甲状腺乳头状癌罕见变异体的临床行为与生存相关：一项基于人群水平的分析。
Clinical behaviors of rare variants of papillary thyroid carcinoma are associated with survival: a population-level analysis.
作者信息
Jiang Chenghao, Cheng Tong, Zheng Xucai, Hong Shikai, Liu Song, Liu Jianjun, Wang Jing, Wang Shengying
机构信息
Department of Head - Neck Surgery, Anhui Provincial Cancer Hospital, West Branch of Anhui Provincial Hospital, Hefei, China.
Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Cancer Manag Res. 2018 Mar 9;10:465-472. doi: 10.2147/CMAR.S157823. eCollection 2018.
OBJECTIVE
This study was to evaluate the risk factors of survival in patients with columnar cell variant (CCV) and encapsulated variant (ECV).
MATERIALS AND METHODS
The Surveillance, Epidemiology, and End Results database (1988-2013) was used to compare the characteristics of CCV and ECV with those of classic papillary thyroid carcinoma (PTC). Survival was analyzed by the Kaplan-Meier method, the log-rank test, and Cox multivariate regression. Multivariate logistic regression was used to further analyze lymph node metastases and distant metastasis. There were 765 CCV, 529 ECV, and 39,035 PTC patients. ECV tumors were similar to PTC in terms of overall survival, disease-specific survival, age, sex, and distant metastasis.
RESULTS
Compared with PTC, CCV tumors tended to be larger, with a higher incidence rate among males and in patients ≥65 years of age. CCV was associated with higher rates of extrathyroidal extension, multifocality, lymph node examinations, and lymph node and distant metastases (<0.0001). Significant differences were found in 10-year overall survival (97.14% vs 89.15%, <0.0001) and disease-specific survival (99.08% vs 93.07%, <0.0001) between PTC and CCV. In CCV, distant metastasis (hazard ratio 5.125, <0.0001) and lymph nodal metastasis (hazard ratio 2.152, =0.032) predicted a poor prognosis. After adjustment, distant metastasis was independently associated with age ≥65 years, and lymph nodal metastasis was independently associated with female sex (odds ratio [OR] 0.341 [0.234-0.496]), extrathyroidal extension (OR 2.453 [1.368-4.397]), multifocality (OR 2.168 [1.318-3.569]), size >20 mm, ≤40 mm (OR 1.851 [1.170-2.928]), and size >40 mm (OR 1.847 [1.088-3.136]).
CONCLUSION
ECV appears to have a similar prognosis to PTC, while CCV has a worse prognosis than classic PTC. Treatment with external beam radiotherapy and radioactive implants should be conducted carefully in patients with CCV.
目的
本研究旨在评估柱状细胞变异型（CCV）和包裹型变异型（ECV）患者的生存风险因素。
材料与方法
利用监测、流行病学和最终结果数据库（1988 - 2013年）比较CCV和ECV与经典乳头状甲状腺癌（PTC）的特征。采用Kaplan-Meier法、对数秩检验和Cox多因素回归分析生存情况。采用多因素逻辑回归进一步分析淋巴结转移和远处转移情况。共有765例CCV患者、529例ECV患者和39035例PTC患者。ECV肿瘤在总生存、疾病特异性生存、年龄、性别和远处转移方面与PTC相似。
结果
与PTC相比，CCV肿瘤往往更大，在男性和≥65岁患者中的发病率更高。CCV与甲状腺外侵犯、多灶性、淋巴结检查以及淋巴结和远处转移的发生率较高相关（<0.0001）。PTC和CCV在10年总生存（97.14%对89.15%，<0.0001）和疾病特异性生存（99.08%对93.07%，<0.0001）方面存在显著差异。在CCV中，远处转移（风险比5.125，<0.0001）和淋巴结转移（风险比2.152，=0.032）预示预后不良。调整后，远处转移与年龄≥65岁独立相关，淋巴结转移与女性独立相关（比值比[OR]0.341[0.234 - 0.496]）、甲状腺外侵犯（OR 2.453[1.368 - 4. ???97]）、多灶性（OR 2.168[1.318 - 3.569]）、大小>20 mm且≤40 mm（OR 1.851[1.170 - 2.928]）以及大小>40 mm（OR 1.847[1.088 - 3.136]）。
结论
ECV的预后似乎与PTC相似，而CCV的预后比经典PTC更差。对于CCV患者，应谨慎进行外照射放疗和放射性植入治疗。
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