Machens Andreas, Hauptmann Steffen, Dralle Henning
Departments of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Saale, Germany.
Clin Endocrinol (Oxf). 2006 Oct;65(4):500-5. doi: 10.1111/j.1365-2265.2006.02623.x.
This investigation was undertaken to quantify histopathological disparities between male and female patients with sporadic and hereditary thyroid cancers, which may reflect a biological 'sex difference' or a behavioural 'gender divide'.
Retrospective cohort analysis (November 1994-January 2006).
1298 Consecutive surgical patients with sporadic papillary (n = 587), sporadic follicular (n = 232), sporadic medullary (n = 320), and hereditary medullary thyroid cancers (n = 159) from a tertiary referral centre.
Age at diagnosis of cancer, primary tumour diameter, frequency of extrathyroidal extension, lymph node and distant metastases, and cancer subtypes.
Primary diameters of sporadic tumour entities (papillary, 26.0 vs. 19.3 mm; follicular, 54.9 vs. 35.1 mm; and medullary, 27.9 vs. 20.8 mm), but not hereditary medullary cancers, were significantly (P <or= 0.001) larger in male patients. Likewise, lymph node metastases from sporadic papillary cancers (60%vs. 44%, P < 0.001), the insular subtype in sporadic follicular cancers (22%vs. 8%, P = 0.003), extrathyroidal extension of sporadic medullary cancers (35%vs. 15%, P < 0.001), and distant metastases from sporadic medullary cancers at the most recent operation (29%vs. 15%, P = 0.002) were seen significantly more often with male patients. No significant differences were observed between male and female patients with hereditary medullary cancers, half of which were detected by screening.
Our data emphasize the need for earlier diagnosis and intervention in male patients to ensure that male sex will cease sometime to constitute an ominous prognostic marker of advanced thyroid cancer.
开展此项研究以量化散发性和遗传性甲状腺癌男性与女性患者之间的组织病理学差异，这可能反映出生物学上的“性别差异”或行为学上的“性别分化”。
回顾性队列分析（1994年11月至2006年1月）。
来自一家三级转诊中心的1298例连续性手术患者，包括散发性乳头状癌（n = 587）、散发性滤泡状癌（n = 232）、散发性髓样癌（n = 320）和遗传性髓样癌（n = 159）。
癌症诊断时的年龄、原发肿瘤直径、甲状腺外侵犯频率、淋巴结及远处转移情况以及癌症亚型。
男性患者散发性肿瘤实体（乳头状癌，26.0对19.3毫米；滤泡状癌，54.9对35.1毫米；髓样癌，27.9对20.8毫米）的原发直径显著更大（P≤0.001），但遗传性髓样癌除外。同样，男性患者散发性乳头状癌的淋巴结转移（60%对44%，P < 0.001）、散发性滤泡状癌岛状亚型的转移（22%对8%，P = 0.003）、散发性髓样癌的甲状腺外侵犯（35%对15%，P < 0.001）以及最近一次手术时散发性髓样癌的远处转移（29%对15%，P = 0.002）更为常见。遗传性髓样癌的男性与女性患者之间未观察到显著差异，其中一半是通过筛查发现的。
我们的数据强调需要对男性患者进行更早的诊断和干预，以确保男性性别不再成为晚期甲状腺癌不良预后的标志。
