Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
J Endocrinol Invest. 2022 Apr;45(4):815-824. doi: 10.1007/s40618-021-01712-3. Epub 2021 Dec 4.
Primary thyroid lymphoma (PTL) is a rare malignancy, and the literature is limited to small case series and case reports. This study aimed to assess the epidemiologic characteristics, survival, and prognostic factors of patients with PTL.
We analyzed 2215 PTL patients from the Surveillance, Epidemiology, and End Results database medical records, between 1983 and 2015, as the training cohort. We enrolled 105 patients from the Cancer Hospital, Chinese Academy of Medical Sciences, for the external validation cohort. The nomograms for predicting the 1-, 5-, and 10-year overall survival (OS) and lymphoma-specific survival (LSS) were constructed.
PTL incidence steadily increased from 1977 to 1994, with an annual percentage change of 3.2% (95% confidence interval [CI]: 1.2-5.2, P < 0.05). The 1-, 5-, and 10-year OS and LSS rates were 84.66%, 71.61%, and 55.95%; and 90.5%, 85.7%, and 82.2%, respectively. Multivariate Cox regression analysis revealed that shorter OS association with age ≥ 60 years (hazard ratio [HR], 3.94; 95% CI 3.31-4.69; P < 0.001), unmarried status (HR, 1.55; 95% CI 1.37-1.75; P < 0.001), Ann Arbor stage III-IV (HR, 1.55; 95% CI 1.37-1.75; P = 0.020), diffuse large B-cell lymphoma (HR, 2.60; 95% CI 1.15-5.87; P = 0.022), and T cell non-Hodgkin lymphoma (HR, 3.53; 95% CI 1.12-11.10; P = 0.031). In the multivariate competing-risk analyzes, age, stages III-IV, year of diagnosis, surgery, radiation, chemotherapy, and histology were strongly predictive of PTL-specific risk of death. To estimate the 1-, 5-, and 10-year LSS and OS rates, respectively, nomograms were built. In the validation cohort, the results also confirmed the utility.
This study presents the first prognostic model with an external validation that could help clinicians identify patients with high-risk PTL to improve their prognosis.
甲状腺原发性淋巴瘤（PTL）是一种罕见的恶性肿瘤，相关文献主要为小样本的病例系列和病例报告。本研究旨在评估 PTL 患者的流行病学特征、生存情况和预后因素。
我们分析了 1983 年至 2015 年间，来自监测、流行病学和最终结果（SEER）数据库的 2215 例 PTL 患者的病历，作为训练队列。我们从中国医学科学院肿瘤医院招募了 105 例患者作为外部验证队列。构建了预测 1 年、5 年和 10 年总生存率（OS）和淋巴瘤特异性生存率（LSS）的列线图。
PTL 的发病率从 1977 年到 1994 年稳步上升，年变化百分比为 3.2%（95%置信区间[CI]：1.2-5.2，P<0.05）。1 年、5 年和 10 年的 OS 和 LSS 率分别为 84.66%、71.61%和 55.95%；90.5%、85.7%和 82.2%。多因素 Cox 回归分析显示，年龄≥60 岁（风险比[HR]，3.94；95%CI 3.31-4.69；P<0.001）、未婚（HR，1.55；95%CI 1.37-1.75；P<0.001）、Ann Arbor 分期 III-IV（HR，1.55；95%CI 1.37-1.75；P=0.020）、弥漫性大 B 细胞淋巴瘤（HR，2.60；95%CI 1.15-5.87；P=0.022）和 T 细胞非霍奇金淋巴瘤（HR，3.53；95%CI 1.12-11.10；P=0.031）与 OS 较短显著相关。在多因素竞争风险分析中，年龄、分期 III-IV、诊断年份、手术、放疗、化疗和组织学是 PTL 特异性死亡风险的强烈预测因素。为了分别估计 1 年、5 年和 10 年的 LSS 和 OS 率，建立了列线图。在验证队列中，结果也证实了其适用性。
本研究首次提出了具有外部验证的预后模型，可帮助临床医生识别高风险 PTL 患者，以改善其预后。
