Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, China.
J Healthc Eng. 2022 Feb 8;2022:4348396. doi: 10.1155/2022/4348396. eCollection 2022.
The purpose of the current study was to determine whether older patients with differentiated thyroid cancer (DTC) who received surgical treatment had a better cause-specific survival (CSS) than patients who were recommended surgery, but declined, and whether patients who underwent postoperative RAI-131 therapy had an impact on CSS based on TNM staging and number of lymph node metastases for all total or near-total thyroidectomy patients. : This retrospective, population-based study analyzed the clinical data of 162 DTC patients from signal institution in China and 26,487 cases from the Surveillance, Epidemiology, and End Results (SEER) program registry. The patients were divided into two groups (underwent surgery and surgery recommended, but not performed) in the SEER cohort. Furthermore, patients were grouped as follows: T4; N1b; M1; T1-3N0-1a; specific number of lymph node metastases; and total or near-total thyroidectomy. : The 120-month cause-specific survival (CSS) rate of women and men showed a gradual declining trend from 60-64 to ≥80 years of age in the group that underwent surgery. The CSS rate of women and men showed a marked downward and irregular trend with an increase in age in the recommended, but no surgery group in the SEER cohort. Univariate analysis indicated that the surgery group had a higher 120-month CSS in women in most stages and men, compared with the no surgery group in the SEER cohort. The analysis of the SEER cohort showed that RAI-131 therapy was associated with an improved 80-month CSS in T4/N1b/M1 women ( < 0.0183) and men ( < 0.0011). However, there were no CSS differences between the RAI-131 therapy and the no-RAI-131 group for the patients with T4/N1b/M1 (AJCC 7th) thyroid cancer in the Chinese cohort. There was no CSS difference in women or men between the T1-3N0 and T1-3N1a patients in the SEER cohort. And similar findings were observed in T1-3N1a patients in the Chinese cohort. There was no statistical difference between the two subgroups. : Surgical treatment should be recommended for elderly DTC patients because surgery can lead to a better CSS. High-risk patients achieve a higher benefit-to-risk ratio with RAI-131 therapy. To avoid the adverse effects associated with RAI-131 therapy, a multidisciplinary discussion should be arranged for intermediate- and low-risk patients.
本研究旨在探讨接受手术治疗的老年分化型甲状腺癌（DTC）患者的特定原因生存（CSS）是否优于推荐手术但拒绝手术的患者，以及接受术后放射性碘-131（RAI-131）治疗的患者是否基于 TNM 分期和淋巴结转移数量对所有全甲状腺或近全甲状腺切除术患者的 CSS 有影响。：本回顾性、基于人群的研究分析了来自中国信号机构的 162 例 DTC 患者和来自监测、流行病学和最终结果（SEER）计划登记处的 26487 例患者的临床数据。在 SEER 队列中，患者被分为两组（接受手术和推荐手术但未行手术）。此外，患者还分为以下几组：T4；N1b；M1；T1-3N0-1a；特定淋巴结转移数量；以及全甲状腺或近全甲状腺切除术。：手术组女性和男性的 120 个月特定原因生存（CSS）率从 60-64 岁逐渐下降至≥80 岁，而 SEER 队列中推荐手术但未行手术组的 CSS 率则随年龄的增长而呈明显下降和不规则趋势。单因素分析表明，与 SEER 队列中未行手术组相比，手术组女性和男性在大多数分期中 120 个月 CSS 更高。SEER 队列的分析表明，RAI-131 治疗与 T4/N1b/M1 女性（<0.0183）和男性（<0.0011）80 个月 CSS 改善相关。然而，在中国队列中 T4/N1b/M1（AJCC 第 7 版）甲状腺癌患者中，RAI-131 治疗组与无 RAI-131 组之间的 CSS 无差异。SEER 队列中 T4/N1b/M1 患者中，女性或男性 T1-3N0 和 T1-3N1a 患者之间的 CSS 无差异。在中国队列中 T1-3N1a 患者中也观察到了类似的结果。两组之间无统计学差异。：对于老年 DTC 患者，应推荐手术治疗，因为手术可导致更好的 CSS。高危患者接受 RAI-131 治疗可获得更高的获益-风险比。对于中低危患者，应安排多学科讨论，以避免与 RAI-131 治疗相关的不良反应。
