甲状腺髓样癌患者无进展生存期的预后因素：一项多中心队列研究。

Prognostic factors for progression free survival in patients with medullary thyroid cancer: a multicenter cohort study.

作者信息

Zheng Guibin, Liu Jianing, Xu Hao, Dong Chaopeng, Cao Xianjiao, He Qingqing, Zhang Guanyu, Wang Wei, Wang Liquan, Yang Xiaoqing, Liu Jiaqi, Hao Min, Xue Kecheng, Li Guolou, Liu Xianqiang, Ding Changyuan, Wang Xufu, Zheng Haitao

机构信息

Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, China.

Department of Thyroid Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, China.

出版信息

Updates Surg. 2025 May 20. doi: 10.1007/s13304-025-02193-2.

DOI:10.1007/s13304-025-02193-2

PMID:40392415

Abstract

Many patients with medullary thyroid cancer (MTC) experience recurrent or persistent disease after surgery due to its aggressive nature. However, the prognostic factors for progression-free survival (PFS) have been poorly investigated. This study aimed to explore prognostic factors associated with PFS in patients with MTC. Patients with MTC were enrolled from 15 medical centers in Shandong Province, China, between January 2010 and December 2021. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors for PFS in patients with MTC. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of the metastatic lymph node ratio (LNR) in predicting PFS. Patients with MTC from the Surveillance, Epidemiology, and End Results (SEER) database were used to test the predictive value of the LNR cutoff for overall survival (OS) and disease-specific survival (DSS). In the Shandong cohort, extrathyroidal extension (HR, 1.622; 95% CI 1.022-2.575, P = 0.040), LNR (HR, 2.806; 95% CI 1.121-7.025, P = 0.028), and T3 stage (HR, 2.060; 95% CI 1.074-3.952, P = 0.030) were independent risk factors for PFS in patients with MTC. The optimal cutoff value of the LNR for predicting PFS was 0.19. Compared to patients with LNR < 0.19, those with LNR ≥ 0.19 suffered worse PFS (Log-rank P < 0.0001) in the Shandong cohort, and worse OS (Log-rank P < 0.0001) and DSS (Log-rank P < 0.0001) in the SEER cohort. This study identified prognostic factors for PFS in patients with MTC. LNR ≥ 0.19 could be used as an adverse prognostic factor for patients with MTC.

摘要

许多甲状腺髓样癌（MTC）患者由于其侵袭性，术后会出现疾病复发或持续存在的情况。然而，对无进展生存期（PFS）的预后因素研究较少。本研究旨在探讨MTC患者中与PFS相关的预后因素。2010年1月至2021年12月期间，从中国山东省的15个医疗中心招募了MTC患者。采用单因素和多因素Cox回归分析来探讨MTC患者PFS的预后因素。进行受试者工作特征曲线分析，以确定转移淋巴结比率（LNR）预测PFS的最佳临界值。使用监测、流行病学和最终结果（SEER）数据库中的MTC患者来检验LNR临界值对总生存期（OS）和疾病特异性生存期（DSS）的预测价值。在山东队列中，甲状腺外侵犯（HR，1.622；95%CI 1.022 - 2.575，P = 0.040）、LNR（HR，2.806；95%CI 1.121 - 7.025，P = 0.028）和T3期（HR，2.060；95%CI 1.074 - 3.952，P = 0.030）是MTC患者PFS的独立危险因素。预测PFS的LNR最佳临界值为0.19。在山东队列中，与LNR < 0.19的患者相比，LNR≥0.19的患者PFS更差（对数秩检验P < 0.0001），在SEER队列中OS更差（对数秩检验P < 0.0001），DSS更差（对数秩检验P < 0.0001）。本研究确定了MTC患者PFS的预后因素。LNR≥0.19可作为MTC患者的不良预后因素。