甲状腺功能亢进症患者接受放射性碘治疗或甲状腺切除术的癌症发病率和死亡率。
Cancer Incidence and Mortality in Patients Treated Either With RAI or Thyroidectomy for Hyperthyroidism.
机构信息
Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland.
出版信息
J Clin Endocrinol Metab. 2015 Oct;100(10):3710-7. doi: 10.1210/jc.2015-1874. Epub 2015 Aug 11.
CONTEXT
Some previous studies have suggested increased cancer risk in hyperthyroid patients treated with radioactive iodine (RAI). It is unclear whether the excess cancer risk is attributable to hyperthyroidism, its treatment, or the shared risk factors of the two diseases.
OBJECTIVE
The objective was to assess cancer morbidity and mortality in hyperthyroid patients treated with either RAI or surgery.
PATIENTS
We identified 4334 patients treated surgically for hyperthyroidism in Finland during 1986-2007 from the Hospital Discharge Registry and 1814 patients treated with RAI for hyperthyroidism at Tampere University Hospital. For each patient, three age- and gender-matched controls were chosen. Information on cancer diagnoses was obtained from the Cancer Registry. The follow-up began 3 months after the treatment and ended at cancer diagnosis, death, emigration, or the common closing date (December 31, 2009).
RESULTS
The overall cancer incidence was not increased among the hyperthyroid patients compared to their controls (rate ratio [RR], 1.05; 95% confidence interval [CI], 0.96-1.15). However, the risk of cancers of the respiratory tract (RR, 1.46; 95% CI, 1.05-2.02) and the stomach (RR, 1.64; 95% CI, 1.01-2.68) was increased among the patients. The overall cancer mortality did not differ between the patients and the controls (RR, 1.08; 95% CI, 0.94-1.25). The type of treatment did not affect the overall risk of cancer (hazard ratio for RAI vs thyroidectomy, 1.03; 95% CI, 0.86-1.23) or cancer mortality (hazard ratio, 1.04; 95% CI, 0.91-1.21).
CONCLUSIONS
In this cohort of Finnish patients with hyperthyroidism treated with thyroidectomy or RAI, the overall risk of cancer was not increased, although an increased risk of gastric and respiratory tract cancers was seen in hyperthyroid patients. Based on this large-scale, long-term follow-up study, the increased cancer risk in hyperthyroid patients is attributable to hyperthyroidism and shared risk factors, not the treatment modality.
背景
一些先前的研究表明，接受放射性碘（RAI）治疗的甲状腺功能亢进患者癌症风险增加。目前尚不清楚这种额外的癌症风险是归因于甲状腺功能亢进、其治疗还是两种疾病的共同危险因素。
目的
评估甲状腺功能亢进患者接受 RAI 或手术治疗后的癌症发病率和死亡率。
患者
我们从芬兰医院出院登记处确定了 1986 年至 2007 年间接受手术治疗甲状腺功能亢进的 4334 例患者，并从坦佩雷大学医院确定了 1814 例接受 RAI 治疗甲状腺功能亢进的患者。为每位患者选择了三名年龄和性别匹配的对照者。癌症诊断信息来自癌症登记处。随访从治疗后 3 个月开始，截止于癌症诊断、死亡、移民或共同截止日期（2009 年 12 月 31 日）。
结果
与对照组相比，甲状腺功能亢进患者的整体癌症发病率并未增加（发病率比 [RR]，1.05；95%置信区间 [CI]，0.96-1.15）。然而，患者中呼吸道（RR，1.46；95%CI，1.05-2.02）和胃部（RR，1.64；95%CI，1.01-2.68）癌症的风险增加。患者和对照组之间的总体癌症死亡率没有差异（RR，1.08；95%CI，0.94-1.25）。治疗类型并未影响癌症的总体风险（RAI 与甲状腺切除术的风险比，1.03；95%CI，0.86-1.23）或癌症死亡率（风险比，1.04；95%CI，0.91-1.21）。
结论
在这项芬兰甲状腺功能亢进患者接受甲状腺切除术或 RAI 治疗的队列研究中，整体癌症风险没有增加，尽管甲状腺功能亢进患者的胃癌和呼吸道癌症风险增加。基于这项大规模、长期随访研究，甲状腺功能亢进患者的癌症风险增加归因于甲状腺功能亢进和共同危险因素，而不是治疗方式。
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