1 Gene Upshaw Memorial Tahoe Forest Cancer Center , Truckee, California.
2 Division of Hematology/Oncology, University of California , Davis, Comprehensive Cancer Center, Sacramento, California.
Thyroid. 2018 Sep;28(9):1143-1152. doi: 10.1089/thy.2017.0483. Epub 2018 Jul 26.
In an era of rising differentiated thyroid cancer incidence, the rate and impact of neck reoperation may inform the intensity of earlier interventions and surveillance. This study sought to define predictors of neck reoperation and to assess its impact on survival.
Using the California Cancer Registry linked to the California Office of Statewide Health Planning and Development records, a retrospective cohort study was performed of 24,230 patients with total or near-total thyroidectomy for papillary or follicular thyroid cancer between 1991 and 2008 and follow-up through 2013. The primary outcome was neck reoperation 91 days to 5 years after the initial thyroid surgery. Using logistic and Cox proportional hazards regression, the impact of sociodemographics, tumor staging, and hospital thyroid cancer surgery volume on neck reoperation and survival was determined.
Neck reoperation was identified in 1231 (5.1%) patients in increasing odds from 1991 to 2008. In multivariable models, male sex, papillary thyroid cancer, and advancing tumor stage were associated with neck reoperation. Among men, neck reoperation was associated with Asian/Pacific Islander (odds ratio [OR] = 1.44 [confidence interval (CI) 1.07-1.94]) race/ethnicity. Among women, neck reoperation was associated with younger age (15-34 years; OR = 1.50 [CI 1.17-1.92] versus ≥55 years), and Asian/Pacific Islander (OR = 1.24 [CI 1.02-1.51]) or Hispanic (OR = 1.20 [CI 1.00-1.44]) race/ethnicity. After controlling for baseline characteristics, neck reoperation predicted worse thyroid cancer-specific survival (hazard ratio = 4.26 [CI 3.50-5.19]). The effect differed between men and women, and was most pronounced among women who received radioiodine in initial treatment (hazard ratio = 8.32 [CI 6.14-11.27]).
Neck reoperation is becoming increasingly frequent and is strongly predictive of mortality. Advancing tumor stage, Asian/Pacific Islander race/ethnicity, male sex, as well as younger age and Hispanic ethnicity among women predict a higher risk for neck reoperation and subsequent mortality, reflecting a higher risk of persistent or more biologically aggressive disease.
在分化型甲状腺癌发病率上升的时代，颈部再次手术的发生率和影响因素可能会影响早期干预和监测的强度。本研究旨在确定颈部再次手术的预测因素，并评估其对生存的影响。
本研究使用加利福尼亚癌症登记处和加利福尼亚州全州卫生规划和发展记录，对 1991 年至 2008 年间因乳头状或滤泡状甲状腺癌接受全甲状腺切除术或近全甲状腺切除术并随访至 2013 年的 24230 例患者进行了回顾性队列研究。主要结果是初始甲状腺手术后 91 天至 5 年内的颈部再次手术。使用逻辑回归和 Cox 比例风险回归，确定社会人口统计学、肿瘤分期和医院甲状腺癌手术量对颈部再次手术和生存的影响。
1991 年至 2008 年，1231 例（5.1%）患者的颈部再次手术风险逐渐增加。多变量模型显示，男性、甲状腺乳头状癌和肿瘤分期进展与颈部再次手术相关。在男性中，颈部再次手术与亚洲/太平洋岛民（比值比 [OR] = 1.44 [置信区间 1.07-1.94]）种族/民族相关。在女性中，颈部再次手术与年龄较轻（15-34 岁；OR = 1.50 [CI 1.17-1.92] 与 ≥55 岁）、亚洲/太平洋岛民（OR = 1.24 [CI 1.02-1.51]）或西班牙裔（OR = 1.20 [CI 1.00-1.44]）种族/民族相关。在控制基线特征后，颈部再次手术预测甲状腺癌特异性生存率更差（风险比 = 4.26 [CI 3.50-5.19]）。该影响在男性和女性之间存在差异，在接受初始治疗时接受放射性碘治疗的女性中最为明显（风险比 = 8.32 [CI 6.14-11.27]）。
颈部再次手术的频率越来越高，并且强烈预测死亡率。肿瘤分期进展、亚洲/太平洋岛民种族/民族、男性，以及女性的年龄较轻和西班牙裔种族/民族预测颈部再次手术和随后死亡率的风险更高，反映出持续存在或更具生物学侵袭性疾病的风险更高。
