Outcomes of patients with differentiated thyroid carcinoma following initial therapy
Outcomes of patients with differentiated thyroid carcinoma following initial therapy
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DOI：
10.1089/thy.2006.16.1229
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发表时间：
2006-12-01
期刊：
影响因子：
6.6
通讯作者：
Sherman, Steven I.
中科院分区：
文献类型：
--
作者：
Jonklaas, Jacqueline;Sarlis, Nicholas J.;Sherman, Steven I.
该分析旨在确定初始治疗对甲状腺癌患者结局的影响。研究背景是一项前瞻性随访的多机构登记研究。患者被分层为低风险（I期和II期）或高风险（III期和IV期）。所采用的治疗包括甲状腺近全切除术、放射性碘给药和甲状腺激素抑制治疗。结果指标为总生存期、疾病特异性生存期和无病生存期。甲状腺近全切除术、放射性碘和积极的甲状腺激素抑制治疗均与高危患者的总生存期延长独立相关。甲状腺近全切除术后放射性碘治疗和中度甲状腺激素抑制治疗，均能提高II期患者的总生存率。没有任何治疗方式，包括缺乏放射性碘，与I期患者生存率的改变相关。根据我们的总体生存数据，我们证实甲状腺近全切除术适用于高危患者。我们还得出结论，放射性碘治疗是有益的II，III和IV期患者。重要的是，我们首次表明，上级结果与高风险患者的积极甲状腺激素抑制治疗相关，但在II期患者中，适度抑制可实现。我们无法显示特定治疗对I期患者的任何积极或消极影响。
This analysis was performed to determine the effect of initial therapy on the outcomes of thyroid cancer patients. The study setting was a prospectively followed multi-institutional registry. Patients were stratified as low risk (stages I and II) or high risk (stages III and IV). Treatments employed included near-total thyroidectomy, administration of radioactive iodine, and thyroid hormone suppression therapy. Outcome measures were overall survival, disease-specific survival, and disease-free survival. Near-total thyroidectomy, radioactive iodine, and aggressive thyroid hormone suppression therapy were each independently associated with longer overall survival in high-risk patients. Near-total thyroidectomy followed by radioactive iodine therapy, and moderate thyroid hormone suppression therapy, both predicted improved overall survival in stage II patients. No treatment modality, including lack of radioactive iodine, was associated with altered survival in stage I patients. Based on our overall survival data, we confirm that near-total thyroidectomy is indicated in high-risk patients. We also conclude that radioactive iodine therapy is beneficial for stage II, III, and IV patients. Importantly, we show for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high-risk patients, but are achieved with modest suppression in stage II patients. We were unable to show any impact, positive or negative, of specific therapies in stage I patients.