van Gerwen Maaike, Sinclair Catherine, Rahman Maleeha, Genden Eric, Taioli Emanuela
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Endocrine. 2020 Nov;70(2):356-363. doi: 10.1007/s12020-020-02301-9. Epub 2020 Apr 19.
In the current era of de-escalation of surgical treatment for low-risk thyroid cancer, it is important to ensure that the natural history of thyroid cancer is as benign as has been suggested previously. We therefore compared the impact of surgery refusal and surgery on disease-specific survival (DSS) in patients with local or regional, papillary thyroid cancer (PTC).
Local and regional stage PTC patients in the Surveillance, Epidemiology, and End Results Program (1988-2015) were included. Cox proportional hazard modeling and propensity score matching were conducted to evaluate DSS.
There were 45,136 patients who received surgery and 146 patients who had surgery recommended but refused. Adjusted analysis showed a significantly better DSS for the surgery group compared with the refusal group (HR: 3.07 (95% CI: 1.54-6.11). After stratification for stage, no statistically significant difference in DSS was found (HR: 3.03 (0.89-10.35) when including only local stage PTC. Propensity matching showed a 10-year DSS of 94.0% (95% CI: 87.7-97.1%) and 96.4% (95% CI: 93.2-98.1%) for the refusal and surgery group (p = 0.060). Propensity matching of local stage PTC showed a 10-year DSS of 96.7% (95% CI: 89.9-98.9%) and 100%, respectively (p = 0.002).
Although no significant difference in survival was found between surgery and no surgery in local stage PTC, a 3.3% improvement of 10-year DSS was found in the surgery group. Overall, these results suggest that local stage PTC has a benign natural history, and that conservative management strategies such as active surveillance may be appropriate.
在当前低风险甲状腺癌手术治疗降阶梯的时代，确保甲状腺癌的自然病程如先前所示那般良性是很重要的。因此，我们比较了局部或区域乳头状甲状腺癌（PTC）患者拒绝手术和接受手术对疾病特异性生存（DSS）的影响。
纳入监测、流行病学和最终结果计划（1988 - 2015年）中的局部和区域分期PTC患者。进行Cox比例风险建模和倾向评分匹配以评估DSS。
有45136例患者接受了手术，146例患者被建议手术但拒绝了。校正分析显示，与拒绝手术组相比，手术组的DSS明显更好（风险比：3.07（95%置信区间：1.54 - 6.11））。按分期分层后，仅纳入局部分期PTC时，DSS未发现统计学上的显著差异（风险比：3.03（0.89 - 10.35））。倾向匹配显示，拒绝手术组和手术组的10年DSS分别为94.0%（95%置信区间：87.7 - 97.1%）和96.4%（95%置信区间：93.2 - 98.1%）（p = 0.060）。局部分期PTC的倾向匹配显示，10年DSS分别为96.7%（95%置信区间：89.9 - 98.9%）和100%（p = 0.002）。
虽然局部分期PTC患者手术和未手术之间在生存方面未发现显著差异，但手术组的10年DSS提高了3.3%。总体而言，这些结果表明局部分期PTC具有良性自然病程，积极监测等保守管理策略可能是合适的。
