Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Endocrine. 2022 Jun;77(1):121-133. doi: 10.1007/s12020-022-03059-y. Epub 2022 May 18.
We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients.
A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years).
The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not.
Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.
我们研究分化型甲状腺癌（DTC）的诊断年龄是否可能是影响老年患者接受初始治疗后的结构性疾病和死亡率的风险因素。
设计了一项多中心回顾性分析，纳入了诊断 DTC 时年龄超过 60 岁的患者。所有患者均接受手术治疗，部分患者联合辅助放射性碘治疗，随访时间至少 1 年。我们比较了老年患者（组 1，60-74 岁）和非常老年患者（组 2，≥75 岁）。
本研究共纳入 1668 例患者（74.3%为女性，中位年龄为 67 岁，87.6%为甲状腺乳头状癌，73.3%接受放射性碘治疗），其中组 1 包含 1397 例患者，组 2 包含 271 例患者。与组 1 相比，组 2 的肿瘤更大（1.8[0.8-3.0]cm 比 1.5[0.7-2.8]cm；P=0.005），血管侵犯比例更高（23.8%比 16.4%；P=0.006），淋巴细胞性甲状腺炎比例更低（18.6%比 24.9%；P=0.013）。Kaplan-Meier 生存分析显示，组 2 的结构性疾病无复发生存（DFS）和总生存（OS）显著低于组 1（P=0.035 和<0.001）。多因素 Cox 回归分析显示，年龄是与 OS 显著相关的危险因素。然而，在未校正分析和校正性别和风险分类变量后，年龄与 DFS 显著相关，但在校正病理和治疗相关变量后，年龄与 DFS 不相关。另一方面，与未接受放射性碘治疗的患者相比，接受放射性碘治疗的患者 DFS 更差（P<0.001）。
尽管年龄是 OS 的一个影响因素，但非常老年患者在整个随访期间发生结构性疾病的风险并不高于老年 DTC 患者。
