Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients
Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients
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DOI：
10.1046/j.1365-2265.1998.00392.x
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发表时间：
1998-03-01
影响因子：
3.2
通讯作者：
Guilhem, I
中科院分区：
文献类型：
--
作者：
Modigliani, E;Cohen, R;Guilhem, I
背景散发性或遗传性甲状腺髓样癌（MTC）的预后因素仍有争议，并在老系列和小系列中进行了评估。更好地了解这些因素将改善患者管理。目的通过单因素和多因素分析，探讨影响MTC预后的因素。设计与患者：法国降钙素肿瘤研究小组（GETC）采用标准化问卷收集了899例1952年至1996年间诊断的MTC患者的临床、生物学、手术和流行病学资料，并在国家数据库中进行处理，测量生存率和生化治疗法（即术后正常基础血清降钙素水平）采用Kaplan和Meier及log-rank检验统计程序进行分析。数据显示为调整后的生存期，而不是观察到的生存期，仅考虑死于MTC的患者。采用Cox前向比例风险模型，单因素分析对生存率有显著影响的因素。结果：除了家族型占比较大（43%）外，我们人群的一般特征与其他研究相似：手术时平均年龄= 43.4岁；性别比= 1男/1.35女；I期= 20.8%；II期= 21.2%；III期= 46.5%，IV期= 11.5%。863例（96%）患者接受了手术；43%的手术患者生化治愈率。5年调整生存率为85.7±1.5%，10年调整生存率为78.4±2.1%。多因素分析显示，年龄和分期是独立的生存预测因素。在单因素分析中，性别、手术类型、家族型仅能预测肿瘤的预后，生化治疗预测肿瘤的生存率为97.7%。真正的复发，即术后降钙素（CT）正常后的升高，为4.9%。在未治愈的患者中（57%），生存率仍然很好：5年和10年分别为80.2%（+/-2.2%）和70.3%（+/-2.9%）。同样，生化治愈的预测也完全取决于分期。结论未治愈的甲状腺髓样癌患者生存率好于预期，分期影响较大，术前诊断的必要性明显。
BACKGROUND Prognostic factors of sporadic or inherited medullary thyroid carcinoma (MTC) are still controversial and have been assessed in old and small series. A better knowledge of these factors would improve patient management.OBJECTIVE To evaluate factors involved in the prognosis of MTC in a large series of cases, using uni- and multivariate analysis.DESIGN AND PATIENTS Clinical, biological, surgical and epidemiological data on 899 MTC patients, diagnosed between 1952 and 1996, were collected by the French Calcitonin Tumors Study Group (GETC) with a standardized questionnaire, and processed in a national database,MEASUREMENTS Survival and biochemical cure (i.e. normal basal post-operative serum calcitonin levels) were analysed with Kaplan and Meier and log-rank test statistical procedures. Data are presented as adjusted rather than observed survival, to consider only patients who died of MTC. Cox's forward-stepping proportional hazard model was used to analyse factors with a significant influence on survival by univariate analysis.RESULTS Apart from the large proportion of familial forms (43%), the general characteristics of our population were similar to those in other studies: mean age at surgery = 43.4 years; sex ratio = 1 male/1.35 female; stage I = 20.8%; stage II = 21.2%; stage III = 46.5% and stage IV = 11.5%. 863 (96%) patients underwent surgery; 43% of operated patients were biochemically cured. Adjusted survival was 85.7 +/- 1.5% at 5 years and 78.4 +/- 2.1% at 10 years. Multivariate analysis showed that age and stage were independent predictive factors of survival. Gender, type of surgery, type of familial form were predictive only in univariate analysis, Biochemical cure predicts a survival rate of 97.7% at in years. Authentic recurrence, that is subsequent elevation of calcitonin (CT) after post-operative normalization, was found in 4.9%. In non-cured patients (57%), survival was still good: 80.2% (+/-2.2%) and 70.3% (+/-2.9%) at 5 and 10 years, respectively. Similarly, prediction of biochemical cure was solely dependent on stage.CONCLUSION Survival of these medullary thyroid carcinoma patients appears better than expected even in non-cured patients, Considering the strong impact of stage, the necessity for pre-operative diagnosis of MTC is obvious.