Ding Wu, Ruan Guodong, Zhu Jianming, Tu Chuanjian, Li Zhian
Department of Oncological Surgery, Shaoxing Second Hospital.
Department of Clinical Medicine, Shaoxing University School of Medicine, Shaoxing.
Medicine (Baltimore). 2020 Nov 25;99(48):e23132. doi: 10.1097/MD.0000000000023132.
The role of primary tumor surgery in the management of differentiated thyroid cancer (DTC) with distant metastases (DM) remains controversial. We aimed to explore the survival benefit of primary tumor surgery in patients with different metastatic sites.A retrospective cohort study based on the SEER database was conducted to identify DTC patients with DM diagnosed between 2010 and 2016. Patients were divided into following 2 groups: surgery and non-surgery group. Propensity score weighting was employed to balance clinicopathologic factors between the 2 groups.Of 3537 DTC patients with DM, 956 (66.0%) patients underwent primary tumor surgery while 493 (34.0%) patients did not. There were 798 all-cause deaths and 704 DTC-specific deaths over a median follow-up of 22 months. The weighted 3-year overall survival (OS) for the surgery group was 55.2%, compared to 27.8% (P < .001) for the non-surgery group. The magnitude of the survival difference of surgery was significantly correlated with metastatic sites (Pinteraction <.001). Significant survival improvements in surgery group compared with non-surgery group were observed in patients with lung-only metastasis (adjusted HR = 0.45, P < .001), bone-only metastasis (adjusted HR = 0.40, P < .001), and liver-only metastasis (adjusted HR = 0.27, P < .001), whereas no survival improvement of surgery was found for patients with brain-only metastasis (adjusted HR = 0.57, P = .059) or multiply organ distant metastases (adjusted HR = 0.81, P = .099).The survival benefit from primary tumor surgery for DTC patients with DM varies by metastatic sites. Decisions for primary tumor surgery of DTC patients with DM should be tailored according to metastatic sites.
原发性肿瘤手术在伴有远处转移（DM）的分化型甲状腺癌（DTC）治疗中的作用仍存在争议。我们旨在探讨原发性肿瘤手术对不同转移部位患者的生存获益情况。基于监测、流行病学与最终结果（SEER）数据库开展了一项回顾性队列研究，以确定2010年至2016年间诊断为伴有DM的DTC患者。患者被分为以下两组：手术组和非手术组。采用倾向得分加权法平衡两组之间的临床病理因素。在3537例伴有DM的DTC患者中，956例（66.0%）患者接受了原发性肿瘤手术，而493例（34.0%）患者未接受手术。在中位随访22个月期间，共有798例全因死亡和704例DTC特异性死亡。手术组加权3年总生存率（OS）为55.2%，而非手术组为27.8%（P<0.001）。手术生存差异的幅度与转移部位显著相关（P交互作用<0.001）。在仅肺转移（调整后HR=0.45，P<0.001）、仅骨转移（调整后HR=0.40，P<0.001）和仅肝转移（调整后HR=0.27，P<0.001）的患者中，观察到手术组与非手术组相比有显著的生存改善，而在仅脑转移（调整后HR=0.57，P=0.059）或多器官远处转移（调整后HR=0.81，P=0.099）的患者中未发现手术有生存改善。伴有DM的DTC患者原发性肿瘤手术的生存获益因转移部位而异。伴有DM的DTC患者原发性肿瘤手术的决策应根据转移部位进行调整。
