From Jefferson Thyroid Center, Jefferson Medical College and Hospital, Philadelphia, Pennsylvania.
Endocr Pract. 2013 Nov-Dec;19(6):995-7. doi: 10.4158/EP13029.OR.
Age greater than 45 years old is a prognostic marker in well-differentiated papillary thyroid cancer (PTC) using the American Joint Cancer Committee/Union Internationale Contre le Cancer Tumor Nodes Metastasis (AJCC/UICC TNM) staging system. Our clinical observation has been that patients aged 45 to 64 years have similar outcomes when compared to patients younger than 45 years, and we questioned the origin and accuracy of this prognostic variable.
Using SEERstat software, we analyzed the Surveillance, Epidemiology, and End Result (SEER) database for PTC using the following International Classification of Diseases for Oncology (ICD-O) codes: 8050, 8260, 8340, 8341, 8342, 8243, and 8344. Data were stratified in 5-year categories by age at diagnosis from 20 to 84 years old, with patients 85 years old and above categorized together. Survival is reported as cause specific.
A total of 53,581 patients were identified. The 5-year survival rate decreased with each increasing age category with no inflection point at age 45 in the survival curve. While the prognosis was less favorable in each advancing age group, survival remained above 90% for all age groups under 65 years.
A review of the literature reveals a lack of data supporting the use of age 45 as a prognostic variable. Our SEER database review revealed a continuum of disease-specific mortality for each incremental 5-year time period above age 45. We conclude that the current use of age 45 as a single prognostic age marker does not accurately reflect the progressive mortality risk that is apparent with each 5-year increment in age.
根据美国癌症联合委员会/国际抗癌联盟肿瘤淋巴结转移（AJCC/UICC TNM）分期系统，年龄大于 45 岁是分化型甲状腺癌（PTC）的预后标志物。我们的临床观察发现，45 至 64 岁的患者与 45 岁以下的患者相比，结局相似，我们质疑这种预后变量的起源和准确性。
使用 SEERstat 软件，我们使用以下国际肿瘤疾病分类（ICD-O）代码在监测、流行病学和结果（SEER）数据库中分析 PTC：8050、8260、8340、8341、8342、8243 和 8344。数据按诊断时年龄分为 5 年一组，年龄 85 岁及以上的患者归为一组。生存报告为特定原因。
共确定了 53581 名患者。5 年生存率随年龄组的增加而降低，但生存曲线在 45 岁时没有拐点。虽然每个年龄组的预后都较差，但所有 65 岁以下年龄组的生存率仍保持在 90%以上。
对文献的回顾显示，缺乏支持将年龄 45 岁用作预后变量的数据。我们对 SEER 数据库的回顾显示，在 45 岁以上的每 5 年时间间隔内，疾病特异性死亡率呈连续变化。我们得出的结论是，目前将年龄 45 岁用作单一预后年龄标志物并不能准确反映随年龄每增加 5 年而出现的渐进性死亡风险。
