Extrathyroidal extension or tumor size of primary lesion influences thyroid cancer outcomes
Extrathyroidal extension or tumor size of primary lesion influences thyroid cancer outcomes
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DOI：
10.1097/mnm.0000000000001731
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发表时间：
2023-07
影响因子：
1.5
通讯作者：
Wanying Shi;Miao Wang;Liyan Dong;Fuxin Li;Xianghui He;Xia Li;Danyang Sun;Xiangqian Zheng;Q. Jia;J. Tan;Wei Zheng;Ning Li;Ke Xu;Z. Meng
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作者：
Wanying Shi;Miao Wang;Liyan Dong;Fuxin Li;Xianghui He;Xia Li;Danyang Sun;Xiangqian Zheng;Q. Jia;J. Tan;Wei Zheng;Ning Li;Ke Xu;Z. Meng
目的甲状腺外展（Extrathyroidal extension， ETE）是美国癌症联合委员会鉴别分化型甲状腺癌（DTC） T3、T4分期的决定性因素。我们的目的是根据肿瘤大小比较不同程度te的临床结果。方法收集2004 - 2015年监测、流行病学和最终结果数据库中诊断为DTC的患者。根据有无淋巴结转移（LNM）或远处转移（DM）分为两组：A组：无淋巴结转移和DM， B组：有淋巴结转移或DM。每组按肿瘤大小（4cm）再分为4组。根据影响程度将其分为三组：无影响、微观影响和宏观影响。采用Kaplan-Meier法和log-rank检验分析癌症特异性生存（CSS）。结果共纳入91,975例患者。在A组和B组中，对于1 cm大小的肿瘤，无te组与显微te组的CSS无显著性差异，而无te组与宏观te组的CSS有显著性差异。对于肿瘤大小bbb1cm， CSS存在显著差异（无ETE与微ETE、无ETE与大ETE）。结论当肿瘤大小大于1 cm时，微te与预后差有显著相关性。T3和T4分期可以考虑肿瘤的大小，而不仅仅是基于te的存在和程度。在TNM分期中重新考虑微te的遗漏可能是谨慎的。
Aims Extrathyroidal extension (ETE) is a determined factor of T3 and T4 stage of differentiated thyroid cancer (DTC) in American Joint Committee on Cancer. We aimed to compare clinical outcomes between different extent of ETE according to tumor size. Methods Patients diagnosed with DTC were collected from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. They were categorized into two groups by presence of lymph node metastases (LNM) or distant metastases (DM): group A: no presence of LNM and DM, and group B: presence of LNM or DM. Each group was further divided into four groups according to tumor size: 4 cm. ETE was divided into three groups by the extent: no ETE, microscopic ETE, and macroscopic ETE. Kaplan–Meier method and log-rank test were used to analyze cancer-specific survival (CSS). Results 91,975 patients were included. In groups A and B, for tumor size 1 cm, there was no significant difference in CSS between no ETE and microscopic ETE, while a significant difference was observed between no ETE and macroscopic ETE. For tumor size >1 cm, there were significant differences in CSS (both no ETE vs. micro ETE and no ETE vs. macro ETE). Conclusion We suggests that when tumor size is more than 1 cm, micro ETE is significantly associated with poorer outcome. T3 and T4 stages may take account into tumor size rather than merely based on the presence and extent of ETE. It may be prudent to revisit the omission of micro ETE in TNM staging.