基于SEER数据库甲状腺髓样癌伴淀粉样间质患者预后分析

Prognostic analysis of medullary thyroid carcinoma with amyloid stroma based on SEER database

目的甲状腺髓样癌(medullary thyroid carcinoma, MTC)约占甲状腺癌的4%,而伴淀粉样间质的髓样癌(medullary thyroid carcinoma with amyloid stroma,MTCAS)更加罕见,这一病理亚型预后研究较缺乏。本研究旨在探究MTCAS患者特异性生存率(cancer-specific survival, CSS)和总体生存率(overall survival,OS)相关的危险因素,分析其预后,并与 MTC、乳头状甲状腺癌(papillary thyroid carcinoma,PTC)和滤泡性甲状腺癌(follicular thyroid carcinoma,FTC)进行比较。方法从美国国立癌症研究所“监测、流行病学和结果数据库”(Surveillance, Epidemiology,and End Results,SEER)数据库中筛选出2004-2013年的MTCAS、MTC、PTC及FTC患者,收集患者年龄、性别、种族、肿瘤大小、甲状腺外侵犯范围、多灶性、TNM分期、手术治疗方式和放射治疗方式等数据,使用Kaplan-Meier分析、对数秩检验和Cox回归模型研究患者预后。结果 MTCAS患者的CSS和OS均与年龄(HR= 1. 066,95%CI为1. 060~1. 072, P<0. 001;HR=l. 077,95%CI 为 1. 074~1.079,P<0. 001)、性别(HR=1. 398,95%CI为 1. 203~1. 625,P<0. 001;HR =1. 633,95%CI 为 1. 524 ~1. 749 ,P<0.001)、TNM 分期(HR=2. 047,95%CI 为 1. 710~2. 450, P<0. 001;HR=l. 498,95%CI 为 1. 368~1. 641, P<0. 001)以及放射治疗(HR = 0. 795,95% CI 为 0. 664~0. 952,P = 0. 013;HR = 0. 701,95%CI为 0.649~0.758,P<0. 001)有关联。排除了相关的混杂因素后,其 CSS(wald=188.17)及 OS(wald= 156. 06)都比MTC患者差(P<0.001),而与PTC和FTC比较时,MTCAS患者的OS高于PTC(P = 0.030),CSS高于FTC(P =0.001)。结论年龄、性别、TNM分期以及放射治疗可能为MTCAS的相关危险因素。MTCAS患者CSS比MTC患者更差,但其OS高于PTC,CSS率高于FTC。

OBJECTIVE Medullary thyroid carcinoma(MTC) accounts for about 4% of thyroid carcinoma. Medullary thyroid carcinoma with amyloid stroma(MTCAS) is more rare,and the prognosis of this pathological subtype is poorly studied. The intention of this study is to investigate the risk factors associated with cancer specific survival and all-cause survival in patients of MTCAS,and to analyze their prognosis,comparing with MTC,PTC and FTC. METHODS Patients of MTCAS,MTC,PTC and FTC were selected from the SEER database (2004-2010) and the patient's information including age,gender, race, tumor size, extrathyroid extension, multifocality, TNM-stage, surgery and radiation were collected from the database. Kaplan-Meier analysis, log-rank test and Cox regression model were used for studying patient prognosis. RESULTS Cancer-specific survival and overall survival in patients with MTCAS were associated with age( HR = 1. 066,95%CI:1.060-1. 072,P<0. 001;HR=l. 077,95%CI: 1. 074-1. 079,P<0. 001, gender( HR= 1. 398,95%CI: 1. 203-1. 625,P<0. 001;HR=l. 633,95%CI: 1. 524-1. 749,P<0. 001, TNM staging( HR= 2. 047,95%CI:l. 710- 2. 450,P<0.001;HR=l. 498,95%CI:1. 368- 1. 641, P<0. 001,and radiation therapy( HR = 0. 795,95%CI:0. 664-0. 952 ,P=0. 013;HR= 0. 701,95 % CI: 0. 649 - 0. 758, P <0. 001. After confounding factors were excluded, the cancerspecific survival and overall survival of patients with MTCAS were worse than those in patients with MTC (188. 17, 156. 06;P<0. 001). But the overall survival of patients with MTCAS was higher than patients with PTC(P = 0. 030),and the cancer-specific survival was higher than patients with FTC(P = 0. 001). CONCLUSIONS Age,gender,TNM staging, and radiation therapy may be associated risk factors for MTCAS. The survival of patients with MTCAS is worse than that of MTC patients, but the overall survival rate is higher than that of PTC, and the cancer-specific survival rate is higher than FTC.