Comparison of the performance of clinical classification systems for myasthenia gravis relapse after thymoma resection.
5 affiliations
- 1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
- 2Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian, China.
- 3State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
- 4Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
- 5Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Abstract
Objective
To characterize clinically significant myasthenia gravis (MG) relapse/exacerbation after thymoma resection and compare classification systems for risk stratification.Methods
This multicenter retrospective cohort included 257 patients with thymoma-associated MG who underwent extended thymectomy at 3 centers from July 2009 through November 2025. The end point was new MG symptoms after postoperative complete stable remission, pharmacologic remission, or minimal manifestation status plus verifiable MG-related treatment escalation or rescue therapy. Death without MG relapse/exacerbation was treated as a competing event. Cumulative incidence functions were estimated with Aalen-Johansen and compared with Gray tests; predictors were assessed with Fine-Gray models.Results
During median follow-up of 41.6 months, 69 relapse/exacerbation events and 21 competing deaths occurred. Cumulative incidence was 20.4% at 3 years and 29.0% at 5 years; 68% and 90% of events occurred within 3 and 5 years, respectively. Among 52 relapse/exacerbation events in patients who underwent surgery in 2018 or later with retrievable treatment-status data, 28 (53.8%) occurred during ongoing immunosuppression and 24 (46.2%) after withdrawal. The a/b phenotype-based grouping of the Myasthenia Gravis Foundation of America classification (1/A/B) showed the strongest separation (3-year cumulative incidences, 2.5%, 12.3%, and 56.4%; 5-year cumulative incidences, 7.6%, 29.6%, and 56.4% for groups 1, A, and B). Groups A and B were independently associated with relapse/exacerbation (subdistribution hazard ratio, 2.65; 95% CI, 1.18-5.91; and 10.55; 95% CI, 4.55-24.47).Conclusions
Clinically significant MG relapse/exacerbation after thymoma resection clustered in the early postoperative years. The a/b phenotype-based grouping of the Myasthenia Gravis Foundation of America classification (1/A/B) provided the most informative risk stratification.
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BibTeX
@article{yao2026comparison,
title = {{Comparison of the performance of clinical classification systems for myasthenia gravis relapse after thymoma resection.}},
author = {Zhiheng Yao and Hongmu Li and Zhenyuan Yang and Yu Huang and Leqi Zhong and Zhenyu Zhao and Yiling Cai and Chun Chen and Bin Zheng},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.101980},
url = {https://europepmc.org/article/MED/42948408},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparison of the performance of clinical classification systems for myasthenia gravis relapse after thymoma resection.
AU - Zhiheng Yao
AU - Hongmu Li
AU - Zhenyuan Yang
AU - Yu Huang
AU - Leqi Zhong
AU - Zhenyu Zhao
AU - Yiling Cai
AU - Chun Chen
AU - Bin Zheng
PY - 2026
DA - 2026/08/22
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101980
UR - https://europepmc.org/article/MED/42948408
AB - Objective To characterize clinically significant myasthenia gravis (MG) relapse/exacerbation after thymoma resection and compare classification systems for risk stratification.Methods This multicenter retrospective cohort included 257 patients with thymoma-associated MG who underwent extended thymectomy at 3 centers from July 2009 through November 2025. The end point was new MG symptoms after postoperative complete stable remission, pharmacologic remission, or minimal manifestation status plus verifiable MG-related treatment escalation or rescue therapy. Death without MG relapse/exacerbation was treated as a competing event. Cumulative incidence functions were estimated with Aalen-Johansen and compared with Gray tests; predictors were assessed with Fine-Gray models.Results During median follow-up of 41.6 months, 69 relapse/exacerbation events and 21 competing deaths occurred. Cumulative incidence was 20.4% at 3 years and 29.0% at 5 years; 68% and 90% of events occurred within 3 and 5 years, respectively. Among 52 relapse/exacerbation events in patients who underwent surgery in 2018 or later with retrievable treatment-status data, 28 (53.8%) occurred during ongoing immunosuppression and 24 (46.2%) after withdrawal. The a/b phenotype-based grouping of the Myasthenia Gravis Foundation of America classification (1/A/B) showed the strongest separation (3-year cumulative incidences, 2.5%, 12.3%, and 56.4%; 5-year cumulative incidences, 7.6%, 29.6%, and 56.4% for groups 1, A, and B). Groups A and B were independently associated with relapse/exacerbation (subdistribution hazard ratio, 2.65; 95% CI, 1.18-5.91; and 10.55; 95% CI, 4.55-24.47).Conclusions Clinically significant MG relapse/exacerbation after thymoma resection clustered in the early postoperative years. The a/b phenotype-based grouping of the Myasthenia Gravis Foundation of America classification (1/A/B) provided the most informative risk stratification.
SN - 2666-2736
ER -