Determinants of life expectancy in medullary thyroid cancer: age does not matter
Determinants of life expectancy in medullary thyroid cancer: age does not matter
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DOI：
10.1111/j.1365-2265.2006.02659.x
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发表时间：
2006-12-01
影响因子：
3.2
通讯作者：
Links, Thera P.
中科院分区：
文献类型：
--
作者：
de Groot, Jan Willem B.;Plukker, John T. M.;Links, Thera P.
目的 在甲状腺髓样癌 (MTC) 中，年龄被认为是重要的预后因素，但生存率从未根据一般人群的基线死亡率进行适当调整。我们旨在通过分析 MTC 患者的预期寿命来确定预后因素。设计我们描述了一项中位随访时间为 8 年（范围 1-35 年）的回顾性队列研究。患者我们纳入了 120 名连续患者，其中 66 名（55%）患有散发性 MTC。男女比例为1：1；中位年龄为 45 岁（范围 3-83 岁）。测量结果为总体生存率和疾病特异性生存率以及预期寿命，以根据普通人群基线死亡率调整后的生存率表示。结果总体生存率和疾病特异性生存率分别为 65% 和 73%。 10年后，29%的患者生化治愈，63%临床治愈。总体预期寿命中位数为 0.58 (95%CI 0.37-0.80)。中位 36 个月（范围 5-518 个月）后，60 名患者出现可检测到的复发。在多变量回归分析中，只有疾病分期和甲状腺外扩展可以预测无复发预期寿命。甲状腺外延长是总体预期寿命的唯一独立预测因素。持续的生化 MTC 并不独立影响预期寿命，但降钙素倍增时间少于一年表明预后较差。初次治疗后未检测到复发的患者的预期寿命与一般人群相似。结论在 MTC 患者中，甲状腺外扩展和诊断时的分期是（无复发）预期寿命的唯一独立预测因素。疾病早期诊断的患者和未检测到复发的患者具有良好的预期寿命，与生化治愈无关。
Objective In medullary thyroid cancer (MTC) age is considered an important prognostic factor but survival has never been properly adjusted for baseline mortality in the general population. We aimed to identify prognostic factors by analysing patients with MTC regarding life expectancy.Design We described a retrospective cohort study with a median follow-up of 8 years (range 1-35 years).Patients We included 120 consecutive patients of whom 66 (55%) had sporadic MTC. Male/female ratio was 1 : 1; median age was 45 years (range 3-83 years).Measurements Measurements were overall and disease-specific survival and life expectancy expressed as survival adjusted for baseline mortality rate in the general population.Results Overall and disease-specific 10-year survival was 65% and 73%, respectively. After 10 years, 29% of patients were biochemically and 63% clinically cured. Median overall life expectancy was 0.58 (95%CI 0.37-0.80). Detectable recurrence occurred in 60 patients after a median of 36 months (range 5-518 months). On multivariate regression analysis only stage of disease and extrathyroidal extension predicted recurrence-free life expectancy. Extrathyroidal extension was the only independent predictor of overall life expectancy. Persistent biochemical MTC did not independently affect life expectancy but calcitonin doubling time of less than one year indicated worse prognosis. Patients without detectable recurrences after initial treatment had a life expectancy similar to the general population.Conclusions In MTC patients, extrathyroidal extension and stage at diagnosis are the only independent predictors of (recurrence-free) life expectancy. Patients diagnosed in an early stage of disease and patients without detectable recurrence have favourable life expectancy independently of biochemical cure.