Recurrence of differentiated thyroid cancer in the elderly
Recurrence of differentiated thyroid cancer in the elderly
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DOI：
10.1530/eje-12-0848
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发表时间：
2013-04-01
影响因子：
5.8
通讯作者：
Goldenberg, David
中科院分区：
文献类型：
--
作者：
Hollenbeak, Christopher S.;Boltz, Melissa M.;Goldenberg, David
目的：来自监测流行病学和最终结果医疗保险相关数据库的数据用于估计复发性甲状腺癌的发生率和相关危险因素，并评估诊断后复发对死亡率的影响，控制死亡率作为竞争风险。设计：我们在1995年至2007年间确定了2883例65岁以上诊断为单一原发性高分化甲状腺癌的患者。如果患者有I-131治疗的证据，转移性甲状腺癌的影像学检查，或诊断超过6个月的完全甲状腺切除术，则考虑复发。采用具有1年和2年里程碑的Cox比例风险模型进行竞争风险回归。结果：2883例患者中有1117例（39%）出现复发。年龄、分期和治疗状态是疾病复发的重要危险因素（P < 0.0001）。复发性疾病患者在诊断后10年内的全因死亡率高于1年和2年无复发的患者。有滤泡组织学和复发的患者死于癌症的可能性低于无复发的患者（风险比0.54;P = 0.03）。结论：该老年患者高分化甲状腺癌复发率为39%。病变程度和年龄对分化型甲状腺癌复发风险有负相关影响。在这些数据中，有滤泡组织学和复发的患者死亡的可能性较小，这表明死亡率和复发是相互竞争的风险。这些数据应考虑到个体化治疗策略的老年患者复发性恶性甲状腺疾病。欧洲内分泌学杂志168 549-556
Objective: Data from the Surveillance Epidemiology and End Results Medicare-linked database were used to estimate the incidence of and risk factors associated with recurrent thyroid cancer, and to assess the impact of recurrence on mortality following diagnosis, controlling for mortality as a competing risk.Design: We identified 2883 patients over 65 years of age diagnosed with a single, primary well-differentiated thyroid cancer between 1995 and 2007. A recurrence was considered if the patient had evidence of I-131 therapy, imaging for metastatic thyroid carcinoma, or complete thyroidectomy beyond 6 months of diagnosis. Competing risk regressions were performed using Cox proportional hazards models with 1- and 2-year landmarks.Results: Recurrence was observed in 1117 (39%) of the 2883 patients in the cohort. Age, stage, and treatment status were significant risk factors for developing recurrent disease (P < 0.0001). Patients with recurrent disease had a higher risk of all-cause mortality within 10 years of diagnosis than patients with no recurrence at 1- and 2-year landmarks. Patients with follicular histology and a recurrence were less likely to die from cancer (hazard ratio 0.54; P = 0.03) than patients with no recurrence.Conclusions: The rate of recurrence of well-differentiated thyroid carcinomas in this sample of elderly patients was 39%. Extent of disease and older age negatively impacted the risk of recurrence from differentiated thyroid cancer. In these data, patients with follicular histology and a recurrence were less likely to die, suggesting that mortality and recurrence are competing risks. These data should be taken into account with individualized treatment strategies for elderly patients with recurrent malignant thyroid disease. European Journal of Endocrinology 168 549-556