利用监测、流行病学和最终结果（SEER）数据库研究组织学亚型、淋巴结转移和远处转移对分化型甲状腺癌预后的协同作用。
Synergic effects of histology subtype, lymph node metastasis, and distant metastasis on prognosis in differentiated thyroid carcinoma using the SEER database.
作者信息
Zhou Ling, Li Qianqian, Chen Sichao, Huang Yihui, Wei Wei, Zhang Chao, Wang Min, Zhou Wei, Zeng Wen, Liu Zeming, Guo Liang
机构信息
Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Pediatrics, St. John Hospital and Medical Center, Detroit, MI, USA.
出版信息
Gland Surg. 2020 Aug;9(4):907-918. doi: 10.21037/gs-20-273.
BACKGROUND
Differentiated thyroid carcinoma (DTC) is the most common clinical type of thyroid carcinoma. There are rare reports on the synergic effects of the different clinicopathological risk factors on the prognosis of it.
METHODS
We retrospectively reviewed data on 86,032 DTC patients from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were conducted to evaluate the correlation between clinicopathological factors and the prognosis of DTC. Relative excess risk (RERI) of synergic effect, attributable proportion (AP) of synergic effect, and synergy index (SI) were calculated to assess synergic effects. Kaplan-Meier analyses with log-rank tests was used to plot the survival curve affected by different risk factors.
RESULTS
Histology subtype, lymph node metastasis (LNM) status, and distant metastasis (DM) were independent risk factors for cancer-specific survival (CSS) and all-cause survival (ACS) in the multivariate analysis (all, P<0.001). Patients' age at diagnosis, sex, extrathyroidal extension, and radiation also influenced prognosis (all, P<0.001). The cancer-specific mortality (CSM) and all-cause mortality (ACM) rates per 1,000 person-years were higher in patients with follicular thyroid carcinoma (FTC) and in those with N1 stage and M1 stage disease. Furthermore, we observed a significant synergic effect between histology subtype and N stage, as well as histology subtype and M stage for the CSM of DTC (RERI =48.806, AP =0.853, SI =7.565; RERI =37.889, AP =0.430, SI =1.771, respectively). However, no synergic effect was observed in the case of the N stage and M stage for the CSM of DTC (RERI =7.928, AP =0.084, SI =1.093).
CONCLUSIONS
Patients with histology subtype of FTC and N1 stage, histology subtype of FTC and M1 stage had significant additive synergic effects on DTC prognosis for CSM.
背景
分化型甲状腺癌（DTC）是甲状腺癌最常见的临床类型。关于不同临床病理危险因素对其预后的协同作用的报道较少。
方法
我们回顾性分析了监测、流行病学和最终结果（SEER）数据库中86032例DTC患者的数据。进行单因素和多因素Cox回归分析，以评估临床病理因素与DTC预后之间的相关性。计算协同效应的相对超额风险（RERI）、协同效应的归因比例（AP）和协同指数（SI），以评估协同效应。采用Kaplan-Meier分析和对数秩检验绘制不同危险因素影响下的生存曲线。
结果
在多因素分析中，组织学亚型、淋巴结转移（LNM）状态和远处转移（DM）是癌症特异性生存（CSS）和全因生存（ACS）的独立危险因素（均P<0.001）。患者的诊断年龄、性别、甲状腺外侵犯和放疗也影响预后（均P<0.001）。滤泡状甲状腺癌（FTC）患者以及N1期和M1期疾病患者每1000人年的癌症特异性死亡率（CSM）和全因死亡率（ACM）更高。此外，我们观察到组织学亚型与N分期之间以及组织学亚型与M分期之间对DTC的CSM有显著的协同效应（RERI =48.806，AP =0.853，SI =7.565；RERI =37.889，AP =0.430，SI =1.771）。然而，在DTC的CSM方面，未观察到N分期和M分期之间的协同效应（RERI =7.928，AP =0.084，SI =1.093）。
结论
FTC组织学亚型和N1期、FTC组织学亚型和M1期患者对DTC的CSM预后有显著的相加协同效应。
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