Hundahl S A, Cady B, Cunningham M P, Mazzaferri E, McKee R F, Rosai J, Shah J P, Fremgen A M, Stewart A K, Hölzer S
Queen's Cancer Institute, Honolulu, Hawaii, USA.
Cancer. 2000 Jul 1;89(1):202-17. doi: 10.1002/1097-0142(20000701)89:1<202::aid-cncr27>3.0.co;2-a.
The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976.
Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base.
Of the 5584 cases of thyroid carcinoma, 81% were papillary, 10% follicular, 3.6% Hürthle cell, 0.5% familial medullary, 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall).
In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes.
自1976年以来，美国外科医师学会癌症委员会（CoC）开展了全国患者护理评估（PCE）研究。
邀请了1500多家拥有CoC批准的癌症项目的医院参与这项对1996年美国甲状腺癌病例的前瞻性队列研究。将通过国家癌症数据库进行随访。
在5584例甲状腺癌病例中，81%为乳头状癌，10%为滤泡状癌，3.6%为许特莱细胞癌，0.5%为家族性髓样癌，2.7%为散发性髓样癌，1.7%为未分化/间变性癌。对人口统计学和疑似风险因素进行了分析。甲状腺细针穿刺活检（53%）或颈部淋巴结细针穿刺活检（7%）、甲状腺核素扫描（39%）和超声检查（38%）是最常用的诊断方法。绝大多数分化型甲状腺癌患者表现为美国癌症联合委员会I期和II期疾病且肿瘤相对较小。对于所有组织学类型，近全甲状腺切除术或全甲状腺切除术是主要的手术治疗方式。相当一部分病例未进行淋巴结检查。手术治疗后11%的病例可记录到残留肿瘤，10%的病例出现低钙血症，1.3%的病例出现喉返神经损伤。并发症最常与全甲状腺切除术联合淋巴结清扫术相关。30天死亡率为0.3%；排除未分化/间变性癌病例后，死亡率降至0.2%。辅助治疗在本研究中可能报告不足，包括激素抑制（总体为50%）和放射性碘治疗（总体为50%）。
除了提供有关风险因素和症状的信息外，当前的PCE研究补充了先前国家癌症数据库报告中的生存信息，并提供了美国当前甲状腺癌管理的监测快照。已确定的护理改进机会包括：1）在诊断中更频繁地使用细针穿刺细胞学检查；2）在术前评估患者时更频繁地使用喉镜检查，尤其是那些有声音改变的患者；3）改进淋巴结切除和分析以改善分期，并在某些情况下改善治疗结果。
