Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania 17033, USA.
Eur J Endocrinol. 2013 Mar 15;168(4):549-56. doi: 10.1530/EJE-12-0848. Print 2013 Apr.
Data from the Surveillance Epidemiology and End Results Medicare-linked database were used to estimate the incidence of and risk factors associated with recurrent thyroid cancer, and to assess the impact of recurrence on mortality following diagnosis, controlling for mortality as a competing risk.
We identified 2883 patients over 65 years of age diagnosed with a single, primary well-differentiated thyroid cancer between 1995 and 2007. A recurrence was considered if the patient had evidence of I-131 therapy, imaging for metastatic thyroid carcinoma, or complete thyroidectomy beyond 6 months of diagnosis. Competing risk regressions were performed using Cox proportional hazards models with 1- and 2-year landmarks.
Recurrence was observed in 1117 (39%) of the 2883 patients in the cohort. Age, stage, and treatment status were significant risk factors for developing recurrent disease (P<0.0001). Patients with recurrent disease had a higher risk of all-cause mortality within 10 years of diagnosis than patients with no recurrence at 1- and 2-year landmarks. Patients with follicular histology and a recurrence were less likely to die from cancer (hazard ratio 0.54; P=0.03) than patients with no recurrence.
The rate of recurrence of well-differentiated thyroid carcinomas in this sample of elderly patients was 39%. Extent of disease and older age negatively impacted the risk of recurrence from differentiated thyroid cancer. In these data, patients with follicular histology and a recurrence were less likely to die, suggesting that mortality and recurrence are competing risks. These data should be taken into account with individualized treatment strategies for elderly patients with recurrent malignant thyroid disease.
利用监测、流行病学和最终结果——医疗保险链接数据库的数据，评估 1995 年至 2007 年间诊断为单发、原发性分化型甲状腺癌的年龄超过 65 岁的患者中癌症复发的发生率及其相关风险因素，并在考虑死亡作为竞争风险的情况下，评估复发对诊断后死亡率的影响。
我们从数据库中识别出 2883 例年龄超过 65 岁、诊断为单发、原发性分化型甲状腺癌的患者。如果患者存在 I-131 治疗、转移性甲状腺癌影像学检查或诊断后 6 个月以上的全甲状腺切除术证据，则认为存在复发。使用 Cox 比例风险回归模型，以 1 年和 2 年为时间节点进行竞争风险回归分析。
在 2883 例患者队列中，有 1117 例（39%）患者发生了复发。年龄、分期和治疗状态是发生疾病复发的显著风险因素（P<0.0001）。与无复发的患者相比，在诊断后 10 年内，有复发的患者发生全因死亡的风险更高，在 1 年和 2 年的时间节点均如此。与无复发的患者相比，具有滤泡状组织学和复发的患者死于癌症的风险较低（风险比 0.54；P=0.03）。
在本老年患者样本中，分化型甲状腺癌的复发率为 39%。疾病的严重程度和年龄的增加对分化型甲状腺癌复发的风险有负面影响。在这些数据中，具有滤泡状组织学和复发的患者死亡的可能性较小，这表明死亡率和复发是竞争风险。在制定具有复发恶性甲状腺疾病的老年患者的个体化治疗策略时，应考虑这些数据。
