Simpson W J, McKinney S E, Carruthers J S, Gospodarowicz M K, Sutcliffe S B, Panzarella T
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Am J Med. 1987 Sep;83(3):479-88. doi: 10.1016/0002-9343(87)90758-3.
This report from the Canadian survey of thyroid cancer describes 1,074 patients with papillary thyroid cancer and 504 with follicular thyroid cancer followed for four to 24 years. The study groups included more patients with "advanced" disease and fewer with "early" disease than in the general population because these patients were referred to radiotherapy cancer centers, sometimes routinely, but often because referring physicians believed that certain clinical features indicated the need for additional treatment. Although this report is subject to all the problems of retrospective studies, a careful assessment of the pretreatment extent of disease combined with a long follow-up period has allowed an analysis of prognostic factors with considerable confidence. Univariate analysis of 12 possible prognostic factors (excluding treatment) demonstrated that nine of them were of statistical significance: postoperative status, age at diagnosis, extrathyroidal invasion, distant metastases, nodal involvement, differentiation, sex, tumor size, and pathologic type (in descending order of importance). Multivariate analysis was carried out using cause-specific survival rates. Independently important prognostic factors at initial treatment were age at diagnosis, extrathyroidal invasion, and degree of differentiation histologically for papillary cancers; and extrathyroidal invasion, distant metastases, primary tumor size, nodal involvement, age at diagnosis, and postoperative status for follicular cancers. The prognostic factors for tumor recurrence were quite different for the papillary and follicular cancers and ranked differently for the two groups.
这份来自加拿大甲状腺癌调查的报告描述了1074例乳头状甲状腺癌患者和504例滤泡状甲状腺癌患者，随访时间为4至24年。与普通人群相比，研究组中“晚期”疾病患者较多，“早期”疾病患者较少，因为这些患者被转诊至放疗癌症中心，有时是常规转诊，但通常是因为转诊医生认为某些临床特征表明需要额外治疗。尽管这份报告存在回顾性研究的所有问题，但对疾病治疗前范围的仔细评估以及较长的随访期使得能够相当有信心地分析预后因素。对12个可能的预后因素（不包括治疗）进行单因素分析表明，其中9个具有统计学意义：术后状态、诊断时年龄、甲状腺外侵犯、远处转移、淋巴结受累、分化程度、性别、肿瘤大小和病理类型（按重要性降序排列）。使用特定病因生存率进行多因素分析。初始治疗时独立重要的预后因素，对于乳头状癌是诊断时年龄、甲状腺外侵犯和组织学分化程度；对于滤泡状癌是甲状腺外侵犯、远处转移、原发肿瘤大小、淋巴结受累、诊断时年龄和术后状态。乳头状癌和滤泡状癌的肿瘤复发预后因素差异很大，两组的排名也不同。
