Pilecki Maksymillian J, Herremans Kelly M, Neal Daniel, Kabbash Michel S, Shaw Christiana M, Nassour Ibrahim, Shirali Aditya S
Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
J Surg Res. 2025 Jul 25;314:38-48. doi: 10.1016/j.jss.2025.06.072.
Oncocytic thyroid carcinoma (OCA) carries a worse prognosis when compared to papillary or follicular thyroid cancer; however, the degree to which OCA is associated with nodal metastases is poorly understood. We sought to determine the predictors of survival in patients with OCA who underwent nodal evaluation.
The National Cancer Database was queried from 2004 to 2020 for patients with OCA who underwent nodal evaluation. Patients who underwent regional lymph node evaluation were included in the analysis. Patient demographics, tumor characteristics, surgical management, and survival were analyzed. Kaplan-Meier and Cox proportional hazards models were used to determine overall survival (OS) rates and estimate the association between nodal disease and survival.
There were 12,438 patients with OCA. A total of 3373 patients (27.1%) underwent nodal evaluation, of which 462 (14%) were found to have pathologic nodal metastases. Patients with nodal metastases were more likely to be older, male, Hispanic, treated at an academic facility, have public insurance, have longer median distance to treatment facility and have a larger tumor size, lymphovascular invasion, and positive margins (P < 0.01). Of the patients who underwent surgery, those with nodal metastases had shorter 1-y, 3-y, and 5-y OS. Nodal metastasis is independently associated with worse OS (hazard ratio: 2.7 [95% confidence interval: 2.12, 3.39], P < 0.0001).
Nodal metastases were found in 14% of patients with OCA who underwent nodal evaluation and were associated with compromised survival. Identifying patients with increased risk of nodal metastases in patients with a high index of suspicion for OCA will help with surgical decision-making.
与乳头状或滤泡状甲状腺癌相比，嗜酸细胞性甲状腺癌（OCA）的预后较差；然而，OCA与淋巴结转移的关联程度尚不清楚。我们试图确定接受淋巴结评估的OCA患者的生存预测因素。
查询2004年至2020年国家癌症数据库中接受淋巴结评估的OCA患者。接受区域淋巴结评估的患者纳入分析。分析患者的人口统计学特征、肿瘤特征、手术治疗情况和生存率。采用Kaplan-Meier法和Cox比例风险模型确定总生存率（OS），并估计淋巴结疾病与生存之间的关联。
共有12438例OCA患者。3373例患者（27.1%）接受了淋巴结评估，其中462例（14%）发现有病理淋巴结转移。有淋巴结转移的患者更可能年龄较大、为男性、西班牙裔、在学术机构接受治疗、有公共保险、到治疗机构的中位距离更长，且肿瘤更大、有脉管侵犯和切缘阳性（P<0.01）。接受手术的患者中，有淋巴结转移的患者1年、3年和5年OS较短。淋巴结转移与较差的OS独立相关（风险比：2.7[95%置信区间：2.12，3.39]，P<0.0001）。
在接受淋巴结评估的OCA患者中，14%发现有淋巴结转移，且与生存受损相关。在高度怀疑为OCA的患者中识别出淋巴结转移风险增加的患者将有助于手术决策。
