附加术前计算机断层成像对甲状腺乳头状癌患者分期、手术和术后生存的影响。
Impact of Additional Preoperative Computed Tomography Imaging on Staging, Surgery, and Postsurgical Survival in Patients With Papillary Thyroid Carcinoma.
机构信息
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Korean J Radiol. 2023 Dec;24(12):1284-1292. doi: 10.3348/kjr.2023.0240.
OBJECTIVE
We investigated the impacts of computed tomography (CT) added to ultrasound (US) for preoperative evaluation of patients with papillary thyroid carcinoma (PTC) on staging, surgical extent, and postsurgical survival.
MATERIALS AND METHODS
Consecutive patients who underwent surgery for PTC between January 2015 and December 2015 were retrospectively identified. Of them, 584 had undergone preoperative additional thyroid CT imaging (CT + US group), and 859 had not (US group). Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for 14 variables and balance the two groups. Changes in nodal staging and surgical extent caused by CT were recorded. The recurrence-free survival and distant metastasis-free survival after surgery were compared between the two groups.
RESULTS
In the CT + US group, discordant nodal staging results between CT and US were observed in 94 of 584 patients (16.1%). Of them, CT accurately diagnosed nodal staging in 54 patients (57.4%), while the US provided incorrect nodal staging. Ten patients (1.7%) had a change in the extent of surgery based on CT findings. Postsurgical recurrence developed in 3.6% (31 of 859) of the CT + US group and 2.9% (17 of 584) of the US group during the median follow-up of 59 months. After adjustment using IPTW (580 vs. 861 patients), the CT + US group showed significantly higher recurrence-free survival rates than the US group (hazard ratio [HR], 0.52 [95% confidence interval {CI}, 0.29-0.96]; = 0.037). PSM analysis (535 patients in each group) showed similar HR without statistical significance (HR, 0.60 [95% CI, 0.31-1.17]; = 0.134). For distant metastasis-free survival, HRs after IPTW and PSM were 0.75 (95% CI, 0.17-3.36; = 0.71) and 0.87 (95% CI, 0.20-3.80; = 0.851), respectively.
CONCLUSION
The addition of CT imaging for preoperative evaluation changed nodal staging and surgical extent and might improve recurrence-free survival in patients with PTC.
目的
我们研究了计算机断层扫描（CT）在术前评估甲状腺乳头状癌（PTC）患者中的应用对分期、手术范围和术后生存的影响。
材料和方法
回顾性分析了 2015 年 1 月至 2015 年 12 月期间接受手术治疗的 PTC 连续患者。其中 584 例患者接受了术前额外的甲状腺 CT 成像（CT+US 组），859 例患者未接受（US 组）。采用逆概率治疗加权（IPTW）和倾向评分匹配（PSM）调整 14 个变量，使两组平衡。记录 CT 引起的淋巴结分期和手术范围的变化。比较两组患者术后无复发生存率和无远处转移生存情况。
结果
在 CT+US 组中，584 例患者中有 94 例（16.1%）CT 与 US 的淋巴结分期结果不一致。其中，CT 准确诊断了 54 例患者（57.4%）的淋巴结分期，而 US 提供了错误的淋巴结分期。10 例患者（1.7%）根据 CT 结果改变了手术范围。在中位随访 59 个月期间，CT+US 组术后复发率为 3.6%（31/859），US 组为 2.9%（17/584）。调整后采用 IPTW（580 例 vs. 861 例），CT+US 组无复发生存率明显高于 US 组（风险比[HR]，0.52[95%可信区间{CI}，0.29-0.96]；=0.037）。PSM 分析（每组 535 例）显示 HR 无统计学意义（HR，0.60[95%CI，0.31-1.17]；=0.134）。对于无远处转移生存，IPTW 和 PSM 后的 HR 分别为 0.75（95%CI，0.17-3.36；=0.71）和 0.87（95%CI，0.20-3.80；=0.851）。
结论
术前评估中添加 CT 成像改变了淋巴结分期和手术范围，可能改善了 PTC 患者的无复发生存率。
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