Li Man, Huang Yihui, Wang Min, Zeng Wen, Chen Sichao, Zhou Wei, Wei Wei, Zhang Chao, Hu Di, Huang Jianglong, Liu Zeming, Guo Liang
Department of Plastic Surgery, Zhongnan Hospital of Wuhan University Wuhan 430071, Hubei Province, China.
Department of Ophthalmology, Zhongnan Hospital of Wuhan University Wuhan 430071, Hubei Province, China.
Am J Transl Res. 2021 Jun 15;13(6):6098-6107. eCollection 2021.
Medullary thyroid carcinoma (MTC) is a rare and lethal cancer. There are currently controversies regarding its staging. This study aimed to verify the significance of the patient's age in the prognosis of MTC and propose its addition to the current staging system. Data on cancer-specific survival (CSS) from the Surveillance, Epidemiology, and End Results database between 2010 and 2015 were used. X-Tile, nomograms, Cox proportional hazards regression analysis, Kaplan-Meier curves, and log-rank tests were used to evaluate mortality rates to create a new staging system. A total of 849 patients were included. Patients were divided into three categories based on their ages at diagnosis: ≤41 years, n = 224 (26.4%); 42-71 years, n = 516 (60.8%); and ≥72 years, n = 109 (12.8%). Independent factors for survival in the multivariate analysis included age (42-71 years, hazard ratio [HR], 2.81, 95% confidence interval [CI], 1.07-7.42; ≥72 years, HR, 8.71, 95% CI, 2.88-26.34), T stage (T2, HR, 3.60, 95% CI, 1.31-9.88), and M stage (M1, HR, 8.43, 95% CI, 4.40-16.16), with P<0.05. The Harrell's concordance index for tumor node metastasis (TNM) nomogram and TNM-age nomogram was 0.904 and 0.908, respectively. The areas under the curve (AUCs) for a 3-year CSS were 0.88 and 0.873, respectively. The corresponding AUCs for a 5-year CSS were 0.892 and 0.888, respectively. A new TNM-age staging system based on cancer-specific mortality rate analysis is proposed. This system provides a more accurate risk stratification and ensures more rational treatment measures for patients with stage IV MTC.
甲状腺髓样癌（MTC）是一种罕见的致命性癌症。目前关于其分期存在争议。本研究旨在验证患者年龄在MTC预后中的意义，并提议将其纳入当前的分期系统。使用了监测、流行病学和最终结果数据库中2010年至2015年期间的癌症特异性生存（CSS）数据。采用X-Tile、列线图、Cox比例风险回归分析、Kaplan-Meier曲线和对数秩检验来评估死亡率，以创建一个新的分期系统。共纳入849例患者。根据诊断时的年龄将患者分为三类：≤41岁，n = 224例（26.4%）；42 - 71岁，n = 516例（60.8%）；≥72岁，n = 109例（12.8%）。多变量分析中生存的独立因素包括年龄（42 - 71岁，风险比[HR]，2.81，95%置信区间[CI]，1.07 - 7.42；≥72岁，HR，8.71，95% CI，2.88 - 26.34）、T分期（T2，HR，3.60，95% CI，1.31 - 9.88）和M分期（M1，HR，8.43，95% CI，4.40 - 16.16），P<0.05。肿瘤淋巴结转移（TNM）列线图和TNM - 年龄列线图的Harrell一致性指数分别为0.904和0.908。3年CSS的曲线下面积（AUC）分别为0.88和0.873。5年CSS的相应AUC分别为0.892和0.888。提出了一种基于癌症特异性死亡率分析的新TNM - 年龄分期系统。该系统提供了更准确的风险分层，并确保为IV期MTC患者采取更合理的治疗措施。
