老年头颈部癌患者放疗后甲状腺功能减退：一项基于人群的研究。
Hypothyroidism in older patients with head and neck cancer after treatment with radiation: a population-based study.
作者信息
Smith Grace L, Smith Benjamin D, Garden Adam S, Rosenthal David I, Sherman Steven I, Morrison William H, Schwartz David L, Weber Randal S, Buchholz Thomas A
机构信息
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
出版信息
Head Neck. 2009 Aug;31(8):1031-8. doi: 10.1002/hed.21066.
BACKGROUND
In patients with head and neck cancer, radiation treatment (RT) is a risk factor for hypothyroidism. However, the specific magnitude of risk after RT in older patients is not known.
METHODS
We identified 5916 patients (age > 65 years) from SEER-Medicare diagnosed with head and neck cancer from 1992 to 2002. Proportional hazards models compared hypothyroidism risk after any RT versus surgery alone.
RESULTS
In patients treated with RT, 5-year incidence of hypothyroidism was 20% and 10-year incidence was 59%; in patients treated with surgery alone, incidence was 7% and 39% (p < .001). Patients treated with RT had increased adjusted risk (hazard ratio [HR] = 2.14; 95% confidence interval [CI] = 1.74-2.62), persisting for up to 10 years of follow-up (HR = 1.85, 95% CI = 1.39-2.44 from 5 to 10 years).
CONCLUSION
In older patients with head and neck cancer, RT is associated with elevated hypothyroidism risk. As onset may be delayed for years, patients may require lifelong thyroid function screening after treatment.
背景
在头颈癌患者中，放射治疗（RT）是甲状腺功能减退的一个风险因素。然而，老年患者接受放疗后具体的风险程度尚不清楚。
方法
我们从监测、流行病学和最终结果（SEER）医保数据库中确定了1992年至2002年期间诊断为头颈癌的5916例患者（年龄>65岁）。比例风险模型比较了接受任何放疗与单纯手术治疗后甲状腺功能减退的风险。
结果
接受放疗的患者中，甲状腺功能减退的5年发病率为20%，10年发病率为59%；单纯接受手术治疗的患者，发病率分别为7%和39%（p<.001）。接受放疗的患者调整后的风险增加（风险比[HR]=2.14；95%置信区间[CI]=1.74-2.62），在长达10年的随访中持续存在（5至10年时HR=1.85，95%CI=1.39-2.44）。
结论
在老年头颈癌患者中，放疗与甲状腺功能减退风险升高相关。由于发病可能会延迟数年，患者在治疗后可能需要终身进行甲状腺功能筛查。
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