成年患者接受治疗性放射后的甲状腺癌风险：基于年龄的监测、流行病学和结果分析。

Risk of thyroid cancer after therapeutic irradiation in adult patients: An Age-Based surveillance, epidemiology, and end results analysis.

机构信息

Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A.

College of Medicine, UT Health McGovern School of Medicine, Houston, Texas, U.S.A.

出版信息

Laryngoscope. 2020 Aug;130(8):2081-2086. doi: 10.1002/lary.28407. Epub 2019 Nov 20.

DOI:10.1002/lary.28407

PMID:31747075

Abstract

OBJECTIVES/HYPOTHESIS: One risk of radiation therapy exposure (XRTe) is second primary thyroid cancer (SPTC). Previous reports examined this in children, but no population-based studies have explored XRTe and SPTC across all ages or stratified by histological subtypes.

STUDY DESIGN

Database study.

METHODS

We report patient characteristics of a Surveillance, Epidemiology, and End Results (SEER) dataset of SPTC (n = 4,669) using χ and t tests. Odds ratio (OR) for SPTC was determined based on age, histology, and XRTe compared to expected values in the SEER database. Kaplan-Meier survival and Cox proportional hazard ratios were reported to determine factors influencing latent survival (LS; time from initial diagnosis to SPTC) and overall survival in univariate and multivariate models.

RESULTS

Extrathyroid extension and node status based on XRTe were similar (P = .684 and P = .776, respectively). XRTe patients were more likely to have smaller tumors (17.6 vs. 19.3 mm, P = .007). XRTe patients were diagnosed with SPTC at younger ages (59.8 vs. 62.7 years, P < .001) without a difference in LS (7.45 vs. 7.50 years, P = .426). Patients aged 1 to 14 years and 15 to 29 years at diagnosis of first cancer are at higher risk of SPTC after XRTe (OR = 1.89, P = .005 and OR = 2.35, P = .001, respectively), unlike patients age 30 to 44 years and 45+ years (OR = 1.03, P = .823 and OR = 0.97, P = .624, respectively). This difference is not present for follicular and medullary SPTC.

CONCLUSIONS

Patients aged 30+ years receiving radiation therapy (XRT) do not have an increased risk of SPTC. Deliberation is necessary in recommending, planning, and delivering XRT to minimize risk of subsequent malignancy in younger patients.

LEVEL OF EVIDENCE

NA Laryngoscope, 130: 2081-2086, 2020.

摘要

目的/假设：放射治疗暴露（XRTe）的风险之一是第二原发甲状腺癌（SPTC）。先前的报告研究了儿童中的这种情况，但没有基于人群的研究探讨过所有年龄段或按组织学亚型分层的 XRTe 和 SPTC。

研究设计

数据库研究。

方法

我们使用 χ 和 t 检验报告了监测、流行病学和最终结果（SEER）数据库中 SPTC（n = 4669）患者的特征。基于年龄、组织学和 XRTe，与 SEER 数据库中的预期值相比，确定了 SPTC 的优势比（OR）。报告 Kaplan-Meier 生存和 Cox 比例风险比，以确定单变量和多变量模型中影响潜伏生存（从初始诊断到 SPTC 的时间）和总体生存的因素。

结果

基于 XRTe 的甲状腺外延伸和淋巴结状态相似（P =.684 和 P =.776）。接受 XRTe 的患者更有可能患有较小的肿瘤（17.6 毫米对 19.3 毫米，P =.007）。接受 XRTe 的患者诊断为 SPTC 的年龄较小（59.8 岁对 62.7 岁，P < .001），但潜伏生存（7.45 年对 7.50 年，P =.426）无差异。诊断为第一癌症时年龄为 1 至 14 岁和 15 至 29 岁的患者，在接受 XRTe 后 SPTC 的风险更高（OR = 1.89，P =.005 和 OR = 2.35，P =.001），而年龄为 30 至 44 岁和 45 岁以上的患者（OR = 1.03，P =.823 和 OR = 0.97，P =.624）则不然。滤泡性和髓样 SPTC 不存在这种差异。