1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
2 Department of Internal Medicine, Chonnam National University Medical School , Gwangju, Korea.
Thyroid. 2018 Sep;28(9):1121-1127. doi: 10.1089/thy.2018.0159. Epub 2018 Jul 23.
Recent studies have reported improved survival in patients with thyroid cancer. This study evaluated the changes in disease-specific survival (DSS) of patients with differentiated thyroid cancer (DTC) in association with clinicopathologic characteristics from 1996 to 2005 in Korea.
This was a retrospective, multicenter cohort study. A total of 4398 DTC patients were included, and they were classified according to the year of initial surgery: 1996-2000 (period 1), 2001-2003 (period 2), and 2004-2005 (period 3).
During the study period, patient age and the proportion of papillary thyroid cancer increased gradually. Primary tumors became smaller (2.3 ± 1.4 cm at period 1 to 1.5 ± 1.2 cm at period 3; p < 0.001). The proportion of high-volume lymph node metastases decreased significantly (20% at period 1 to 13% at period 3; p for trend <0.001). DSS differed significantly according to period during the median 10 years follow-up (p = 0.002). The 10-year DSS rates were 98.0%, 98.7%, and 99.2% in periods 1, 2, and 3, respectively. After adjusting for various characteristics, the disease-specific mortality risk was significantly lower during period 2 (hazard ratio = 0.49 [confidence interval CI 0.25-0.90], p = 0.021) and period 3 (hazard ratio = 0.40 [confidence interval 0.21-0.77], p = 0.006) compared to that of period 1. This trend was also significant in a subgroup analysis of low (I-II) and high (III-IV) TNM stages.
The disease-specific mortality of patients with DTC in Korea decreased over time. Earlier detection of small DTCs with less extensive disease and standardization of treatment may be associated with this phenomenon.
最近的研究报告显示甲状腺癌患者的生存率有所提高。本研究评估了 1996 年至 2005 年韩国分化型甲状腺癌（DTC）患者的疾病特异性生存率（DSS）与临床病理特征的变化。
这是一项回顾性、多中心队列研究。共纳入 4398 例 DTC 患者，根据初始手术年份分为 1996-2000 年（第 1 期）、2001-2003 年（第 2 期）和 2004-2005 年（第 3 期）。
研究期间，患者年龄和乳头状甲状腺癌的比例逐渐增加。原发肿瘤逐渐缩小（第 1 期为 2.3±1.4cm，第 3 期为 1.5±1.2cm；p<0.001）。高体积淋巴结转移的比例显著下降（第 1 期为 20%，第 3 期为 13%；p 趋势<0.001）。在中位 10 年随访期间，DSS 随时期显著不同（p=0.002）。第 1、2 和 3 期的 10 年 DSS 率分别为 98.0%、98.7%和 99.2%。调整各种特征后，第 2 期（风险比=0.49[置信区间 0.25-0.90]，p=0.021）和第 3 期（风险比=0.40[置信区间 0.21-0.77]，p=0.006）的疾病特异性死亡率明显低于第 1 期。在低（I-II）和高（III-IV）TNM 分期的亚组分析中也存在这种趋势。
韩国 DTC 患者的疾病特异性死亡率随时间降低。早期发现较小的 DTC，疾病范围较小，治疗标准化可能与此现象有关。
