Taylor T, Specker B, Robbins J, Sperling M, Ho M, Ain K, Bigos S T, Brierley J, Cooper D, Haugen B, Hay I, Hertzberg V, Klein I, Klein H, Ladenson P, Nishiyama R, Ross D, Sherman S, Maxon H R
University of Cincinnati Medical Center, Ohio 45267, USA.
Ann Intern Med. 1998 Oct 15;129(8):622-7. doi: 10.7326/0003-4819-129-8-199810150-00007.
Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial.
To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high-risk papillary and non-Hürthle-cell follicular thyroid carcinoma.
Analysis of data from a multicenter study.
14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry.
385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma).
Death, disease progression, and disease-free survival.
Total or near-total thyroidectomy was done in 85.3% of patients with papillary carcinoma and 71.3% of patients with follicular cancer. Overall surgical complication rate was 14.3%. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95% CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine-131 was given to 85.4% of patients with papillary cancer and 79.3% of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease-free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5% of patients and was not associated with improved survival, lack of progression, or disease-free survival.
This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.
分化型甲状腺癌的治疗已研究多年，但初始广泛甲状腺手术以及联合放射性碘治疗或外照射放疗的益处仍存在争议。
确定手术范围、放射性碘治疗和外照射放疗在高危乳头状和非嗜酸性滤泡性甲状腺癌治疗中的关系。
对一项多中心研究的数据进行分析。
美国和加拿大的14家机构参与了国家甲状腺癌治疗合作研究登记处。
385例高危甲状腺癌患者（303例乳头状癌患者和82例滤泡状癌患者）。
死亡、疾病进展和无病生存期。
85.3%的乳头状癌患者和71.3%的滤泡状癌患者接受了全甲状腺切除术或近全甲状腺切除术。总体手术并发症发生率为14.3%。全甲状腺切除术或近全甲状腺切除术改善了乳头状癌患者的总生存期（风险比[RR]，0.37[95%CI，0.18至0.75]），但未改善癌症特异性死亡率、进展或无病生存期。在滤泡状甲状腺癌患者中未观察到手术范围的影响。85.4%的乳头状癌患者和79.3%的滤泡状癌患者术后接受了碘-131治疗。在乳头状癌患者中，放射性碘治疗与癌症特异性死亡率改善（RR，0.30[仅多因素分析的CI，0.09至0.93]）和进展改善（RR，0.30[CI，0.13至0.72]）相关。排除高细胞变体后，对结局的影响不显著。放射性碘治疗后，滤泡状甲状腺癌患者的总死亡率（RR，0.17[CI，0.06至0.47]）、癌症特异性死亡率（RR，0.12[CI，0.04至0.42]）、进展（RR，0.21[CI，0.08至0.56]）和无病生存期（RR，0.29[CI，0.08至1.01]）均有改善。18.5%的患者接受了颈部外照射放疗，这与生存期改善、无进展或无病生存期无关。
本研究支持术后碘-131治疗后乳头状和滤泡状甲状腺癌患者的总死亡率和癌症特异性死亡率有所改善。放射性碘治疗还与乳头状癌患者的进展改善以及滤泡状癌患者的进展和无病生存期改善相关。
