多灶性甲状腺微小乳头状癌患者行甲状腺切除术与腺叶切除术的生存比较。
The survival after thyroidectomy versus lobectomy in multifocal papillary thyroid microcarcinoma patients.
机构信息
Department of Thyroid and Breast Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China.
Breast Disease Center, Southwest Hospital, the Army Military Medical University, Chongqing, 400038, China.
出版信息
Endocrine. 2024 Sep;85(3):1244-1251. doi: 10.1007/s12020-024-03794-4. Epub 2024 Apr 15.
BACKGROUND
The extent of thyroid surgery for multifocal papillary thyroid microcarcinoma (PTMC) remains controversial. Studies on the optimal surgical approach for a multifocal PTMC are scarce. This study aimed to compare the effectiveness of thyroidectomy and lobectomy for the treatment of multifocal PTMC.
METHODS
A population-based retrospective cohort of patients with multifocal PTMC was analyzed using the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2017, and divided into two groups (thyroidectomy, lobectomy) based on the surgical approach. The clinicopathologic features and survival outcomes were compared between the two groups. Cox proportional hazards regression analysis to explore prognostic factors of survival. Propensity score matching (PSM) was used to balance covariates.
RESULTS
Overall, a total of 9387 multifocal PTMC patients were included in the study. Among them, 8,107 (86.36%) patients received thyroidectomy, and 1280 (13.64%) patients underwent lobectomy. Compared to patients in the thyroidectomy group, patients in the lobectomy group were diagnosed with older age (50.47 years vs. 49.32 years, p = 0.003), a higher proportion of males (20.47% vs. 14.99%, p < 0.001), larger tumors (6.22 mm vs. 4.97 mm, p < 0.001), and more frequently underwent radiotherapy (35.40% vs. 10.16%, p < 0.001). Multivariate Cox regression analysis revealed that age was the only independent prognostic factor for thyroid cancer-specific survival (TCSS), and the determinants of overall survival (OS) were age and gender. Unadjusted survival analysis revealed no difference between the two treatment groups in TCSS (p = 0.598) and OS (p = 0.126). After 1:1 Propensity Score Matching (PSM), there was still no difference in TCSS (p = 0.368) or OS (p = 0.388). The stratified analysis revealed that for patients aged under or above 55, thyroidectomy was not associated with superior BCSS or OS (p > 0.05).
CONCLUSIONS
Thyroidectomy was not associated with improved survival compared to thyroid lobectomy for patients with multifocal PTMC.
背景
甲状腺手术治疗多灶性甲状腺微小乳头状癌（PTMC）的范围仍存在争议。关于多灶性 PTMC 最佳手术方法的研究很少。本研究旨在比较甲状腺切除术和腺叶切除术治疗多灶性 PTMC 的效果。
方法
利用 2004 年至 2017 年间的监测、流行病学和最终结果（SEER）数据库，对多灶性 PTMC 患者进行了一项基于人群的回顾性队列研究，并根据手术方式将患者分为两组（甲状腺切除术、腺叶切除术）。比较两组的临床病理特征和生存结局。采用 Cox 比例风险回归分析探讨生存的预后因素。采用倾向评分匹配（PSM）平衡协变量。
结果
总体而言，共有 9387 例多灶性 PTMC 患者纳入本研究。其中，8107 例（86.36%）患者接受甲状腺切除术，1280 例（13.64%）患者接受腺叶切除术。与甲状腺切除术组相比，腺叶切除术组患者的诊断年龄更大（50.47 岁比 49.32 岁，p=0.003），男性比例更高（20.47%比 14.99%，p<0.001），肿瘤更大（6.22mm 比 4.97mm，p<0.001），且更常接受放疗（35.40%比 10.16%，p<0.001）。多因素 Cox 回归分析显示，年龄是甲状腺癌特异性生存（TCSS）的唯一独立预后因素，而总生存（OS）的决定因素是年龄和性别。未校正生存分析显示，两组 TCSS（p=0.598）和 OS（p=0.126）无差异。经过 1:1 倾向评分匹配（PSM）后，TCSS（p=0.368）或 OS（p=0.388）仍无差异。分层分析显示，对于年龄在 55 岁以下或以上的患者，甲状腺切除术与更好的 BCSS 或 OS 无关（p>0.05）。
结论
与甲状腺腺叶切除术相比，甲状腺切除术并不能改善多灶性 PTMC 患者的生存。
Zotero 插件