Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
Thyroid. 2011 May;21(5):501-4. doi: 10.1089/thy.2010.0451. Epub 2011 Apr 10.
Death from well-differentiated thyroid cancer (WDTC) is rare, and over the past century there has been a trend away from local recurrence as the primary cause of death. The objective of our study was to report the cause of death from thyroid cancer in patients with WDTC treated with curative intent with surgery ± adjuvant radioactive iodine.
An institutional database of 1811 patients with WDTC treated surgically for WDTC between 1986 and 2005 was analyzed and identified 165 (9.4%) who had died. Case records were studied to determine the cause of death in each patient.
Of the 165 deaths, 17 (10%) patients were confirmed to have died of thyroid cancer and 6 (4%) died of an unknown cause but had thyroid cancer present at the time of last follow-up. The remaining 142 (86%) died from other causes and were considered free of thyroid cancer at their last follow-up. We therefore identified only 23 cause-specific deaths from the entire cohort (1.3%). Of the 17 patients known to have died of thyroid cancer, all had distant recurrence. Ninety-four percent had pulmonary metastases. Of these, 47% also had bony metastasis at the time of death. Two patients had recurrent disease in the neck at the time of death, but both also had distant disease. Of the six patients (4%) who died of unknown causes but had thyroid cancer at last follow-up, four (67%) had distant disease alone, one (17%) had local and regional recurrence, and one had local and distant recurrence at last follow-up.
After successful resection of WDTC, we report a low disease-specific death rate (1.3%). In contrast to earlier reports, death caused by central compartment disease in this recent series is very rare, with metastatic disease accounting for almost all fatalities.
分化型甲状腺癌（WDTC）导致的死亡较为罕见，在过去一个世纪，死亡原因已从局部复发逐渐转变为远处转移。本研究旨在报告 WDTC 患者接受以手术为基础的治愈性治疗（手术+辅助放射性碘）后的甲状腺癌死亡原因。
对 1986 年至 2005 年间接受手术治疗的 1811 例 WDTC 患者的机构数据库进行分析，发现 165 例（9.4%）患者死亡。研究病例记录以确定每位患者的死亡原因。
在 165 例死亡病例中，17 例（10%）患者被证实死于甲状腺癌，6 例（4%）患者死于不明原因，但在最后一次随访时存在甲状腺癌。其余 142 例（86%）患者死于其他原因，且在最后一次随访时被认为无甲状腺癌。因此，我们从整个队列中仅确定了 23 例与甲状腺癌相关的特定死亡病例（1.3%）。在已知死于甲状腺癌的 17 例患者中，所有患者均存在远处转移。94%的患者有肺部转移。其中，47%的患者在死亡时还有骨转移。2 例患者在死亡时颈部有复发病灶，但两者均有远处转移。在最后一次随访时死于不明原因但存在甲状腺癌的 6 例患者中，4 例（67%）仅存在远处疾病，1 例（17%）存在局部和区域复发，1 例存在局部和远处复发。
在成功切除 WDTC 后，我们报告的疾病特异性死亡率较低（1.3%）。与早期报告不同，在本研究系列中，中央区疾病导致的死亡非常罕见，几乎所有的死亡都是由转移病灶引起的。
