Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20007, USA.
J Clin Endocrinol Metab. 2012 Jun;97(6):E878-87. doi: 10.1210/jc.2011-2864. Epub 2012 Apr 10.
Thyroid cancer predominately affects women, carries a worse prognosis in older age, and may have higher mortality in men. Superimposed on these observations is the fact that most women have attained menopause by age 55 yr.
The objective of the study was to determine whether men contribute disproportionately to papillary thyroid cancer (PTC) mortality or whether menopause affects PTC prognosis.
Gender-specific mortality was normalized using age-matched subjects from the U.S. population. Multivariate Cox proportional hazard regression models incorporating gender, age, and National Thyroid Cancer Treatment Cooperative Study Group stage were used to model disease-specific survival (DSS).
Patients were followed in a prospective registry.
The relationships between gender, age, and PTC outcomes were analyzed.
The unadjusted hazard ratio (HR) for DSS for women was 0.40 [confidence interval (CI) 0.24-0.65]. This female advantage diminished when DSS was adjusted for age at diagnosis and stage with a HR encompassing unity (HR 0.72, CI 0.44-1.19). Additional multivariate models of DSS considering gender, disease stage, and various age groupings showed that the DSS for women diagnosed at under 55 yr was improved over men (HR 0.33, CI 0.13-0.81). However, the HR for DSS increased to become similar to men for women diagnosed at 55-69 yr (HR 1.01, CI 0.42-2.37) and at 70 yr or greater (HR 1.17, CI 0.48-2.85).
Although the overall outcome of women with PTC is similar to men, subgroup analysis showed that this composite outcome is composed of two periods with different outcomes. The first period is a period with better outcomes for women than men when the diagnosis occurs at younger than 55 yr; the second is a period with similar outcomes for both women and men diagnosed at ages greater than 55 yr. These data raise the question of whether an older age cutoff would improve current staging systems. We hypothesize that older age modifies the effect of gender on outcomes due to menopause-associated hormonal alterations.
甲状腺癌主要影响女性，在老年时预后更差，且男性死亡率可能更高。在此基础上，大多数女性在 55 岁前已绝经。
本研究旨在确定男性是否不成比例地导致甲状腺乳头状癌（PTC）死亡率增加，或者绝经是否影响 PTC 预后。
使用美国人口中的年龄匹配受试者对性别特异性死亡率进行标准化。采用包含性别、年龄和国家甲状腺癌治疗合作研究组分期的多变量 Cox 比例风险回归模型，对疾病特异性生存（DSS）进行建模。
患者在一个前瞻性注册中接受随访。
分析性别、年龄与 PTC 结局之间的关系。
未经调整的 DSS 危险比（HR）女性为 0.40（置信区间 0.24-0.65）。当根据诊断时的年龄和分期调整 DSS 时，女性优势减弱，HR 接近 1（HR 0.72，95%CI 0.44-1.19）。在考虑性别、疾病分期和各种年龄分组的 DSS 进一步多变量模型中，55 岁以下诊断的女性 DSS 优于男性（HR 0.33，95%CI 0.13-0.81）。然而，55-69 岁（HR 1.01，95%CI 0.42-2.37）和 70 岁及以上（HR 1.17，95%CI 0.48-2.85）诊断的女性 DSS HR 增加到与男性相似。
尽管女性 PTC 的总体结局与男性相似，但亚组分析表明，这一综合结局由两个不同结局的时期组成。第一个时期是女性比男性更早诊断（<55 岁）时，女性的结局更好；第二个时期是女性和男性在 55 岁以上诊断时的结局相似。这些数据提出了一个问题，即是否可以采用一个更老的年龄截止值来改善当前的分期系统。我们假设，由于绝经相关的激素变化，老年会改变性别对结局的影响。
