Department of Surgery, The University of Virginia Health System, P.O. Box 800681, Charlottesville, VA, 22908, USA.
Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA.
Am J Surg. 2021 Feb;221(2):478-484. doi: 10.1016/j.amjsurg.2020.09.025. Epub 2020 Sep 26.
The aim of this study was to evaluate the association between age and disease specific mortality (DSM) among adults diagnosed with medullary thyroid cancer (MTC).
Surveillance, Epidemiology, and End Results (SEER-18) was used to analyze adult MTC patients stratified by age (18-64, 65-79, ≥80 years). Associations between patient demographics, tumor size, nodal status, metastatic disease, and extent of surgery on DSM was assessed with multivariable Cox regression.
Among 1457 patients with MTC, 1008 (69.2%) were younger adults, 371 (25.5%) older adults, and 78 (5.4%) were super-elderly. A significantly higher proportion of older adults and super-elderly had less than the recommended operation for MTC. On multivariable analysis, older adults and super-elderly were 2.9 and 6.7 times more likely to have an increased DSM (HR:2.91, 95% CI: 1.83-4.63; p < 0.001 and HR: 6.70, 95%CI: 3.69-12.20; p < 0.001). Extent of surgery or lymphadenectomy did not affect DSM.
Increased age is an independent predictor of DSM in patients with MTC.
本研究旨在评估成年人甲状腺髓样癌（MTC）诊断后年龄与疾病特异性死亡率（DSM）之间的关联。
使用监测、流行病学和最终结果（SEER-18）数据库，对年龄（18-64 岁、65-79 岁、≥80 岁）分层的成人 MTC 患者进行分析。使用多变量 Cox 回归评估患者人口统计学特征、肿瘤大小、淋巴结状态、转移性疾病以及手术范围与 DSM 之间的关联。
在 1457 例 MTC 患者中，1008 例（69.2%）为年轻成年人，371 例（25.5%）为老年成年人，78 例（5.4%）为超高龄成年人。更多的老年成年人和超高龄成年人接受的手术不符合 MTC 推荐手术。多变量分析显示，老年成年人和超高龄成年人发生 DSM 增加的风险分别是年轻成年人的 2.9 倍和 6.7 倍（HR：2.91，95%CI：1.83-4.63；p<0.001 和 HR：6.70，95%CI：3.69-12.20；p<0.001）。手术范围或淋巴结清扫术并不影响 DSM。
年龄增长是 MTC 患者 DSM 的独立预测因素。
