Yildirim Emin
Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
J Am Coll Surg. 2005 Mar;200(3):378-92. doi: 10.1016/j.jamcollsurg.2004.10.031.
This study was performed to determine the prognostic factors for differentiated thyroid cancer, and to establish a mathematical prognostic model.
A retrospective study was conducted in 347 differentiated thyroid cancer patients. Univariate and multivariate prognostic factor analyses were carried out using the Kaplan-Meier and Cox regression methods.
Without adjustment for treatment in the multivariate analysis, age, tumor size, angioinvasion, and distant metastasis were significant predictors of outcomes. The very low-risk, low-risk, high-risk, and very high-risk groups were identified from the logistic regression equation. Overall and event-free survival estimations at 10 years were 100% and 100% for very low-risk patients, 88% and 75% for low-risk patients, 30% and 16% for high-risk patients, and 5% and 0% for very high-risk patients. Inclusion of treatment in the multivariate analysis showed, in addition to other variables, that both total or near total thyroidectomy (versus thyroidectomy less than total and near total thyroidectomy, p = 0.0002; hazard ratio, 0.4; 95% CI, 0.3-0.7) and adjuvant radioactive iodine treatment (versus no treatment with radioactive iodine, p = 0.0001; hazard ratio, 0.5; 95% CI, 0.2-0.8) were associated with a reduced hazard of death in the followup period. By subgroup analysis, total and near total thyroidectomy, along with radioactive iodine, appeared to provide a survival benefit for all patients except those in the very low-risk group.
The proposed mathematical model is satisfactory for predicting outcomes. Total and near total thyroidectomy along with radioactive iodine treatment might provide a survival advantage for differentiated thyroid cancer, except for those with very low risk.
本研究旨在确定分化型甲状腺癌的预后因素，并建立一个数学预后模型。
对347例分化型甲状腺癌患者进行了一项回顾性研究。使用Kaplan-Meier法和Cox回归方法进行单因素和多因素预后因素分析。
在多因素分析中，未对治疗进行调整时，年龄、肿瘤大小、血管侵犯和远处转移是预后的重要预测因素。根据逻辑回归方程确定了极低风险、低风险、高风险和极高风险组。极低风险患者10年的总生存率和无事件生存率估计分别为100%和100%，低风险患者为88%和75%，高风险患者为30%和16%，极高风险患者为5%和0%。在多因素分析中纳入治疗因素后发现，除其他变量外，全甲状腺切除或近全甲状腺切除（与小于全甲状腺切除和近全甲状腺切除相比，p = 0.0002；风险比，0.4；95%可信区间，0.3 - 0.7）和辅助放射性碘治疗（与未进行放射性碘治疗相比，p = 0.0001；风险比，0.5；95%可信区间，0.2 - 0.8）与随访期间死亡风险降低相关。通过亚组分析，全甲状腺切除和近全甲状腺切除以及放射性碘似乎为除极低风险组患者外的所有患者提供了生存益处。
所提出的数学模型在预测预后方面令人满意。全甲状腺切除和近全甲状腺切除以及放射性碘治疗可能为分化型甲状腺癌患者提供生存优势，但极低风险患者除外。
