Department of Surgery, University of Wisconsin Madison, WI 53792, USA.
Ann Surg. 2011 Oct;254(4):653-60. doi: 10.1097/SLA.0b013e318230036d.
The purpose of this study was to identify the risk factors that predict papillary thyroid microcarcinoma (PTMC)-related death in a large patient population to determine which patients need aggressive treatment.
The management of PTMC is controversial and ranges from observation to total thyroidectomy. The lack of consensus is predominantly due to the general excellent overall prognosis, thereby requiring a large cohort to delineate differences in outcome.
All papillary thyroid cancer patients with tumor size of 1 cm or less in the Surveillance, Epidemiology and End Results Cancer Database from 1988 to 2007 were identified. Outcomes, including overall and disease-specific survival, were compared, and different risk groups were evaluated by multivariate analysis.
A total of 18,445 cases of PTMC with surgery were identified. The 10-year and 15-year overall survivals were 94.6% and 90.7%, respectively, while disease-specific survivals were 99.5% and 99.3%. Age greater than 45 years, male sex, African American or minority race, node metastases, extrathyroidal invasion, and distant metastases were stratified to be significant risk factors for overall survival. There were 49 thyroid cancer-related deaths. Forty-five (92%) of the 49 patients had at least 2 risk factors, and 51% of these 49 patients had 3 or more risk factors (vs 5.7% in the rest of the cohort, P < 0.001).
Although PTMC is generally associated with an excellent prognosis, 0.5% patients may die of PTMC. The presence of 2 or more risk factors is strongly associated with cancer-related mortality and can help to identify patients who should be considered for more aggressive management.
本研究旨在确定可预测甲状腺微小乳头状癌（PTMC）相关死亡风险的因素，以确定哪些患者需要积极治疗。
PTMC 的治疗存在争议，范围从观察到全甲状腺切除术。缺乏共识主要是由于总体预后良好，因此需要一个大的队列来阐明结局的差异。
从 1988 年至 2007 年的监测、流行病学和最终结果癌症数据库中确定了所有肿瘤大小为 1cm 或更小的甲状腺乳头状癌患者。比较了总生存率和疾病特异性生存率等结果，并通过多变量分析评估了不同的风险组。
共确定了 18445 例接受手术治疗的 PTMC 病例。10 年和 15 年的总生存率分别为 94.6%和 90.7%，而疾病特异性生存率分别为 99.5%和 99.3%。年龄大于 45 岁、男性、非裔美国人或少数民族、淋巴结转移、甲状腺外侵犯和远处转移被分层为总生存率的显著危险因素。有 49 例甲状腺癌相关死亡。49 例患者中有 45 例（92%）至少有 2 个危险因素，其中 51%（49 例中有 25 例）有 3 个或更多危险因素（而其余队列中为 5.7%，P<0.001）。
尽管 PTMC 通常与良好的预后相关，但仍有 0.5%的患者可能死于 PTMC。存在 2 个或更多危险因素与癌症相关的死亡率密切相关，可以帮助识别需要更积极治疗的患者。
