Ten Hoor Maaike B C, Lin Jia F, Metman Madelon J H, Rodriguez Schaap Pedro M, Links Thera P, Altena Renske, van Ginhoven Tessa M, Zandee Wouter T, Engelsman Anton F, Kruijff Schelto
Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Surgery, Amsterdam University Medical Centre, Location VUmc Cancer Centre Amsterdam, Amsterdam, the Netherlands.
World J Surg. 2025 Apr;49(4):985-996. doi: 10.1002/wjs.12457. Epub 2024 Dec 25.
The 2015 American Thyroid Association guidelines recommend de-escalating surgical treatment for papillary thyroid cancer (PTC). We hypothesize that the Dutch PTC population might differ due to a restrictive diagnostic policy that mainly selects symptomatic and palpable thyroid nodules for further diagnostics, potentially selecting relatively more aggressive tumors. We aimed to describe the Dutch PTC population because differences in populations can have consequences for the adoption of foreign guidelines.
From the Dutch national cancer registry, patients diagnosed with pT1-T3 PTC between 2005 and 2015 were included. Baseline characteristics, disease-free interval, and overall survival were compared between low-risk and non-low risk PTC. Furthermore, the TNM stage of the Dutch and U.S. cohorts were compared via literature search.
Of the 3368 pT1-T3 patients included, 1813 (53.8%) had a low-risk PTC, and 1555 (46.2%) had a non-low-risk PTC. In the Dutch PTC population, pT1 tumors occurred in 45.8%, pT2 and pT3 tumors occurred in 34.9% and 19.3% of the patients, respectively. Of all patients, 10.2% had central lymph node metastases and 16.6% had lateral lymph node metastasis. Distant metastasis only occurred in 18 (0.5%) of the patients. The 10-year overall survival was 89.6%, with rates of 91.6% for low-risk and 87.3% for non-low-risk patients (p = < 0.001). During the follow-up period, 257 patients (7.6%) had a recurrence.
The higher frequency of advanced tumors among the Dutch PTC population in contrast to the U.S. emphasizes the need for careful national data analyses before the adoption of surgical intervention de-escalation protocols from other countries.
2015年美国甲状腺协会指南建议降低对甲状腺乳头状癌（PTC）的手术治疗强度。我们推测，荷兰的PTC患者群体可能有所不同，因为荷兰的诊断政策较为严格，主要针对有症状且可触及的甲状腺结节进行进一步诊断，这可能导致相对更多侵袭性肿瘤被选中。我们旨在描述荷兰的PTC患者群体，因为不同群体之间的差异可能会影响国外指南的采用。
从荷兰国家癌症登记处纳入2005年至2015年间诊断为pT1-T3期PTC的患者。比较低风险和非低风险PTC患者的基线特征、无病生存期和总生存期。此外，通过文献检索比较荷兰和美国队列的TNM分期。
在纳入的3368例pT1-T3期患者中，1813例（53.8%）为低风险PTC，1555例（46.2%）为非低风险PTC。在荷兰的PTC患者群体中，pT1期肿瘤患者占45.8%，pT2期和pT3期肿瘤患者分别占34.9%和19.3%。所有患者中，10.2%有中央淋巴结转移，16.6%有侧方淋巴结转移。远处转移仅发生在18例（0.5%）患者中。10年总生存率为89.6%，低风险患者为91.6%，非低风险患者为87.3%（p = <0.001）。随访期间，257例患者（7.6%）复发。
与美国相比，荷兰PTC患者群体中晚期肿瘤的发生率更高，这凸显了在采用其他国家的手术干预降级方案之前，需要仔细进行国家数据分析。
