2015 年美国甲状腺协会指南对低危分化型甲状腺癌老年患者治疗的影响。
Impact of the 2015 American thyroid association guidelines on treatment in older adults with low-risk, differentiated thyroid cancer.
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Am J Surg. 2022 Jul;224(1 Pt B):412-417. doi: 10.1016/j.amjsurg.2022.01.033. Epub 2022 Feb 1.
BACKGROUND
The impact of the 2015 ATA guidelines on treatment for differentiated thyroid cancer (DTC) in older adults is unclear.
METHODS
60,567 adults (age≥18) with low-risk DTC diagnosed between 2010 and 2018 were identified using SEER-21. Annual rates of total thyroidectomy (TT), hemithyroidectomy (HT), and active surveillance (AS) were analyzed using interrupted time series stratified by age: younger adults (18-64), older adults (65-79), and the super-elderly (≥80).
RESULTS
After 2015, annual rates of TT decreased by 2.6% and 1.9% in younger and older adults (p < 0.001), but increased by 4.6% in the super-elderly (p = 0.0126). Annual rates of HT increased by 2.6% and 1.7% in younger and older adults (p < 0.001), but decreased by 3.8% in the super-elderly (p = 0.0029). Older adults and the super-elderly were more likely than younger adults to undergo HT (aOR = 1.1, 95% CI: 1.03-1.2, p = 0.002 and aOR = 1.5, 95% CI: 1.3-1.7, p < 0.001) and AS (aOR = 1.5, 95% CI: 1.4-1.7, p < 0.001 and aOR = 6.5, 95% CI: 5.4-7.7, p < 0.001) when compared to TT following 2015.
CONCLUSIONS
Treatment of DTC continues to vary significantly among age groups.
背景
2015 年美国甲状腺协会（ATA）指南对老年分化型甲状腺癌（DTC）治疗的影响尚不清楚。
方法
使用 SEER-21 数据库，共确定了 60567 名 2010 年至 2018 年期间确诊为低危 DTC 的成年人（年龄≥18 岁）。通过年龄分层（18-64 岁的年轻成年人、65-79 岁的老年人和≥80 岁的超高龄老年人），采用中断时间序列分析法分析全甲状腺切除术（TT）、半甲状腺切除术（HT）和主动监测（AS）的年度治疗率。
结果
2015 年后，年轻和老年成年人的 TT 年度治疗率分别下降了 2.6%和 1.9%（p<0.001），但超高龄老年人的 TT 年度治疗率增加了 4.6%（p=0.0126）。年轻和老年成年人的 HT 年度治疗率分别增加了 2.6%和 1.7%（p<0.001），但超高龄老年人的 HT 年度治疗率下降了 3.8%（p=0.0029）。与 TT 相比，老年人和超高龄老年人更倾向于选择 HT（OR=1.1，95%CI：1.03-1.2，p=0.002 和 OR=1.5，95%CI：1.3-1.7，p<0.001）和 AS（OR=1.5，95%CI：1.4-1.7，p<0.001 和 OR=6.5，95%CI：5.4-7.7，p<0.001）。
结论
2015 年以后，DTC 的治疗方法在不同年龄组之间仍存在显著差异。
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