Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Ann Surg Oncol. 2011 Dec;18(13):3559-65. doi: 10.1245/s10434-011-1777-1. Epub 2011 May 15.
Differentiated thyroid cancer (DTC) survivors are at increased risk of developing nonsynchronous second primary malignancy (NSPM). This study aims to examine possible risk factors leading to occurrence of NSPM as well as risk factors leading to NSPM-related death in patients with DTC.
Of the 1,106 patients with DTC managed at our institution, 92 (8.3%) patients developed NSPM and 40 (3.6%) patients died of NSPM. All causes of death were confirmed by medical record, autopsy report or death certificate. Clinicopathological variables were compared between those without NSPM and with NSPM as well as between those who died of NSPM and did not die of NSPM. Significant variables on univariate analysis were entered into a Cox proportional hazards model.
The median latency period from diagnosis of DTC to NSPM was 142.7 (range 16.8-511.0) months. For occurrence of NSPM, age at DTC diagnosis ≥50 years old [relative risk (RR) = 2.35], cumulative radioactive iodine (RAI) activity 3.0-8.9 GBq (RR = 2.38), and external local radiotherapy (ERT) (RR = 1.95) were significant risk factors. For NSPM-related death, age at DTC diagnosis ≥50 years old (RR = 3.32) and nonbreast cancer (RR = 5.76) were significant risk factors.
NSPM accounted for 18.7% of all deaths in DTC, but mortality was high (43.5%). Age at DTC diagnosis ≥50 years old, cumulative RAI activity 3.0-8.9 GBq, and ERT were significant risk factors for occurrence of NSPM, whereas age at DTC diagnosis ≥50 years old and the diagnosis of nonbreast cancer were significant risk factors for NSPM-related death.
分化型甲状腺癌（DTC）幸存者发生非同步第二原发恶性肿瘤（NSPM）的风险增加。本研究旨在探讨导致 DTC 患者发生 NSPM 的可能危险因素，以及导致与 NSPM 相关的死亡的危险因素。
在我院治疗的 1106 例 DTC 患者中，92 例（8.3%）发生 NSPM，40 例（3.6%）死于 NSPM。所有死因均经病历、尸检报告或死亡证明证实。比较无 NSPM 与有 NSPM 的患者、以及死于 NSPM 与未死于 NSPM 的患者的临床病理变量。单因素分析中有意义的变量被纳入 Cox 比例风险模型。
从 DTC 诊断到 NSPM 的中位潜伏期为 142.7（范围 16.8-511.0）个月。对于 NSPM 的发生，DTC 诊断时年龄≥50 岁[相对风险（RR）=2.35]、累积放射性碘（RAI）活度 3.0-8.9GBq（RR=2.38）和外部局部放疗（ERT）（RR=1.95）是显著的危险因素。对于与 NSPM 相关的死亡，DTC 诊断时年龄≥50 岁（RR=3.32）和非乳腺癌（RR=5.76）是显著的危险因素。
NSPM 占 DTC 所有死亡的 18.7%，但死亡率较高（43.5%）。DTC 诊断时年龄≥50 岁、累积 RAI 活度 3.0-8.9GBq 和 ERT 是发生 NSPM 的显著危险因素，而 DTC 诊断时年龄≥50 岁和诊断为非乳腺癌是与 NSPM 相关的死亡的显著危险因素。
