Vini Louiza, Hyer Stephen L, Marshall Jennifer, A'Hern Roger, Harmer Clive
Thyroid Unit, Royal Marsden National Health Service Trust, Sutton, United Kingdom.
Cancer. 2003 Jun 1;97(11):2736-42. doi: 10.1002/cncr.11410.
The authors assessed the biologic behavior of differentiated thyroid carcinoma in patients age 70 years or older and evaluated factors that influenced long-term survival.
Among 1448 patients with differentiated thyroid carcinoma who were treated at the authors' institution over the past 60 years, 111 patients were identified who were age 70 years or older at the time of their initial diagnosis (range, 70-93 years). The authors conducted a retrospective analysis of the outcome of these 111 patients, who had a median follow-up of 9 years (range, 2-9 years).
There were 83 female patients and 28 male patients (female to male ratio, 3:1). Fifty-eight tumors were papillary, 46 tumors were follicular, and 7 tumors were Hürthle cell carcinoma. Eighty percent of patients presented with a thyroid mass, and 70% of tumors were pathologic stage T3 (pT3) or pT4. Lymph node disease was evident at presentation in 44% of patients, and distant metastases were documented at diagnosis in 23% of patients. Forty-six patients underwent total thyroidectomy, and the remaining patients underwent subtotal thyroidectomy or biopsy only. Radioiodine was administered to 80 patients, and external beam radiotherapy was administered to 19 patients. The cause specific survival rates were 75%, 50%, and 50% at 5 years, 10 years, and 15 years, respectively. Multivariate analysis showed that the presence of metastases was the most important independent prognostic factor for survival. External beam radiotherapy was associated with a poorer prognosis, in that it was reserved for patients with either inoperable disease or residual disease after surgery and patients with no uptake of radioiodine.
A large proportion of thyroid tumors showed extrathyroid spread and distant metastases, which frequently were not iodine-avid. The prevalent histologic type was papillary, often with features of poor differentiation. Thyroid carcinoma in the elderly appears to behave more aggressively, and they have a less favorable prognosis compared with younger adults.
作者评估了70岁及以上分化型甲状腺癌患者的生物学行为，并评估了影响长期生存的因素。
在过去60年里于作者所在机构接受治疗的1448例分化型甲状腺癌患者中，确定了111例在初次诊断时年龄为70岁及以上的患者（年龄范围为70 - 93岁）。作者对这111例患者的结局进行了回顾性分析，这些患者的中位随访时间为9年（范围为2 - 9年）。
有83例女性患者和28例男性患者（女性与男性比例为3:1）。58例肿瘤为乳头状，46例肿瘤为滤泡状，7例肿瘤为许特莱细胞癌。80%的患者表现为甲状腺肿块，70%的肿瘤为病理分期T3（pT3）或pT4。44%的患者在初诊时出现淋巴结病变，23%的患者在诊断时记录有远处转移。46例患者接受了全甲状腺切除术，其余患者仅接受了次全甲状腺切除术或活检。80例患者接受了放射性碘治疗，19例患者接受了外照射放疗。5年、10年和15年的病因特异性生存率分别为75%、50%和50%。多因素分析表明，转移的存在是生存的最重要独立预后因素。外照射放疗与较差的预后相关，因为它仅用于患有不可手术疾病或手术后残留疾病以及不摄取放射性碘的患者。
很大一部分甲状腺肿瘤表现为甲状腺外扩散和远处转移，这些转移灶通常不摄取碘。常见的组织学类型为乳头状，常具有分化不良的特征。老年甲状腺癌似乎行为更具侵袭性，与年轻成年人相比预后较差。
