Tariq Khurram, Rana Fauzia, Zaiden Robert, Zuberi Lara, Farhangi Arezo, Ibrahim Saif, Tariq Wajiha, Palacio Carlos, Al-Saffar Farah, Pham Dat
Division of Hematology and Medical Oncology, University of Florida, Jacksonville, FL, USA.
World J Oncol. 2014 Jun;5(3):113-117. doi: 10.14740/wjon835w. Epub 2014 Jun 25.
Patients with head and neck cancers (HNCs) are often treated with external beam radiation therapy (XRT). Unfortunately this therapy is not without its unintended consequences. One of these side effects includes the development of radiation-induced hypothyroidism. Our study is designed to pay special attention to variables like gender and smoking history and analyze their relationship with the development of hypothyroidism.
Patients' charts were reviewed over a period of 13 years from January 1, 2000 to November 30, 2013 to gather information on patients who had previously received XRTs for HNCs. We used the Tumor Registry Database at the University of Florida, College of Medicine in Jacksonville for this retrospective review. Patient characteristics were examined including age, gender, race/ethnicity and smoking history. Special attention was paid to the development of hypothyroidism (thyroid stimulating hormones > 5.0 with appropriate decrease in free serum T4) levels after exposure to XRT for HNCs. Results were then analyzed using the univariate statistical analysis which was done using the SAS software using a 0.05 alpha level of significance expressed in terms of odds ratio (OR) with 95% confidence intervals (CIs).
We found a total of 1,116 patients in our database who have received XRTs for HNCs. Out of these 72 (6.45%) patients developed hypothyroidism. Out of 263 African American patients 20 (7.6%) had hypothyroidism, whereas 49 (6%) out of 819 white people had this outcome. As for gender 32 out of 341 females (9.4%) and 40 out of 775 males had hypothyroidism. Thirty-five out of 544 (6.4%) with no family history and 19 (2.4%) out of 205 (9.3%) with positive family history for cancer had the outcome too. Finally 43 (6.5%) out of 664 smokers and 17 (8.3%) out of 206 non-smokers were found to develop hypothyroid as well. Both groups were found to have homogenous average age at diagnosis. When the univariate analysis was conducted, the strongest predicting variable was gender as hypothyroid patients were 1.90 (95% CI 1.17 - 3.09) times more likely to be females, and these results were statistically significant with P value of 0.008. More patients tended to be African Americans with OR 1.21 (CI 0.822 - 1.78), had positive family history of cancer (negative family history had OR 0.67 (CI 0.38 - 1.21), and less likely to be smokers (OR 0.77 (0.43 - 1.38). However, race, family history of cancer and smoking history did not achieve any statistical significance as evident by the P values.
In our patient population, females were more likely to develop radiation-induced hypothyroidism.
头颈癌（HNC）患者常接受外照射放疗（XRT）。不幸的是，这种治疗并非没有意外后果。其中一个副作用是放射性甲状腺功能减退的发生。我们的研究旨在特别关注性别和吸烟史等变量，并分析它们与甲状腺功能减退发生的关系。
回顾了2000年1月1日至2013年11月30日这13年间患者的病历，以收集此前因头颈癌接受过XRT治疗的患者信息。我们使用佛罗里达大学杰克逊维尔医学院的肿瘤登记数据库进行这项回顾性研究。检查了患者的特征，包括年龄、性别、种族/民族和吸烟史。特别关注头颈癌接受XRT治疗后甲状腺功能减退（促甲状腺激素>5.0且游离血清T4相应降低）的发生情况。然后使用单变量统计分析对结果进行分析，该分析使用SAS软件，以0.05的α显著性水平表示，以比值比（OR）和95%置信区间（CI）表示。
我们在数据库中总共发现1116名因头颈癌接受过XRT治疗的患者。其中72名（6.45%）患者出现了甲状腺功能减退。在263名非裔美国患者中，20名（7.6%）患有甲状腺功能减退，而在819名白人中，49名（6%）有此结果。至于性别，341名女性中有32名（9.4%），775名男性中有40名患有甲状腺功能减退。544名无家族癌症史的患者中有35名（6.4%），205名有癌症家族史阳性的患者中有19名（9.3%）出现了该结果。最后，664名吸烟者中有43名（6.5%），206名不吸烟者中有17名（8.3%）也被发现患有甲状腺功能减退。两组在诊断时的平均年龄均具有同质性。进行单变量分析时，最强的预测变量是性别，因为甲状腺功能减退患者为女性的可能性是男性的1.90倍（95%CI 1.17 - 3.09），这些结果具有统计学意义，P值为0.008。更多患者倾向于为非裔美国人，OR为1.21（CI 0.822 - 1.78），有癌症家族史阳性（阴性家族史的OR为0.67（CI 0.38 - 1.21），且吸烟的可能性较小（OR为0.77（0.43 - 1.38）。然而，种族、癌症家族史和吸烟史并未达到任何统计学意义，P值表明了这一点。
在我们的患者群体中，女性更易发生放射性甲状腺功能减退。
