LONG-TERM IMPACT OF INITIAL SURGICAL AND MEDICAL THERAPY ON PAPILLARY AND FOLLICULAR THYROID-CANCER
LONG-TERM IMPACT OF INITIAL SURGICAL AND MEDICAL THERAPY ON PAPILLARY AND FOLLICULAR THYROID-CANCER
复制标题
DOI：
10.1016/0002-9343(94)90321-2
复制
发表时间：
1994-11-01
影响因子：
5.9
通讯作者：
JHIANG, SM
中科院分区：
文献类型：
--
作者：
MAZZAFERRI, EL;JHIANG, SM
目得：为了确定长期的影响，医疗和手术治疗分化良好的乳头状和滤泡性甲状腺cancer.METHODS：乳头状和滤泡性癌（n = 1，355）治疗无论是在美国空军或俄亥俄州州立大学医院在过去的40年中，前瞻性调查问卷或个人检查，以确定治疗结果。结果：中位随访时间为15.7年，42%（568）的患者随访20年，14%（185）的患者随访30年。30年后，生存率为76%，复发率为30%，癌症死亡率为8%。复发最常见于年龄的极端（59岁）。癌症死亡率在40岁以下的患者中最低，并且随着随后的每十年的生活而增加。滤泡癌患者的30年癌症死亡率最高，他们更可能有不良预后因素：年龄较大，肿瘤较大，纵隔淋巴结受累较多，远处转移。当排除诊断时有远处转移的患者时，滤泡癌和乳头状癌的死亡率相似（10% vs 6%，P无显著性[NS]）。在排除有远处转移的患者的考克斯回归模型中，癌症死亡的可能性（1）随着年龄大于或等于40岁、肿瘤大小大于或等于1.5 cm、局部肿瘤浸润、区域淋巴结转移和治疗延迟大于或等于12个月而增加;（2）受女性、手术范围大于肺叶切除术、I-131加甲状腺激素治疗的影响;（3）不受肿瘤组织学类型的影响。I-131治疗仅切除正常甲状腺残留后，复发率低于单纯甲状腺激素治疗后复发率的1/3（P
PURPOSE: To determine the long-term impact of medical and surgical treatment of well differentiated papillary and follicular thyroid cancer.METHODS: Patients with papillary and follicular cancer (n = 1,355) treated either in U.S. Air Force or Ohio State University hospitals over the past 40 years were prospectively followed by questionnaire or personal examination to determine treatment outcomes. Outcomes were analyzed by Kaplan-Meier survival curves and Cox proportional-hazard regression model.RESULTS: Median follow-up was 15.7 years; 42% (568) of the patients were followed for 20 years and 14% (185) for 30 years. After 30 years, the survival rate was 76%, the recurrence rate was 30%, and the cancer death rate was 8%. Recurrences were most frequent at the extremes of age (59 years). Cancer mortality rates were lowest in patients younger than 40 years and increased with each subsequent decade of life. Thirty-year cancer mortality rates were greatest in follicular cancer patients, who were more likely to have adverse prognostic factors: older age, larger tumors, more mediastinal node involvement, and distant metastases. When patients with distant metastases at diagnosis were excluded, follicular and papillary cancer mortality rates were similar (10% versus 6%, P not significant [NS]). In a Cox regression model that excluded patients who presented with distant metastases, the likelihood of cancer death was (1) increased by age greater than or equal to 40 years, tumor size greater than or equal to 1.5 cm, local tumor invasion, regional lymph-node metastases, and delay in therapy greater than or equal to 12 months; (2) reduced by female sex, surgery more extensive than lobectomy, and I-131 plus thyroid hormone therapy; and (3) unaffected by tumor histologic type. Following I-131 therapy given only to ablate normal thyroid gland remnants, the recurrence rate was less than one third the rate after thyroid hormone therapy alone (P