Radiation-Induced Differentiated Thyroid Cancer Is Associated with Improved Overall Survival but Not Thyroid Cancer-Specific Mortality or Disease-Free Survival.
Radiation-Induced Differentiated Thyroid Cancer Is Associated with Improved Overall Survival but Not Thyroid Cancer-Specific Mortality or Disease-Free Survival.
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放射诱导的分化型甲状腺癌与总体生存率改善相关，但与甲状腺癌特异性死亡率或无病生存率无关。
DOI：
10.1089/thy.2015.0634
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Onel,Kenan
中科院分区：
文献类型：
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作者：
White,MichaelG;Cipriani,NicoleA;Abdulrasool,Layth;Kaplan,Sharone;Aschebrook-Kilfoy,Briseis;Angelos,Peter;Kaplan,EdwinL;Grogan,RaymonH;Onel,Kenan
背景：放射是分化型甲状腺癌（DTC）的一个众所周知的危险因素。虽然DTC的自然历史后，核灾难和医疗工作者与慢性辐射暴露（RE）已被描述，很少有人知道DTC后，短期暴露于治疗性医疗辐射的良性疾病。本研究比较了DTC的形态和结果，患者有和没有以前的治疗性外部RE.Methods的历史：一项回顾性研究进行了DTC治疗的患者在芝加哥大学1951年和1987年之间，中位随访27年（范围0.3-60年）。患者被分类为有（RE+）或无（RE-）治疗性RE病史。检查的变量包括性别、RE时的年龄、RE剂量、RE适应症、DTC组织学和结局。通过对所有可用的组织学切片进行盲态回顾性审查来确定形态学。使用考克斯比例风险模型和Kaplan-Meier curves.Results：257例DTC患者中，165例（64%）为RE-，92例（36%）为RE+，RE+组中男性占更大比例（43.5% vs. 27.3%;p= 0.01）。共有94.2%的DTC病例为经典乳头状癌; RE+和RE-队列之间的组织学无差异（p= 0.73）。RE与中位总生存期增加相关（OS; 43年vs. 38年;风险比[HR] = 0.55 [置信区间（CI）0.34-0.89];p= 0.01）。RE-组男性的生存率显著低于RE-女性（HR = 1.78 [CI 1.05-3.03];p= 0.03）或RE+男性（HR = 2.98 [CI 1.39-6.38];p= 0.01）。RE+和RE-组之间的复发率没有差异（HR = 0.85 [CI 0.52-1.41];p= 0.54），DTC特异性死亡率也没有差异（HR = 0.54 [CI 0.21-1.37];p= 0.20）。结论：虽然在历史上认为RE后的DTC比没有RE的DTC更具侵袭性，但目前的数据表明RE+ DTC与比RE-DTC更好的OS相关，尤其是对于男性。此外，最近的报告证实了甲状腺癌复发率相当。这些结果需要进一步研究这一意外发现的潜在因素。
Background:Radiation is a well-described risk factor for differentiated thyroid carcinoma (DTC). Although the natural history of DTC following nuclear disasters and in healthcare workers with chronic radiation exposure (RE) has been described, little is known about DTC following short-term exposure to therapeutic medical radiation for benign disease. This study compares DTC morphology and outcomes in patients with and without a prior history of therapeutic external RE.Methods:A retrospective review was performed of patients with DTC treated at The University of Chicago between 1951 and 1987, with a median follow-up of 27 years (range 0.3–60 years). Patients were classified as either having (RE+) or not having (RE–) a history of therapeutic RE. Variables examined included sex, age at RE, dose of RE, indication for RE, DTC histology, and outcome. Morphology was determined by blinded retrospective review of all available histologic slides. Outcomes were assessed using Cox proportional hazards model and Kaplan–Meier curves.Results:Of 257 DTC patients, 165 (64%) were RE– and 92 (36%) were RE+, with males comprising a greater proportion of the RE+ group (43.5% vs. 27.3%;p= 0.01). A total of 94.2% of DTC cases were classic papillary cancers; histology did not differ between RE+ and RE– cohorts (p= 0.73). RE was associated with an increased median overall survival (OS; 43 years vs. 38 years; hazard ratio [HR] = 0.55 [confidence interval (CI) 0.34–0.89];p= 0.01). Survival for males in the RE– group was significantly worse than it was for RE– females (HR = 1.78 [CI 1.05–3.03];p= 0.03) or RE+ males (HR = 2.98 [CI 1.39–6.38];p= 0.01). Recurrence did not differ between the RE+ and RE– groups (HR = 0.85 [CI 0.52–1.41];p= 0.54), nor did DTC-specific mortality (HR = 0.54 [CI 0.21–1.37];p= 0.20).Conclusions:While DTC following RE has historically been considered a more aggressive variant than DTC in the absence of RE, the present data indicate that RE+ DTC is associated with better OS than RE– DTC, especially for males. Additionally, recent reports are confirmed of equivalent rates of thyroid cancer recurrence. These results warrant further investigation into the factors underlying this unexpected finding.