The Whiteley-Martin Research Centre, Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia.
The Whiteley-Martin Research Centre, Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia.
Eur J Surg Oncol. 2019 Mar;45(3):310-317. doi: 10.1016/j.ejso.2018.07.055. Epub 2018 Sep 6.
Thyroid cancer, the most common endocrine malignancy, has patients who generally have excellent prognosis. It has been shown that elderly patients are more likely to undergo sub-therapeutic management, despite having more aggressive disease, resulting in increased mortality and morbidity. The present study aimed to quantitatively investigate the risks of elderly patients who underwent thyroidectomy for thyroid cancer regarding mortality/survival, recurrence of disease, and complications arising from thyroidectomy. A systematic search and meta-analysis was carried out using the electronic databases PubMed and Medline. We searched for articles containing epidemiological evidence of mortality and recurrence of disease in patients above the age of 60, who are treated for operatively thyroid cancer and data involving complications following total thyroidectomy. The meta-analysis consisted of a total of 16 studies meeting the inclusion and exclusion criteria. The current study confirmed that patients have increased risk of recurrence (HR 4.84; 95% CI = 22.2-10.52; I = 0.00; P = 0.98) including increased risk of lymph node recurrence and distant metastases. Additionally these patients had an increased risk of complications (OR 1.82; 95% CI = 0.88-3.77; I = 77.01; P = 0.005) following thyroidectomy compared to patients in the younger cohort. The current study also qualitatively compared survival data between the different age cohorts, and identified a reduced overall survival and disease free survival for elderly patients. The current study suggests that elderly patients should be classified as higher risk following total thyroidectomy for thyroid cancer and puts an emphasis is early detection and intervention.
甲状腺癌是最常见的内分泌恶性肿瘤，大多数患者预后良好。有研究表明，尽管老年患者的疾病更具侵袭性，但他们更有可能接受低于治疗标准的治疗，导致死亡率和发病率增加。本研究旨在定量研究老年甲状腺癌患者接受甲状腺切除术的死亡率/生存率、疾病复发和甲状腺切除术相关并发症的风险。使用电子数据库 PubMed 和 Medline 进行了系统搜索和荟萃分析。我们搜索了包含 60 岁以上患者的死亡率和疾病复发的流行病学证据的文章，这些患者接受手术治疗甲状腺癌，并且涉及全甲状腺切除术后并发症的数据。荟萃分析共包括 16 项符合纳入和排除标准的研究。本研究证实，老年患者的复发风险增加（HR 4.84；95%CI=22.2-10.52；I=0.00；P=0.98），包括淋巴结复发和远处转移的风险增加。此外，与年轻患者相比，这些患者在接受甲状腺切除术后发生并发症的风险增加（OR 1.82；95%CI=0.88-3.77；I=77.01；P=0.005）。本研究还定性比较了不同年龄组的生存数据，发现老年患者的总生存率和无病生存率降低。本研究表明，老年患者在接受甲状腺癌全甲状腺切除术后应被归类为更高风险，并强调早期发现和干预。
