Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
Surgery. 2021 Jan;169(1):2-6. doi: 10.1016/j.surg.2020.04.003. Epub 2020 Jul 16.
The eighth edition American Joint Committee on Cancer tumor-node-metastasis staging for well-differentiated thyroid cancers, no longer considers "minimal" extrathyroidal extension for tumor staging. This change prompted us to examine the effect of extrathyroidal extension on patient outcomes.
Patients (n = 177,497) in the 2016 National Cancer Database with classic papillary thyroid cancer were evaluated to determine the effect of extrathyroidal extension on overall survival and risk for nodal and distant metastases. Kaplan-Meier curves with the log-rank test were used to evaluate survival differences. Multivariable Cox and logistic regression analyses included relevant clinicopathologic variables (e.g. age, sex, race, and Charlson Comorbidity Index).
Patients with "minimal" extrathyroidal extension had worse survival versus patients with no extrathyroidal extension (10-year survival 89.3% vs 93.1%, hazard ratio 1.23; 95% confidence interval, 1.13-1.35; P < .001). Any extrathyroidal extension was associated with higher risks for lymph node (odds ratio 2.78; 95% confidence interval, 2.69-2.87) and distant metastasis (odds ratio 3.5; 95% confidence interval, 3.05-4.04). These associations persisted when comparing "micro" (extension into the thyroid capsule) versus none for nodal risk (odds ratio 1.25; 95% confidence interval, 1.18-1.33) and distant metastasis (OR 1.52; 95% confidence interval, 1.11-2.09).
All levels of extrathyroidal extension, including microscopic, were associated with increased risk for nodal and distant metastasis. Both minimal and macroscopic extrathyroidal extension were also associated with decreased overall survival. Such findings have the potential to affect the clinical decision making for patients diagnosed with papillary thyroid cancer.
第八版美国癌症联合委员会（AJCC）肿瘤-淋巴结-转移（TNM）分期系统不再将分化型甲状腺癌的“微小”甲状腺外扩展视为肿瘤分期的一部分。这一改变促使我们研究甲状腺外扩展对患者预后的影响。
我们评估了 2016 年国家癌症数据库中患有经典型甲状腺乳头状癌的 177497 例患者，以确定甲状腺外扩展对总生存和淋巴结及远处转移风险的影响。采用 Kaplan-Meier 曲线和对数秩检验评估生存差异。多变量 Cox 和逻辑回归分析包括相关的临床病理变量（如年龄、性别、种族和 Charlson 合并症指数）。
与无甲状腺外扩展的患者相比，“微小”甲状腺外扩展的患者生存较差（10 年生存率 89.3%对 93.1%，风险比 1.23；95%置信区间，1.13-1.35；P<0.001）。任何程度的甲状腺外扩展均与更高的淋巴结（优势比 2.78；95%置信区间，2.69-2.87）和远处转移（优势比 3.5；95%置信区间，3.05-4.04）风险相关。当比较淋巴结风险时，“微”（扩展至甲状腺包膜内）与无甲状腺外扩展相比，这些关联仍然存在（优势比 1.25；95%置信区间，1.18-1.33）和远处转移（OR 1.52；95%置信区间，1.11-2.09）。
所有程度的甲状腺外扩展，包括显微镜下的甲状腺外扩展，都与淋巴结和远处转移风险的增加相关。微小和肉眼可见的甲状腺外扩展均与总生存降低相关。这些发现有可能影响诊断为甲状腺乳头状癌的患者的临床决策。
