Liu Zeming, Zeng Wen, Zhou Ling, Zhou Wei, Chen Danyang, Feng Haifeng, Wei Wei, Zhang Chao, Wang Min, Guo Liang
Department of Plastic Surgery, Zhongnan Hospital of Wuhan University Wuhan 430071, China.
Department of Ophthalmology, Zhongnan Hospital of Wuhan University Wuhan 430071, China.
Am J Transl Res. 2019 Jan 15;11(1):176-187. eCollection 2019.
Insular thyroid cancer (ITC) is a relatively rare thyroid malignancy that has an unclear prognosis. Recent studies have indicated that watchful waiting is sufficient for younger patients with more differentiated thyroid lesions such as papillary thyroid microcarcinoma (PTMC). In this study, we investigated the prognosis of younger patients (< 45 and < 55 years old) with ITC and compared their outcomes to patients with PTMC and follicular thyroid microcarcinoma (FTMC). We hypothesized that ITC, like PTMC and FTMC, can be managed with active surveillance in younger patients with this disease. We investigated a large cohort of younger patients with ITC, PTMC, or FTMC who were listed in the Surveillance, Epidemiology, and End Results database between 2004 and 2013. Patient mortality was examined by Kaplan-Meier analyses with log-rank tests and Cox proportional hazards regression analyses. In the study cohort, the rate of cancer-specific mortality per 1000 person-years for younger ITC patients (< 45 and < 55 years) was lower than that for PTMC and FTMC. Kaplan-Meier analyses revealed that the cancer-specific and all-cause mortality rates in younger ITC patients were similar to those of PTMC and FTMC. Similar results were obtained when cases with tumor extension were excluded from the analysis. The unanticipated excellent prognosis of younger patients with ITC challenges the current clinical practice of automatically treating this disease, and offers new implications for management such as pursuing active surveillance instead.
甲状腺微小癌（ITC）是一种相对罕见的甲状腺恶性肿瘤，其预后尚不清楚。最近的研究表明，对于患有分化程度更高的甲状腺病变（如甲状腺微小乳头状癌（PTMC））的年轻患者，密切观察就足够了。在本研究中，我们调查了年轻的ITC患者（<45岁和<55岁）的预后，并将他们的结果与PTMC和甲状腺微小滤泡癌（FTMC）患者进行比较。我们假设，与PTMC和FTMC一样，ITC在年轻患者中可以通过积极监测来管理。我们调查了2004年至2013年期间列入监测、流行病学和最终结果数据库的一大群患有ITC、PTMC或FTMC的年轻患者。通过Kaplan-Meier分析、对数秩检验和Cox比例风险回归分析来检查患者死亡率。在研究队列中，年轻ITC患者（<45岁和<55岁）每1000人年的癌症特异性死亡率低于PTMC和FTMC。Kaplan-Meier分析显示，年轻ITC患者的癌症特异性死亡率和全因死亡率与PTMC和FTMC相似。当将有肿瘤侵犯的病例排除在分析之外时，也得到了类似的结果。年轻ITC患者出人意料的良好预后挑战了目前对这种疾病进行自动治疗的临床实践，并为管理提供了新的启示，比如改为采用积极监测。
