Cady B, Rossi R, Silverman M, Wool M
Surgery. 1985 Dec;98(6):1171-8.
Three hundred nine consecutive patients primarily treated at the Lahey Clinic Foundation for differentiated thyroid carcinoma between the years 1961 and 1980 were followed for a median of 13 years and a minimum of 5 years. The recurrence and survival rates of these patients are strikingly different in the low-risk group (men 40 years of age and under and women 50 years and under) compared with the high-risk group (all older patients). Only two patients died and eight others had recurrences but survived in 192 low-risk patients, whereas 18 died and 23 had recurrences in 117 high-risk patients. Thus 20% of patients with recurrence in the low-risk group died but 78% of patients with recurrence in the high-risk group died. Follicular carcinoma and major capsular invasion carries a poor prognosis, but only 22% of low-risk in contrast to 55% of high-risk patients died. The fact that low- and high-risk patients have a separate biology is emphasized by unique sex ratio differences. Low-risk patients have a constant male to female ratio of about 5:1, whereas high-risk patients have progressively increased from 1:3 to a male predominance during the past 5 decades. This study showing unique differences in results by age reemphasizes the concept of basic risk groups in differentiated thyroid cancer. The effect of this basic risk group, as in our previous report, supercedes the effect of pathologic type, extent of local disease, or aspects of therapy and exerts principal control over biologic behavior.
1961年至1980年间，在拉希诊所基金会接受分化型甲状腺癌主要治疗的309例连续患者，接受了中位时间为13年、最短时间为5年的随访。与高危组（所有年龄较大的患者）相比，这些患者在低危组（40岁及以下男性和50岁及以下女性）中的复发率和生存率有显著差异。192例低危患者中，仅2例死亡，另外8例复发但存活；而117例高危患者中，18例死亡，23例复发。因此，低危组复发患者中有20%死亡，而高危组复发患者中有78%死亡。滤泡癌和包膜严重侵犯预后较差，但低危患者中只有22%死亡，而高危患者中这一比例为55%。独特的性别比例差异强调了低危和高危患者具有不同生物学特性这一事实。低危患者的男女比例恒定在约5:1，而高危患者在过去50年中从1:3逐渐增加到男性占主导。这项按年龄显示结果存在独特差异的研究再次强调了分化型甲状腺癌基本风险组的概念。正如我们之前的报告所述，这种基本风险组的影响超越了病理类型、局部疾病范围或治疗方面的影响，并对生物学行为起主要控制作用。
