Al-Qurayshi Zaid, Mohamed Hossam, Bhatia Parisha, Srivastav Sudesh, Aslam Rizwan, Kandil Emad
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S691-8. doi: 10.1245/s10434-015-4800-0. Epub 2015 Aug 18.
Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary thyroid cancer. We aim to examine the difference between primary and secondary thyroid cancer in terms of patient characteristics and perioperative outcomes at the national level.
A cross-sectional study utilizing the Nationwide Inpatient Sample database for 2003-2010 was merged with County Health Rankings Data. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify adult patients with thyroid cancer.
A total of 21,581 discharge records were included. Overall, 16,625 (77.0 %) patients had primary cancer, while the rest (23.0 %) had secondary cancer. Younger (<45 years) and older (>65 years) patients, males, and those of White or Hispanic background were more likely to have secondary cancers (p < 0.05 each). The prevalence of secondary cancer was higher in communities of low health risk (24.0 % vs. 21.1 %; p < 0.024). Secondary cancer was more likely to be managed by total thyroidectomy (odds ratio [OR] 2.40, 95 % CI 2.12-2.73) and to require additional radical neck dissection (OR 12.51, 95 % CI 10.98-14.25). Patients with secondary thyroid cancers were at higher risk of postoperative complications (p < 0.01 each). The cost of secondary cancer management was significantly higher than primary cancer (US$12,449.00 ± 302.07 vs. US$7848.12 ± 149.05; p < 0.001). However, compared with intermediate-volume surgeons, the complication risk was lower for high-volume (OR 0.47, 95 % CI 0.24-0.92; p = 0.026).
Secondary thyroid cancer is associated with a higher risk of perioperative complications and higher cost and distinct demographic profile. Patients managed by higher-volume surgeons were less likely to experience disadvantageous outcomes.
人们认为继发性甲状腺癌会导致比原发性甲状腺癌更具侵袭性的临床病程。我们旨在在全国范围内研究原发性和继发性甲状腺癌在患者特征和围手术期结局方面的差异。
一项横断面研究利用了2003 - 2010年全国住院患者样本数据库，并与县卫生排名数据合并。使用国际疾病分类第九版（ICD - 9）编码来识别成年甲状腺癌患者。
共纳入21,581份出院记录。总体而言，16,625名（77.0%）患者患有原发性癌症，其余（23.0%）患有继发性癌症。年龄较小（<45岁）和较大（>65岁）的患者、男性以及白人或西班牙裔背景的患者更有可能患有继发性癌症（各p < 0.05）。在健康风险较低的社区中，继发性癌症的患病率更高（24.0%对21.1%；p < 0.024）。继发性癌症更有可能通过全甲状腺切除术进行治疗（优势比[OR] 2.40，95%置信区间2.12 - 2.73），并且更有可能需要额外的根治性颈清扫术（OR 12.51，95%置信区间10.98 - 14.25）。继发性甲状腺癌患者术后并发症的风险更高（各p < 0.01）。继发性癌症的治疗费用显著高于原发性癌症（12,449.00美元±302.07对7848.12美元±149.05；p < 0.001）。然而，与中等手术量的外科医生相比，高手术量外科医生的并发症风险更低（OR 0.47，9
