Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China.
Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
World J Surg Oncol. 2018 Mar 5;16(1):45. doi: 10.1186/s12957-018-1340-7.
The incidence of thyroid cancer in black Americans is significantly lower than that in white Americans, and the impact of race on the prognosis of thyroid cancer remains controversial. The purpose of this study was to determine the risk factors for survival in black and white patients and to compare the survival of differentiated thyroid carcinoma subtypes between these two races. We further investigated the association of lymph node and distant metastases with races.
This is a retrospective analysis using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. A total of 70,346 cases were included in our study. Patients' demographics and cancer- and treatment-related characteristics were compared between the black and white Americans using chi-square and Fisher's exact tests. For multivariate analysis, Cox proportional hazards regression were used to assess the association between potential risk factors and the survival in black and white patients.
Black Americans had a worse overall survival than white Americans (HR = 1.127, P = 0.002). While disease-specific survival (DSS) was comparable, the risk factors for DSS were different between white and black Americans. Black Americans had less lymph node metastasis of classical variant papillary thyroid carcinoma (CPTC, OR = 0.476, P < 0.001) and follicular variant papillary thyroid carcinoma (FVPTC, OR = 0.522, P < 0.001), but not follicular thyroid carcinoma (FTC). However, black Americans with FVPTC, but not CPTC or FTC, had a higher potential of distant metastasis (OR = 1.715, P = 0.026). Furthermore, only white patients with tumor > 2 cm and lymph node metastasis benefited from radioactive iodine.
The risk factors for DSS were significantly different in white and black patients. The impact of race should be considered in treatment strategy for thyroid cancer.
美国黑种人群甲状腺癌的发病率明显低于白种人群，种族对甲状腺癌预后的影响仍存在争议。本研究旨在确定黑人和白人患者生存的危险因素，并比较这两种人群中分化型甲状腺癌亚型的生存情况。我们进一步探讨了淋巴结和远处转移与种族的关系。
这是一项使用美国国家癌症研究所监测、流行病学和最终结果计划的数据进行的回顾性分析。我们的研究共纳入了 70346 例病例。使用卡方检验和 Fisher 确切检验比较了黑人和白人美国患者的人口统计学和癌症及治疗相关特征。对于多变量分析，使用 Cox 比例风险回归评估潜在危险因素与黑人和白人患者生存之间的关系。
黑种美国人的总生存率明显低于白种美国人（HR=1.127，P=0.002）。虽然疾病特异性生存率（DSS）相当，但白种人和黑种美国人的 DSS 危险因素不同。黑种美国人的经典型乳头状甲状腺癌（CPTC，OR=0.476，P<0.001）和滤泡型乳头状甲状腺癌（FVPTC，OR=0.522，P<0.001）的淋巴结转移较少，但滤泡状甲状腺癌（FTC）则不然。然而，黑种美国人的 FVPTC 而不是 CPTC 或 FTC 远处转移的可能性更高（OR=1.715，P=0.026）。此外，只有肿瘤>2cm 且有淋巴结转移的白种患者受益于放射性碘治疗。
白种人和黑种患者的 DSS 危险因素有显著差异。在制定甲状腺癌治疗策略时应考虑种族因素。
