分化型甲状腺癌的临床显著预后因素：一项基于人群的巢式病例对照研究。

Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study.

作者信息

Lundgren Catharina Ihre, Hall Per, Dickman Paul W, Zedenius Jan

机构信息

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

出版信息

Cancer. 2006 Feb 1;106(3):524-31. doi: 10.1002/cncr.21653.

DOI:10.1002/cncr.21653

PMID:16369995

Abstract

BACKGROUND

Different scoring systems currently are being used to stratify patients with differentiated thyroid carcinoma (DTC) into risk groups. DTC is usually subdivided into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). The objective of the current study was to identify those factors that predict long-term unfavorable prognosis and to evaluate the predictive accuracy of the TNM staging system.

METHODS

The authors conducted a nested case-control study within the cohort of all patients (n=5123) diagnosed with DTC in Sweden between 1958-1987 who survived at least 1 year after diagnosis. One control, matched by age at diagnosis, gender, and calendar period, was randomly selected for each case (patients who died of DTC). All patients were classified at the time of diagnosis according to the TNM staging system. The effect of prognostic factors on DTC mortality was evaluated using conditional logistic regression.

RESULTS

Patients with widely invasive FTC experienced a significantly higher mortality compared with PTC patients. The grade of differentiation was found to influence mortality significantly. Patients with TNM Stage IV disease had a higher mortality rate compared with patients with Stage II disease (odds ratio [OR]=9.1; 95% confidence interval [95% CI], 5.7-14.6). Patients with lymph node metastases experienced a higher mortality (OR=2.5; 95% CI, 1.6-4.1) and patients with distant metastasis at the time of diagnosis were found to have a nearly 7-fold higher mortality rate (OR=6.6; 95% CI, 4.1-10.5). Incomplete surgical excision was associated with higher mortality, particularly in patients with Stage I disease.

CONCLUSIONS

In the current study, the following were found to be clinically significant prognostic factors for patients with DTC: histopathologic subgroup, TNM staging including lymph node metastases and distant metastases, and completeness of the surgical excision.

摘要

背景

目前使用不同的评分系统将分化型甲状腺癌（DTC）患者分层为风险组。DTC通常细分为乳头状甲状腺癌（PTC）和滤泡状甲状腺癌（FTC）。本研究的目的是确定那些预测长期不良预后的因素，并评估TNM分期系统的预测准确性。

方法

作者在1958年至1987年期间在瑞典诊断为DTC且诊断后至少存活1年的所有患者（n = 5123）队列中进行了一项巢式病例对照研究。为每个病例（死于DTC的患者）随机选择一名按诊断时年龄、性别和日历时间匹配的对照。所有患者在诊断时根据TNM分期系统进行分类。使用条件逻辑回归评估预后因素对DTC死亡率的影响。

结果

与PTC患者相比，广泛侵袭性FTC患者的死亡率显著更高。发现分化程度对死亡率有显著影响。TNM分期IV期疾病患者的死亡率高于II期疾病患者（比值比[OR]=9.1；95%置信区间[95%CI]，5.7 - 14.6）。有淋巴结转移的患者死亡率更高（OR = 2.5；95%CI，1.6 - 4.1），并且发现诊断时伴有远处转移的患者死亡率几乎高出7倍（OR = 6.6；95%CI，4.1 - 10.5）。手术切除不完全与较高的死亡率相关，特别是在I期疾病患者中。