Locoregional recurrence and death from medullary thyroid carcinoma in a contemporaneous series: 5-year results
Locoregional recurrence and death from medullary thyroid carcinoma in a contemporaneous series: 5-year results
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DOI：
10.1530/eje-07-0095
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发表时间：
2007-07-01
影响因子：
5.8
通讯作者：
Dralle, Henning
中科院分区：
文献类型：
--
作者：
Machens, Andreas;Hofmann, Christine;Dralle, Henning
目的：研究甲状腺髓样癌患者的预后需要长期随访，以积累足够的癌症特异性事件。由于诊断和治疗的时间依赖性变化，长时间的观察使研究容易受到“时间偏差”的影响，从而产生虚假的结果。本研究的目的是调查癌症特异性事件发生率后，最初的颈部切除术在同期患者招募不到10年内。设计：机构队列研究的128名连续患者进行了分区导向的颈部手术在1994年和2002年之间，在第三外科中心迄今未经治疗的甲状腺髓样癌。研究方法：Kaplan-Meier法与log-rank检验相结合，用于分析时间依赖性outcomes.Results：随访120例（94%），其中包括63例重排转染（RET）载体。在110例初次颈部切除术时手术切缘清晰的患者中有6例局部复发，在120例随访患者中有12例癌症特异性死亡。Kaplan-Meier分析。大多数临床病理学变量与无复发生存率和癌症特异性生存率显著相关。在64.5个月的中位观察期内，淋巴结阴性肿瘤患者未发生局部复发或死于恶性肿瘤。低事件发生率排除了所有临床病理变量的多变量分析。通过我们广泛的手术方法，中位无复发生存率和癌症特异性生存率分别为95.2%和89.3%。我们的5年局部复发率为4.8%，非常有利。我们的5年癌症特异性死亡率为10.7%，是有史以来报告的最低水平。在同期患者中，局部甲状腺髓样癌的比例不断增加，预计最终会降低事件发生率。使未来的研究结果复杂化。
Objective: Studies of outcome in patients with medullary thyroid carcinoma require long follow-ups to accrue enough cancer-specific events. Owing to time-dependent changes in diagnosis and therapy, long observation periods render studies susceptible to 'time bias' which can yield spurious results. This study was designed to investigate cancer-specific event rates after initial neck resection in contemporaneous patients recruited within less than a decade.Design: Institutional cohort study of 128 consecutive patients who underwent compartment-oriented neck surgery between 1994 and 2002 at a tertiary surgical center for hitherto untreated medullary thyroid carcinoma. Methods: The Kaplan-Meier method was used in conjunction with the log-rank test for analysis of time-dependent outcomes.Results: Follow-up was available for 120 patients (94%) including 63 rearranged during transfection (RET) carriers. There were six locoregional recurrences in the 110 patients with clear surgical margins at initial neck resection, and 12 cancer-specific deaths in the 120 patients with available follow-up. On Kaplan-Meier analysis. most clinicopathological variables were significantly associated with recurrence-free survival and cancer-specific survival. Within the median observation period of 64.5 months, patients with node-negative tumors did not develop locoregional recurrence or die front their malignancies. The low event rates precluded multivariate analyses with all clinicopathological variables. With our extensive surgical approach, median recurrence-free survival and cancer-specific survival Lit 5 years were 95.2 and 89.3%, respectively.Discussion: Compared with literature data. Our 5-year locoregional recurrence rate of 4.8%, appeared very favorable. and our 5-year cancer-specific mortality rate of 10.7% was among the lowest ever reported. The growing proportion of localized medullary thyroid carcinomas among contemporaneous patients can be expected to ultimately lower the event rates. complicating future Studies of outcome.