completeness of resection, adjuvant therapy.
  
  
  RESULTS
  Seven hundred ninety-seven patients were included: 375 (47%) had MG. MG patients were younger and more frequently female, with a B2-B3 thymoma. At the end of the study, 129 patients (54 with MG) developed a recurrence and 165 (66 with MG) died. At univariate analysis, MG showed a slight protective effect on OS, not confirmed by the multivariate model. Age, incomplete resection, advanced stages and thymic carcinoma were negative prognostic variables. Univariate analyses showed no evidence of MG protective effect on CIR. Advanced stages and induction therapy were significant negative predictors.
  
  
  CONCLUSIONS
  our study showed that MG was significantly associated with female, lower age and B2-B3 thymoma; it demonstrated a slight protective effect on OS at the univariate analysis which was not confirmed in multivariate as well as no impact on CIR. Advanced tumor stages and thymic carcinoma histology for OS and induction therapy and advanced stages for CIR were negative prognostic variables.
authors.affiliation: University of Torino Italy, Torino, Italy. Electronic address: pierluigi.filosso@unito.it.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.affiliation: Unit of Cancer Epidemiology and CPO Piedmont, S. Giovanni Battista Hospital, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: University of Torino Italy, Torino, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, S. Andrea Hospital Rome, Italy.
authors.forename: Erino Angelo
authors.initials: EA
authors.lastname: Rendina
authors.affiliation: Catholic University "Sacred Heart" Rome, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.affiliation: Catholic University "Sacred Heart" Rome, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Novellis
authors.affiliation: "Amedeo Avogadro" University Novara Italy, Novara, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Rena
authors.affiliation: "Amedeo Avogadro" University Novara Italy, Novara, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Casadio
authors.affiliation: Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, S. Andrea Hospital Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Andreetti
authors.affiliation: University of Torino Italy, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerrera
authors.affiliation: University of Torino Italy, Torino, Italy.
authors.forename: Paolo Olivo
authors.initials: PO
authors.lastname: Lausi
authors.affiliation: Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico Umberto I Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Diso
authors.affiliation: University of Pisa Italy, Pisa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
authors.affiliation: Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, Policlinico Umberto I Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: University of Torino Italy, Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
authors.affiliation: University of Pisa Italy, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009157:Myasthenia Gravis / Q000150:complications*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013945:Thymoma / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy
keywords: Myasthenia Gravis; Paraneoplastic syndrome; Recurrence; Surgery; Survival; Thymoma