Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years.
Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years.
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DOI：
10.1016/j.surg.2016.04.053
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发表时间：
2017-01
期刊：
影响因子：
3.8
通讯作者：
Pitt SC
中科院分区：
文献类型：
--
作者：
Randle RW;Balentine CJ;Leverson GE;Havlena JA;Sippel RS;Schneider DF;Pitt SC
最近的医学进步对甲状腺髓样癌（MTC）患者的疾病表现、手术范围和疾病特异性生存率（DSS）的影响尚不清楚。我们使用了监测、流行病学和最终结果登记处来比较1983-1992年、1993-2002年和2003-2012年三个时间段的趋势。在1983年至2012年期间，有2，940名患者被诊断患有MTC。在此期间，MTC的发病率从0.14/100，000人增加到0.21/100，000人，诊断时的平均年龄从49.8岁增加到53.8岁（p<0.001）。≤1cm的肿瘤比例也从1983-1992年的11.4%、1993-2002年的19.6%增加到2003-2012年的25.1%（p<0.001），但诊断时的分期保持不变（p=0.57）。此外，在研究期间，接受甲状腺全切除术和淋巴结清扫术的患者比例从58.2%增加到76.5%（p<0.001）。在最近的时间间隔内，所有患者的5年DSS从86%改善至89%（p<0.001），但对于局部（82%至91%，p=0.003）和远处（40%至51%，p=0.02）疾病的患者尤其如此。这些数据表明，MTC患者的手术范围正在增加。DSS也在改善，主要是在区域性和远处疾病患者中。
The impact of recent medical advances on disease presentation, extent of surgery, and disease specific survival (DSS) for patients with medullary thyroid cancer (MTC) is unclear. We used the Surveillance, Epidemiology, and End Results registry to compare trends over three time periods, 1983–1992, 1993–2002, and 2003–2012. There were 2,940 patients diagnosed with MTC between 1983 and 2012. The incidence of MTC increased during this time period from 0.14 to 0.21 per 100,000 population, and mean age at diagnosis increased from 49.8 to 53.8 (p<0.001). The proportion of tumors ≤1cm also increased from 11.4% in 1983–1992, 19.6% in 1993–2002, to 25.1% in 2003–2012 (p<0.001), but stage at diagnosis remained constant (p=0.57). In addition, the proportion of patients undergoing a total thyroidectomy and lymph node dissection increased from 58.2% to 76.5% during the study period (p<0.001). In the most recent time interval, 5-year DSS improved from 86% to 89% in all patients (p<0.001), but especially for patients with regional (82% to 91%, p=0.003) and distant (40% to 51%, p=0.02) disease. These data demonstrate that the extent of surgery is increasing for patients with MTC. DSS is also improving, primarily in patients with regional and distant disease.