手术对转移型间变性甲状腺癌原发肿瘤的作用：汇总分析和基于 SEER 的研究。
Role of surgery to the primary tumor in metastatic anaplastic thyroid carcinoma: pooled analysis and SEER-based study.
机构信息
Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.
Department of Internal Medicine IV, University Hospital, LMU Munich, 81377, Munich, Germany.
出版信息
J Cancer Res Clin Oncol. 2023 Jul;149(7):3527-3547. doi: 10.1007/s00432-022-04223-7. Epub 2022 Aug 12.
PURPOSE
Anaplastic thyroid carcinoma (ATC) is an orphan disease with a fatal outcome. Surgery to the primary tumor in metastatic ATC is controversial. Determination of specific surgical techniques may help facilitate local control and, hence, beneficial overall and disease-specific survival.
METHODS
Using individualized patient data derived from our systematic review of literature and our single center study (n = 123), conducting a Surveillance, Epidemiology, and End Results register (SEER)-based study (n = 617) we evaluated surgery, its combination with systemic and local therapies in metastatic ATC.
RESULTS
Pooled cohort study showed surgery (p < 0.001), RT ≥ 30 Gy (p < 0.001), ChT (p < 0.001) and multimodal treatment (p = 0.014) to result in improved OS univariately. In the multivariate analysis, surgery (1.997 [1.162-3.433], p = 0.012) and RT ≥ 30 Gy (1.877 [1.232-2.843], p = 0.012) were independent predictors for OS. In SEER-based study of patients undergoing any tumor-directed treatment (n = 445) total thyroidectomy (p = 0.031), administration of ChT (p = 0.007), RT (p < 0.001), combination of surgery and RT ± ChT (p < 0.001) and multimodal treatment (p < 0.001) correlated with an improved DSS univariately. On the multivariate analysis, debulking surgery was an independent predictor for a worse outcome (HR 0.535, 95%CI 0.332-0.862, p = 0.010), whereas RT administration correlated with a longer DSS (HR 2.316, 95%CI 1.362-3.939, p = 0.002). Among operated patients from SEER register total thyroidectomy (p = 0.031), ChT (p = 0.007), RT (p < 0.001), combination of surgery and RT ± ChT (p < 0.001) and multimodal treatment (p < 0.001) correlated with an improved DSS in the univariate analysis, whereas debulking surgery was inversely correlated with the DSS (p < 0.001). On the multivariate analysis, debulking surgery was an independent predictor for a worse DSS (HR 0.535, 95%CI 0.332-0.862, p = 0.010), whilst RT administration correlated with a longer DSS (HR 2.316, 95%CI 1.362-3.939, p = 0.002).
CONCLUSIONS
Surgery to the primary tumor with the aim of R0/R1 resection, but not debulking, is associated with a significant OS and DSS benefit even in systemically metastasized disease.
目的
间变性甲状腺癌（ATC）是一种致命的孤儿病。转移性 ATC 原发肿瘤的手术存在争议。确定特定的手术技术可能有助于局部控制，并因此带来整体和疾病特异性生存的获益。
方法
利用我们对文献的系统评价和单中心研究中获得的个体化患者数据（n=123），我们开展了一项基于监测、流行病学和最终结果登记处（SEER）的研究（n=617），评估了手术以及手术联合系统和局部治疗在转移性 ATC 中的应用。
结果
汇总队列研究表明，手术（p<0.001）、放疗≥30 Gy（p<0.001）、化疗（p<0.001）和多模式治疗（p=0.014）可改善 OS，这在单变量分析中是显著的。在多变量分析中，手术（1.997 [1.162-3.433]，p=0.012）和放疗≥30 Gy（1.877 [1.232-2.843]，p=0.012）是 OS 的独立预测因素。在 SEER 登记处接受任何肿瘤定向治疗的患者中（n=445），全甲状腺切除术（p=0.031）、化疗（p=0.007）、放疗（p<0.001）、手术联合放疗±化疗（p<0.001）和多模式治疗（p<0.001）在单变量分析中与 DSS 改善相关。在多变量分析中，肿瘤减灭术是预后不良的独立预测因素（HR 0.535，95%CI 0.332-0.862，p=0.010），而放疗与 DSS 延长相关（HR 2.316，95%CI 1.362-3.939，p=0.002）。在 SEER 登记处接受手术的患者中，全甲状腺切除术（p=0.031）、化疗（p=0.007）、放疗（p<0.001）、手术联合放疗±化疗（p<0.001）和多模式治疗（p<0.001）与 DSS 的改善相关，而肿瘤减灭术与 DSS 呈负相关（p<0.001）。在多变量分析中，肿瘤减灭术是 DSS 不良的独立预测因素（HR 0.535，95%CI 0.332-0.862，p=0.010），而放疗与 DSS 延长相关（HR 2.316，95%CI 1.362-3.939，p=0.002）。
结论
以实现 R0/R1 切除为目标的原发肿瘤手术，而非肿瘤减灭术，与 OS 和 DSS 的显著获益相关，即使在系统性转移疾病中也是如此。
Zotero 插件