Tang Jing, Liu Hans B, Yu Lujiao, Meng Xin, Leng Sean X, Zhang Haiyan
Department of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China.
Department of Geriatrics, The First People's Hospital of Jingmen, Jingmen, Hubei, 448000, P.R. China.
J Cancer. 2018 Jan 1;9(2):256-262. doi: 10.7150/jca.22700. eCollection 2018.
The incidence of papillary thyroid microcarcinoma (PTMC) has increased dramatically over the past three decades worldwide. The annual rate of increase in the elderly (≥65) PTMC patients is 1.4 times higher than that in the adult (<65) PTMC patients. The aim of the present study is to identify the clinical-pathological characteristics and prognostic factors in the elderly PTMC patients. The source population is PTMC patients whose information is available in the Surveillance, Epidemiology and End Results (SEER) database (2004-2013). We analyzed specific selected clinical-pathological parameters and prognostic factors for the PTMC patients who were aged 65 or above (N=4812). Within the elderly group, the male patients, in comparison to the females, had a higher percentage of lymph-node metastases (5.29% vs. 12.27%, < 0.001), distant metastasis (0.27% vs. 1.07%, < 0.001), and stage III-IV tumors (9.19% vs. 15.85%, < 0.001). Moreover, the elderly patients had a lower median cause-specific survival (CSS) compared with the adult patients ( < 0.001). Stage III-IV disease (hazard ratio (HR): 8.064, < 0.001) was a strong risk factor for PTMC CSS. Being female (HR: 0.440, = 0.011), total thyroidectomy (HR: 0.057, = 0.001), and lobectomy (HR: 0.058, < 0.001) were all strong protectors of PTMC CSS. Thyroidectomy improved CSS of the elderly PTMC patients. Compared with thyroid lobectomy, total thyroidectomy did not increase CSS for the elderly PTMC patients. The elderly PTMC patients who received radio therapy did not experience an increase in CSS.
在过去三十年里，全球甲状腺微小乳头状癌（PTMC）的发病率急剧上升。老年（≥65岁）PTMC患者的年增长率比成年（<65岁）PTMC患者高1.4倍。本研究的目的是确定老年PTMC患者的临床病理特征和预后因素。源人群为监测、流行病学和最终结果（SEER）数据库（2004 - 2013年）中可获取信息的PTMC患者。我们分析了年龄在65岁及以上的PTMC患者（N = 4812）特定选择的临床病理参数和预后因素。在老年组中，男性患者与女性患者相比，有更高比例的淋巴结转移（5.29%对12.27%，<0.001）、远处转移（0.27%对1.07%，<0.001）以及III - IV期肿瘤（9.19%对15.85%，<0.001）。此外，老年患者的中位特定病因生存率（CSS）低于成年患者（<0.001）。III - IV期疾病（风险比（HR）：8.064，<0.001）是PTMC患者CSS的一个强风险因素。女性（HR：0.440，=0.011）、甲状腺全切术（HR：0.057，=0.001）和甲状腺叶切除术（HR：0.058，<0.001）都是PTMC患者CSS的强保护因素。甲状腺切除术改善了老年PTMC患者的CSS。与甲状腺叶切除术相比，甲状腺全切术并未增加老年PTMC患者的CSS。接受放疗的老年PTMC患者的CSS并未增加。
