预测分化型甲状腺癌的远处转移性疾病：一项配对病例对照研究。
Predicting distant metastatic disease in differentiated thyroid cancer: a matched case-control study.
作者信息
Jaffar Sukaina, Jayasekara Jayani, Aniss Ahmad M, Tsang Venessa H M, Learoyd Diana L, Clifton-Bligh Roderick, Gill Anthony J, Glover Anothony R, Sidhu Stan B, Robinson Bruce, Sywak Mark
机构信息
Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
出版信息
ANZ J Surg. 2021 Apr;91(4):716-723. doi: 10.1111/ans.16652. Epub 2021 Feb 16.
BACKGROUND
The occurrence of distant metastasis (DM) is the most important prognostic factor influencing survival outcomes in differentiated thyroid cancer (DTC). Identifying patients who are likely to develop DM and offering these cases more aggressive surgical approaches and I-131 therapy, is paramount to achieving the best possible outcomes. DM on presentation in DTC are uncommon, with an incidence of 1-9%. However, the incidence of DTC is rising and the disease affects a relatively young cohort of patients. The aims of this study were to investigate predictive factors in the development of DM by comparing a homogenous group of DTC patients with and without DM, and to illustrate the overall and disease-specific survival (DSS) rates of DTC patients presenting with DM.
METHODS
A matched case-control study of patients with DTC and DM was undertaken. The study group comprised a consecutive series of cases with DM treated in the period 1968-2014. Patients with DM at initial presentation were identified (DTC-DM group). A control group of patients without DM were matched based on age, gender, tumour size and histological subtype. The primary outcome measures were overall and disease-free survival. Secondary outcome measures were lymph node involvement (LNI), extra-thyroidal extension (ETE) of tumour and presence of BRAFV600E mutation identified on immunohistochemistry.
RESULTS
A total of 2547 patients with DTC were reviewed and of these 83 (3.26%) had DM at initial presentation. At 5 and 10 years, the overall survival rates for DTC-DM patients were 89.6% and 64%, respectively. The 5 and 10 year DSS rates for DTC-DM cases were 90.2% and 67.3%, respectively. When compared to the DTC group, the DTC-DM group had significantly higher rates of ETE (63% vs. 29.5%, P < 0.0001) and LNI (32.5% vs. 18.8%, P = 0.044). Among patients with papillary thyroid cancer (PTC), the presence of BRAFV600E mutation was significantly associated with DM (62.2% vs. 36.8%, P = 0.028).
CONCLUSION
ETE, LNI and BRAFV600E mutation in PTC are significant predictors for the development of distant metastatic disease.
背景
远处转移（DM）的发生是影响分化型甲状腺癌（DTC）生存结局的最重要预后因素。识别可能发生DM的患者并为这些病例提供更积极的手术方法和I-131治疗，对于实现最佳结局至关重要。DTC初诊时即出现DM的情况并不常见，发生率为1%-9%。然而，DTC的发病率正在上升，且该疾病影响相对年轻的患者群体。本研究的目的是通过比较一组同质的有DM和无DM的DTC患者，调查DM发生的预测因素，并阐明初诊时即有DM的DTC患者的总生存率和疾病特异性生存率（DSS）。
方法
对DTC合并DM的患者进行了一项匹配病例对照研究。研究组包括1968年至2014年期间连续治疗的一系列DM病例。确定初诊时即有DM的患者（DTC-DM组）。根据年龄、性别、肿瘤大小和组织学亚型匹配一组无DM的患者作为对照组。主要结局指标是总生存率和无病生存率。次要结局指标是淋巴结受累（LNI）、肿瘤的甲状腺外扩展（ETE）以及免疫组织化学检测到的BRAFV600E突变的存在情况。
结果
共审查了2547例DTC患者，其中83例（3.26%）初诊时即有DM。在5年和10年时，DTC-DM患者的总生存率分别为89.6%和64%。DTC-DM病例的5年和10年DSS率分别为90.2%和67.3%。与DTC组相比，DTC-DM组的ETE发生率（63%对29.5%，P<0.0001）和LNI发生率（32.5%对18.8%，P=0.044）显著更高。在甲状腺乳头状癌（PTC）患者中，BRAFV600E突变的存在与DM显著相关（62.2%对36.8%，P=0.028）。
结论
PTC中的ETE、LNI和BRAFV600E突变是远处转移性疾病发生的重要预测因素。
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