甲状腺滤泡细胞癌：3311 例患者的人群水平分析。

Hurthle cell carcinoma: a population-level analysis of 3311 patients.

机构信息

Milano-Bicocca University, Monza, Italy.

出版信息

Cancer. 2013 Feb 1;119(3):504-11. doi: 10.1002/cncr.27770. Epub 2012 Aug 14.

DOI:10.1002/cncr.27770

PMID:22893587

Abstract

BACKGROUND

Hurthle cell carcinoma (HCC) is an uncommon and more aggressive thyroid cancer. To date, there is a paucity of data at a population level. In this study, demographic, clinical, and pathologic characteristics of HCC were investigated and compared with other types of differentiated thyroid cancers (ODTCs). The authors also evaluated disease-specific survival and compliance with American Thyroid Association (ATA) management guidelines from 2009.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2009 was used to obtain data on patients with thyroid cancer. Data analyses were performed using chi-square tests, analysis of variance, Kaplan-Meier analysis, binary logistic regression, and Cox proportional hazards regression.

RESULTS

In total, 3311 patients with HCC and 59,585 patients with ODTC were identified. Compared with ODTC, HCC was more common among men (31.1% vs 23.0% for ODTC; P < .001) and among older patients (mean age, 57.6 years vs 48.9 years for ODTC; P < .001). Patients with HCC presented with higher SEER disease stage (P < .001), and their tumors were larger (36.1 mm vs 20.2 mm for ODTC; P < .001). Fewer patients underwent total thyroidectomy (P = .028). Both overall and disease-specific survival were lower for patients with HCC (P < .001), and neither improved over the last 2 decades (P = .689). After adjustment, age ≥45 years, not undergoing surgery, and metastatic disease were strongly associated with a worse prognosis (hazard ratio >3.0). Compliance with recommended surgical treatment according to ATA guidelines was lower among patients with HCC aged ≥65 years (odds ratio [OR], 1.43; P = .002) and among unmarried patients (OR, 1.29; P = .004). Predictors of noncompliance with ATA guidelines for treatment with radioactive implants or radioisotopes were age ≥65 years (OR, 1.31; P = .017), diagnosis between 1988 and 1997, no surgery, and partial thyroidectomy (OR, 1.81, 19.48, and 4.02, respectively; P < .001).

CONCLUSIONS

HCC has more aggressive behavior and compromised survival compared with ODTC. The current results indicated that it may be important to consider a different staging system or separate practice guidelines.

摘要

背景

Hurthle 细胞癌（HCC）是一种罕见且侵袭性更强的甲状腺癌。迄今为止，在人群水平上的数据仍然很少。本研究调查了 HCC 的人口统计学、临床和病理特征，并将其与其他类型的分化型甲状腺癌（ODTC）进行了比较。作者还评估了 2009 年美国甲状腺协会（ATA）管理指南的疾病特异性生存率和依从性。

方法

使用 1988 年至 2009 年的监测、流行病学和最终结果（SEER）数据库获取甲状腺癌患者的数据。使用卡方检验、方差分析、Kaplan-Meier 分析、二元逻辑回归和 Cox 比例风险回归进行数据分析。

结果

共确定了 3311 例 HCC 患者和 59585 例 ODTC 患者。与 ODTC 相比，HCC 更常见于男性（31.1%比 ODTC 的 23.0%；P<0.001）和老年患者（平均年龄 57.6 岁比 ODTC 的 48.9 岁；P<0.001）。HCC 患者的 SEER 疾病分期更高（P<0.001），肿瘤更大（36.1mm 比 ODTC 的 20.2mm；P<0.001）。接受全甲状腺切除术的患者较少（P=0.028）。HCC 患者的总生存率和疾病特异性生存率均较低（P<0.001），且在过去 20 年中均无改善（P=0.689）。调整后，年龄≥45 岁、未行手术和转移性疾病与预后较差密切相关（风险比>3.0）。≥65 岁的 HCC 患者（优势比 [OR]，1.43；P=0.002）和未婚患者（OR，1.29；P=0.004）更不符合 ATA 指南推荐的手术治疗。不符合 ATA 指南放射性碘或放射性同位素治疗的预测因素为年龄≥65 岁（OR，1.31；P=0.017）、诊断时间为 1988 年至 1997 年、未行手术和行甲状腺部分切除术（OR，1.81、19.48 和 4.02；P<0.001）。