Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Cancer. 2012 Jul 1;118(13):3260-7. doi: 10.1002/cncr.26638. Epub 2012 Jan 17.
Insular thyroid cancer (ITC) is an uncommon, poorly differentiated thyroid malignancy. To date, there have been no population-level studies of the characteristics and outcomes of patients with ITC.
The authors used the Surveillance, Epidemiology, and End Results (SEER) database from 1999 to 2007 to compare the characteristics and prognosis of patients who had ITC with those of patients who had well differentiated thyroid cancer (WDTC) and anaplastic thyroid cancer (ATC). Data analyses were performed using chi-square tests, analyses of variance, log-rank tests, and multivariate regression.
There were 114 patients with ITC, 497 patients with ATC, and 34,021 patients with WDTC. The mean age of patients with ITC was 62.1 years versus 48.1 years for patients with WDTC and 69.5 years for patients with ATC (P < .001). The mean ITC tumor size was 5.9 cm versus 2.0 cm for WDTC and 6.4 cm for ATC (P < .001). Distant metastasis occurred in 31% of patients with ITC versus 4.5% of patients with WDTC and 59.1% of patients with ATC (P < .001). Insular histology was associated independently with compromised survival in the overall study sample (hazard ratio [HR], 2.1; P = .001). The 5-year disease-specific survival rate was 72.6%, 97.2%, and 9.1% for patients with ITC, WDTC, and ATC, respectively (P < .001). After adjustment, radioiodine therapy (HR, 0.15; 95% confidence interval, 0.04-0.5) and distant metastasis (HR, 15.3; 95% confidence interval, 3.7-62.2) were associated independently with ITC survival. The mortality rate was 7.1%, 12%, and 54.3% for patients with localized, regional, and distant stage ITC, respectively (P < .001). For patients who had ITC with distant metastasis, thyroidectomy and radioiodine therapy independently improved survival.
ITC is rare and aggressive. The current results indicated that its treatment should include total thyroidectomy and high-dose radioiodine for all patients and neck dissections for patients with lymph node disease. Early diagnosis and close surveillance are essential in the management of patients with ITC.
岛状甲状腺癌（ITC）是一种罕见的、低分化的甲状腺恶性肿瘤。迄今为止，尚无关于 ITC 患者特征和结局的人群水平研究。
作者使用 1999 年至 2007 年的监测、流行病学和最终结果（SEER）数据库，比较了 ITC 患者与分化型甲状腺癌（WDTC）和间变性甲状腺癌（ATC）患者的特征和预后。数据分析采用卡方检验、方差分析、对数秩检验和多变量回归。
共有 114 例 ITC 患者、497 例 ATC 患者和 34021 例 WDTC 患者。ITC 患者的平均年龄为 62.1 岁，WDTC 患者为 48.1 岁，ATC 患者为 69.5 岁（P<0.001）。ITC 肿瘤的平均大小为 5.9cm，WDTC 为 2.0cm，ATC 为 6.4cm（P<0.001）。31%的 ITC 患者发生远处转移，而 WDTC 患者为 4.5%，ATC 患者为 59.1%（P<0.001）。在整个研究样本中，岛状组织学与生存受损独立相关（风险比[HR]，2.1；P=0.001）。ITC、WDTC 和 ATC 患者的 5 年疾病特异性生存率分别为 72.6%、97.2%和 9.1%（P<0.001）。调整后，放射性碘治疗（HR，0.15；95%置信区间，0.04-0.5）和远处转移（HR，15.3；95%置信区间，3.7-62.2）与 ITC 生存独立相关。局部、区域和远处 ITC 分期 I 期患者的死亡率分别为 7.1%、12%和 54.3%（P<0.001）。对于有远处转移的 ITC 患者，甲状腺切除术和放射性碘治疗可独立改善生存。
ITC 罕见且侵袭性强。目前的结果表明，所有患者均应接受全甲状腺切除术和大剂量放射性碘治疗，有淋巴结疾病的患者应行颈部清扫术。早期诊断和密切监测是 ITC 患者管理的关键。
