Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.
Surgery. 2010 Dec;148(6):1191-6; discussion 1196-7. doi: 10.1016/j.surg.2010.09.022.
There are few data on the degree to which thyroid cancer survivors are at risk of second primary malignancy (SPM). This study aimed at evaluating the risk of SPM in patients with differentiated thyroid carcinoma (DTC) and how the timing of SPM might affect the disease course.
Among 1,043 patients diagnosed with DTC between 1970 and 2008, 27 (2.6%) had synchronous SPM (ie, diagnosed within 6 months of DTC) and 71 (6.8%) had metachronous SPM (ie, diagnosed > 6 months after DTC) in 10,419 person-years of follow-up. Standardized incidence ratios were estimated overall and for each SPM site.
DTC survivors had a 39% greater risk of SPM (SIR = 1.39; 95% CI, 1.09-1.73) compared to the general population. Those with SPM had a worse overall survival than those without SPM (P < .001). The synchronous group had a worse DTC-specific survival (P = .002), whereas the metachronous group had a worse SPM-specific survival (P = .042). A lesser proportion in the metachronous group were able to receive curative treatment for SPM (32/71 vs 20/27; P = .013).
DTC survivors had an increased risk of SPM. The occurrence of SPM adversely affected the survival of DTC. The synchronous group tended to die from DTC, whereas the metachronous group from SPM. Heightened postoperative surveillance might improve survival.
有关甲状腺癌幸存者发生第二原发恶性肿瘤（SPM）风险的相关数据较少。本研究旨在评估分化型甲状腺癌（DTC）患者发生 SPM 的风险，以及 SPM 的发生时间如何影响疾病进程。
在 1970 年至 2008 年间诊断为 DTC 的 1043 名患者中，27 名（2.6%）患者在 DTC 确诊后 6 个月内（即同步性 SPM）发生了同时性 SPM，71 名（6.8%）患者在 DTC 确诊后 6 个月以上（即异时性 SPM）发生了异时性 SPM，随访时间为 10419 人年。总体和每个 SPM 部位均估计了标准化发病比。
与普通人群相比，DTC 幸存者发生 SPM 的风险增加了 39%（SIR=1.39；95%CI，1.09-1.73）。患有 SPM 的患者总生存率低于未患有 SPM 的患者（P<0.001）。同步组 DTC 特异性生存率更差（P=0.002），而异时组 SPM 特异性生存率更差（P=0.042）。异时组中能接受 SPM 根治性治疗的患者比例较少（71 例中 32 例 vs 27 例中 20 例；P=0.013）。
DTC 幸存者发生 SPM 的风险增加。SPM 的发生对 DTC 的生存产生了不利影响。同步组倾向于死于 DTC，而异时组倾向于死于 SPM。加强术后监测可能会改善生存。
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