Roman Sanziana, Lin Rong, Sosa Julie Ann
Section of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Cancer. 2006 Nov 1;107(9):2134-42. doi: 10.1002/cncr.22244.
Medullary thyroid cancer (MTC) is a rare cancer. There is a relative paucity of data over the last decade with regard to the prognosis of these patients. Therefore, the authors used the population-based Surveillance, Epidemiology, and End Results (SEER) registry to update what to their knowledge is one of the largest series of patients with MTC reported to date.
All patients with a diagnosis of MTC with active follow-up in the SEER database from 1973 to 2002 were included. Univariate and multivariate regression analyses were used to assess the associations between demographic, clinical, and pathologic characteristics of patients and survival.
A total of 1252 patients with MTC were identified over 29 years of follow-up. In all, 87% of patients were white and 60% were female, with a mean age of 50 years. Although many variables were significant on univariate analysis, SEER stage and age at diagnosis were found to be the strongest predictors of survival in the multivariate analysis. Prognosis was poor in patients with advanced disease (hazards ratio [HR], 4.47), or those age >65 years (HR, 6.55). Patients who underwent surgery fared better than those who did not. Overall, 51% of patients had less than the currently recommended treatment guidelines for MTC. Adjuvant radiation therapy was found to be independently associated with a decreased survival (HR, 1.65).
Stage of disease and age at diagnosis were found to be the strongest predictors of survival for patients with MTC. To the authors' knowledge there has been no change in stage at diagnosis or a significant improvement in survival noted over the last 30 years. Many patients underwent surgery that was deemed less than optimal for stage of disease.
甲状腺髓样癌（MTC）是一种罕见的癌症。在过去十年中，关于这些患者预后的数据相对较少。因此，作者使用基于人群的监测、流行病学和最终结果（SEER）登记系统，更新了据他们所知是迄今为止报告的最大系列MTC患者之一的数据。
纳入1973年至2002年在SEER数据库中确诊为MTC且有积极随访记录的所有患者。采用单因素和多因素回归分析来评估患者的人口统计学、临床和病理特征与生存率之间的关联。
在29年的随访中，共识别出1252例MTC患者。总体而言，87%的患者为白人，60%为女性，平均年龄为50岁。虽然在单因素分析中有许多变量具有显著性，但在多因素分析中发现SEER分期和诊断时的年龄是生存的最强预测因素。晚期疾病患者（风险比[HR]，4.47）或年龄>65岁的患者（HR，6.55）预后较差。接受手术的患者比未接受手术的患者预后更好。总体而言，51%的患者接受的治疗少于目前推荐的MTC治疗指南。发现辅助放疗与生存率降低独立相关（HR，1.65）。
疾病分期和诊断时年龄是MTC患者生存的最强预测因素。据作者所知，在过去30年中，诊断分期没有变化，生存率也没有显著提高。许多患者接受的手术被认为对疾病分期而言并非最佳。
