患者年龄与甲状腺微小乳头状癌的远处转移显著相关。

Patient Age Is Significantly Related to Distant Metastasis of Papillary Thyroid Microcarcinoma.

机构信息

Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Front Endocrinol (Lausanne). 2021 Dec 23;12:748238. doi: 10.3389/fendo.2021.748238. eCollection 2021.

DOI:10.3389/fendo.2021.748238

PMID:35002953

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8733652/

Abstract

OBJECTIVE

Distant metastasis in papillary thyroid microcarcinoma (PTMC) is rare but fatal, and its relationship with patient age remains unclear. The objective of this study was to examine the association between age at diagnosis and metachronous distant metastasis in PTMC.

METHODS

Consecutive patients who underwent thyroidectomy for PTC measuring 10 mm or less at a tertiary hospital from January 2000 to December 2016 were enrolled. Patients who had evidence of distant metastasis at diagnosis or underwent postoperative radioiodine (RAI) ablation were excluded. A Cox proportional hazards model with restricted cubic splines (RCS) was applied to examine the association between age at diagnosis and distant metastasis.

RESULTS

A total of 4,749 patients were evaluated. The median age was 44 years (range, 8-78 years), and 3,700 (78%) were female. After a median follow-up of 65 months, 21 distant metastases (20 lung, 1 liver) were recognized. A univariate Cox proportional model using a 5-knot RCS revealed a significant overall ( = 0.01) and a potential nonlinear association ( = 0.08) between distant metastasis and age at diagnosis. In multivariate analysis, age at diagnosis, extrathyroidal extension (ETE), and lymph node metastasis (pN+) were independent risk factors for distant metastasis. Compared with the middle-aged group (30-45 years old), younger and older patients had a higher risk of distant metastasis [HR, 95% CI, -value, age ≤ 30, 4.54 (0.91-22.60), 0.06, age > 45, 6.36 (1.83-22.13), <0.01].

CONCLUSION

Age at diagnosis is associated with metachronous distant metastasis of PTMC, and patients with younger or older age have a higher risk of distant metastasis than middle-aged patients.

摘要

目的

甲状腺微小乳头状癌（PTMC）远处转移罕见但致命，其与患者年龄的关系尚不清楚。本研究旨在探讨诊断时年龄与 PTMC 患者发生异时性远处转移的关系。

方法

连续纳入 2000 年 1 月至 2016 年 12 月在一家三级医院因 10mm 或以下甲状腺乳头状癌行甲状腺切除术的患者。排除诊断时存在远处转移或术后行放射性碘（RAI）消融的患者。采用受限立方样条（RCS）的 Cox 比例风险模型来检测诊断时年龄与远处转移之间的关系。

结果

共评估了 4749 例患者。中位年龄为 44 岁（范围，8-78 岁），3700 例（78%）为女性。中位随访 65 个月后，发现 21 例远处转移（20 例肺部，1 例肝脏）。采用包含 5 个节点的 RCS 的单变量 Cox 比例模型显示，远处转移与诊断时年龄之间存在显著的总体关联（ = 0.01）和潜在的非线性关联（ = 0.08）。多变量分析显示，诊断时年龄、甲状腺外侵犯（ETE）和淋巴结转移（pN+）是远处转移的独立危险因素。与中年组（30-45 岁）相比，年轻和年长患者远处转移的风险更高[HR，95%CI，-值，年龄≤30 岁，4.54（0.91-22.60），0.06；年龄＞45 岁，6.36（1.83-22.13），＜0.01]。