Abiri Arash, Goshtasbi Khodayar, Torabi Sina J, Kuan Edward C, Armstrong William B, Tjoa Tjoson, Haidar Yarah M
Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA.
Department of Neurological Surgery, University of California-Irvine, Orange, California, USA.
Otolaryngol Head Neck Surg. 2023 Apr;168(4):745-753. doi: 10.1177/01945998221095720. Epub 2023 Feb 5.
To analyze the variant-specific survival benefits and usage patterns of standardized treatment combinations of surgery (S), radioactive iodine ablation (RAI), and thyroid-stimulating hormone suppression therapy (THST) for high-risk differentiated thyroid cancer.
Retrospective cohort study.
National Cancer Database.
The 2004-2017 National Cancer Database was queried for patients receiving definitive surgery for high-risk papillary, follicular, or Hurthle cell thyroid cancer. Cox proportional hazards and Kaplan-Meier analyses assessed for treatment-associated survival.
Of 21,076 cases, 18,214 underwent survival analysis with a mean ± SD age of 50.6 ± 17.1 years (71.3% female). When compared with surgery alone, S + RAI was associated with reduced mortality in papillary (hazard ratio [HR], 0.574; P < .001) and follicular (HR, 0.489; P = .004) thyroid cancer. S + RAI + THST was associated with reduced mortality in papillary (HR, 0.514; P < .001), follicular (HR, 0.602; P = .016), and Hurthle cell (HR, 0.504; P = .021) thyroid cancer. In papillary thyroid cancer, S + RAI (91.3%), S + THST (89.2%), and S + RAI + THST (92.7%) were associated with higher 5-year overall survival rates than surgery (85.4%, all P < .001). Papillary thyroid cancer treatments involving THST were associated with higher 5-year overall survival rates than corresponding regimens without THST (all P < .001). In follicular thyroid cancer, S + RAI (73.9%) and S + RAI + THST (78.7%) were associated with higher 5-year overall survival rates than surgery (65.6%, all P < .05). In Hurthle cell thyroid cancer, S + RAI (66.5%) and S + RAI + THST (73.4%) were associated with higher 5-year overall survival rates than surgery (53.7%, all P < .05). On linear regression, THST usage increased by 77.5% (R = 0.944, P < .001), while RAI usage declined by 11.3% (R = 0.320, P = .035).
High-risk differentiated thyroid cancer exhibited varying susceptibilities to different treatment combinations depending on histology, with greatest responses to regimens that included RAI. Physician practices have trended toward decreased RAI and increased THST usage.
分析手术（S）、放射性碘消融（RAI）和促甲状腺激素抑制治疗（THST）标准化治疗组合对高危分化型甲状腺癌的特定变异生存获益和使用模式。
回顾性队列研究。
国家癌症数据库。
查询2004 - 2017年国家癌症数据库中接受高危乳头状、滤泡状或许特耳细胞甲状腺癌根治性手术的患者。采用Cox比例风险模型和Kaplan - Meier分析评估治疗相关生存率。
在21076例病例中，18214例进行了生存分析，平均年龄±标准差为50.6±17.1岁（71.3%为女性）。与单纯手术相比，S + RAI与乳头状甲状腺癌（风险比[HR]，0.574；P <.001）和滤泡状甲状腺癌（HR，0.489；P =.004）的死亡率降低相关。S + RAI + THST与乳头状甲状腺癌（HR，0.514；P <.001）、滤泡状甲状腺癌（HR，0.602；P =.016）和许特耳细胞甲状腺癌（HR，0.504；P =.021）的死亡率降低相关。在乳头状甲状腺癌中，S + RAI（91.3%）、S + THST（89.2%）和S + RAI + THST（92.7%）的5年总生存率高于手术（85.4%，所有P <.001）。涉及THST的乳头状甲状腺癌治疗的5年总生存率高于相应未使用THST的方案（所有P <.001）。在滤泡状甲状腺癌中，S + RAI（73.9%）和S + RAI + THST（78.7%）的5年总生存率高于手术（65.6%，所有P <.05）。在许特耳细胞甲状腺癌中，S + RAI（66.5%）和S + RAI + THST（73.4%）的5年总生存率高于手术（53.7%，所有P <.05）。在线性回归分析中，THST的使用增加了77.5%（R = 0.944，P <.001），而RAI的使用下降了11.3%（R = 0.320，P =.035）。
高危分化型甲状腺癌根据组织学类型对不同治疗组合表现出不同的敏感性，对包含RAI的方案反应最大。医生的治疗趋势是RAI使用减少，THST使用增加。
