Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei University College of Medicine, Seoul, South Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
Sci Rep. 2023 Sep 28;13(1):16280. doi: 10.1038/s41598-023-43461-8.
We aimed to investigate the effect of thyroid hormone administration on the risk of second primary cancer in patients who underwent thyroidectomy for differentiated thyroid cancer. Data were extracted from the medical billing data of the Health Insurance Review and Assessment Service in South Korea. Patients between 19 and 80 years old who underwent thyroid surgery at least once between January 2009 and June 2020 were included. Data of patients with second primary cancer and control patients with matched age, sex, operation date, and follow-up duration were extracted at a ratio of 1:4. A nested case-control analysis was performed to exclude length bias to confirm the correlation between the duration of thyroid hormone administration, dose, and incidence of second primary cancer. Of the 261,598 patients who underwent surgery for thyroid cancer included in the study, 11,790 with second primary cancer and 47,160 without second primary cancer were matched. The average dose of thyroid hormone increased the adjusted odds ratio (OR) for both low (≤ 50 μg, OR 1.29, confidence interval (CI) 1.12-1.48) and high (< 100 μg, OR 1.24, CI 1.12-1.37) doses. Analyzing over time, the adjusted OR of second primary cancer increased, especially in short (≤ 1 year) (OR 1.19; CI 1.06-1.34) and long (> 5 years) duration (OR 1.25; CI 1.10-1.41). In conclusion, insufficient and excessive thyroid hormone replacement might be linked to increased second primary cancer in patients who underwent thyroidectomy for differentiated thyroid cancer.
我们旨在研究甲状腺激素治疗对分化型甲状腺癌患者甲状腺切除术后发生第二原发癌风险的影响。数据来自韩国健康保险审查与评估服务的医疗计费数据。纳入年龄在 19 至 80 岁之间，至少在 2009 年 1 月至 2020 年 6 月期间接受过甲状腺手术的患者。以 1:4 的比例提取第二原发癌患者和匹配年龄、性别、手术日期和随访时间的对照组患者的数据。进行嵌套病例对照分析以排除长度偏倚，以确认甲状腺激素治疗持续时间、剂量与第二原发癌发生之间的相关性。在纳入研究的 261598 例甲状腺癌手术患者中，有 11790 例发生第二原发癌，47160 例未发生第二原发癌。甲状腺激素的平均剂量增加了低剂量（≤50μg，OR1.29，95%置信区间 1.12-1.48）和高剂量（<100μg，OR1.24，95%置信区间 1.12-1.37）的调整后的比值比（OR）。随着时间的推移进行分析，第二原发癌的调整后 OR 增加，尤其是在短时间（≤1 年，OR1.19；95%置信区间 1.06-1.34）和长时间（>5 年，OR1.25；95%置信区间 1.10-1.41）。总之，分化型甲状腺癌患者甲状腺切除术后甲状腺激素替代不足和过量可能与第二原发癌的增加有关。
