Randle Reese W, Balentine Courtney J, Leverson Glen E, Havlena Jeffrey A, Sippel Rebecca S, Schneider David F, Pitt Susan C
Department of Surgery, University of Wisconsin, Madison, WI.
Department of Surgery, University of Wisconsin, Madison, WI.
Surgery. 2017 Jan;161(1):137-146. doi: 10.1016/j.surg.2016.04.053. Epub 2016 Nov 11.
The impact of recent medical advances on disease presentation, extent of operation, and disease-specific survival for patients with medullary thyroid cancer is unclear.
We used the Surveillance, Epidemiology, and End Results registry to compare trends over 3 time periods, 1983-1992, 1993-2002, and 2003-2012.
There were 2,940 patients diagnosed with medullary thyroid cancer between 1983 and 2012. The incidence of medullary thyroid cancer increased during this time period from 0.14 to 0.21 per 100,000 population, and mean age at diagnosis increased from 49.8 to 53.8 (P < .001). The proportion of tumors ≤1 cm also increased from 11.4% in 1983-1992, 19.6% in 1993-2002, to 25.1% in 2003-2012 (P < .001), but stage at diagnosis remained constant (P = .57). In addition, the proportion of patients undergoing a total thyroidectomy and lymph node dissection increased from 58.2% to 76.5% during the study period (P < .001). In the most recent time interval, 5-year, disease-specific survival improved from 86% to 89% in all patients (P < .001) but especially for patients with regional (82% to 91%, P = .003) and distant (40% to 51%, P = .02) disease.
These data demonstrate that the extent of operation is increasing for patients with medullary thyroid cancer. Disease-specific survival is also improving, primarily in patients with regional and distant disease.
近期医学进展对甲状腺髓样癌患者的疾病表现、手术范围及疾病特异性生存率的影响尚不清楚。
我们使用监测、流行病学和最终结果登记系统比较了1983 - 1992年、1993 - 2002年和2003 - 2012年三个时间段的趋势。
1983年至2012年期间，共有2940例患者被诊断为甲状腺髓样癌。在此期间，甲状腺髓样癌的发病率从每10万人0.14例增至0.21例，诊断时的平均年龄从49.8岁增至53.8岁（P <.001）。肿瘤≤1 cm的比例也从1983 - 1992年的11.4%、1993 - 2002年的19.6%增至2003 - 2012年的25.1%（P <.001），但诊断时的分期保持不变（P =.57）。此外，在研究期间，接受全甲状腺切除术和淋巴结清扫术的患者比例从58.2%增至76.5%（P <.001）。在最近的时间段内，所有患者的5年疾病特异性生存率从86%提高到了89%（P <.001），特别是区域疾病患者（从82%提高到91%，P =.003）和远处疾病患者（从40%提高到51%，P =.02）。
这些数据表明，甲状腺髓样癌患者的手术范围在扩大。疾病特异性生存率也在提高，主要是区域和远处疾病患者。
