甲状腺微小乳头状癌外科手术方式趋势及相关因素分析:基于SEER数据库的回顾性研究

Trends and related factors analyses for surgical procedure in patients with papillary thyroid microcarcinoma:A retrospective study based on SEER database

目的:了解甲状腺微小乳头状癌(PTMC)外科手术方式的趋势,分析可能影响手术方式选择的相关因素。方法:提取美国SEER数据库2004年至2014年病理诊断为PTMC患者的病例资料,回顾性分析甲状腺和区域淋巴结外科手术方式的趋势及相关因素。甲状腺手术方式分为甲状腺全/近全切除术和甲状腺非全切除术,区域淋巴结手术方式分为清扫和未清扫。结果:32984例患者纳入分析,中位年龄49岁(IQR:23~76岁),男性占17.15%,女性占82.85%。甲状腺手术方式全/近全切除率从2004年的72.43%逐渐增至2012年的79.90%,甲状腺非全切除比例从2004年的27.46%逐渐降至2012年的20.05%。患者年龄、性别、病灶数和肿瘤分期与甲状腺手术方式的选择显著相关(P<0.001)。区域淋巴结的清扫比例从2004年的34.10%逐渐增至2012年的44.54%,未清扫比例从2004年的64.68%逐渐降至2011年的54.43%。区域淋巴结手术方式与年龄、病灶数和肿瘤分期密切相关(P<0.001),与性别无相关性(P=0.053)。结论:PTMC患者甲状腺全/近全切除比例和区域淋巴结清扫比例呈增加趋势,应根据患者的肿瘤特性、疾病分期和复发分层选择手术方式。

Objective:To investigate the trend of surgical procedures in patients with papillary thyroid microcarcinoma(PTMC),and explore the potential factors influencing the surgery choice.Methods:Clinical data of PTMC patient confirmed by pathology was extracted from the American surveillance,epidemiology,and end results database between 2004 and 2014.We retrospectively analyzed the surgical procedure trend and relative factors.Thyroid surgical procedure was divided into subtotal/total thyroidectomy and non-total thyroidectomy,and regional lymph node surgery was classified as dissection and non-dissection.Results:32984 patients with PTMC were enrolled in the analyses,with the median age of 49 years old(IQR:23~76 years old),17.15%male and 82.85%female.The percentage of subtotal/total thyroidectomy was gradually increased from 72.43%in 2004 to 79.90%in 2012,and the percentage of non-thyroidectomy was gradually decreased from 27.46%in 2004 to 20.05%in 2012.Patients'age,gender,number of lesions,and tumor stage were significantly correlated with the choice of thyroid surgery(P<0.001).The proportion of regional lymph node dissection gradually increased from 34.10%in 2004 to 44.54%in 2012,and the proportion of undissection gradually decreased from 64.68%in 2004 to 54.43%in 2011.Regional lymph node surgery was closed correlated with age,number of lesions and tumor stage(P<0.001),but not with gender(P=0.053).Conclusion:The proportion of subtotal/total thyroidectomy and regional lymph node dissection in patients with PTMC showed an increasing trend,and surgical procedures should be selected according to patients'tumor characteristics,stage and recurrence risk.