Mendelsohn Abie H, Elashoff David A, Abemayor Elliot, St John Maie A
Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA.
Arch Otolaryngol Head Neck Surg. 2010 Nov;136(11):1055-61. doi: 10.1001/archoto.2010.181.
To further understanding of treatment of papillary thyroid carcinoma (PTC).
The Surveillance, Epidemiology, and End Results Program database was searched for patients who had undergone surgery for PTC.
Areas covered by Surveillance, Epidemiology, and End Results population-based registries.
Patients who had undergone PTC surgery between January 1, 1988, and December 31, 2001, were included in the study.
Disease-specific survival (DSS) and overall survival (OS).
Of the total 22,724 patients with PTC, 5964 patients underwent lobectomy. There were 2138 total and 471 disease-specific deaths. Controlling for tumor size, multivariate analysis revealed no survival difference between patients who had undergone total thyroidectomy and those who had undergone lobectomy. Increased tumor size, extrathyroidal extent, positive nodal status, and increased age displayed significantly worse DSS and OS (P < .001). Histologically, follicular PTC subtype did not affect DSS or OS. Patients who had received radioactive iodine had poorer DSS but improved OS. Patients undergoing external beam radiation therapy had poor DSS (hazard ratio, 4.48; 95% confidence interval, 3.30-6.06; P < .001) and OS (1.71; 1.42-2.07; P < .001).
The results of this study compel us to reinvestigate the current PTC surgical recommendations of total thyroidectomy based on tumor size because this may not affect survival across all populations. In addition, the current use of external beam radiation therapy for the treatment of PTC should be reexamined.
进一步了解甲状腺乳头状癌（PTC）的治疗方法。
在监测、流行病学和最终结果计划数据库中搜索接受过PTC手术的患者。
基于监测、流行病学和最终结果人群登记处覆盖的地区。
纳入1988年1月1日至2001年12月31日期间接受PTC手术的患者。
疾病特异性生存（DSS）和总生存（OS）。
在总共22724例PTC患者中，5964例接受了肺叶切除术。共有2138例死亡，其中471例为疾病特异性死亡。在控制肿瘤大小后，多变量分析显示，接受全甲状腺切除术的患者与接受肺叶切除术的患者之间的生存率没有差异。肿瘤大小增加、甲状腺外侵犯、淋巴结阳性状态和年龄增加均显示DSS和OS显著较差（P < 0.001）。从组织学上看，滤泡状PTC亚型不影响DSS或OS。接受放射性碘治疗的患者DSS较差，但OS有所改善。接受外照射放疗的患者DSS较差（风险比，4.48；95%置信区间，3.30 - 6.06；P < 0.001），OS也较差（1.71；1.42 - 2.07；P < 0.001）。
本研究结果促使我们重新审视目前基于肿瘤大小进行全甲状腺切除术的PTC手术建议，因为这可能不会影响所有人群的生存率。此外，目前使用外照射放疗治疗PTC的方法应重新审视。
