不同年龄节点对甲状腺癌患者风险分层的评估效果

Application value of different age threshold on the risk stratification of patients with thyroid cancer

目的评估第8版美国癌症联合委员会(AJCC)/TNM甲状腺癌分期系统中将甲状腺乳头状癌(PTC)风险分层的年龄节点从45岁增加到55岁后对PTC患者风险分层的价值。方法选取2016年6月至2020年12月南京医科大学附属逸夫医院收治的127例PTC患者。根据PTC诊断时的年龄将患者按照两个年龄节点(45岁和55岁)分为两组:<45岁组53例,≥45岁组74例;<55岁组91例,≥55岁组36例。比较各组患者的临床病理特征和术前超声特征的差异。使用单因素Logistic回归分析探讨年龄与肿瘤分期及淋巴结转移的关联性。结果≥55岁组与<55岁组pTNM分期、肿瘤分期及淋巴结转移差异有统计学意义(P<0.001)。≥45岁组与<45岁组的pTNM分期差异有统计学意义(P<0.05),肿瘤分期及淋巴结转移差异无统计学意义(P>0.05)。单因素Logistic回归分析结果显示,≥45岁组中局部晚期肿瘤(pT3+pT4)和淋巴结转移(pN1)的风险程度与<45岁组差异无统计学意义(P>0.05)。≥55岁组中局部晚期肿瘤和淋巴结转移的风险明显高于<55岁组(P<0.05)。同时根据术前彩超的特征,年长组(≥45岁和≥55岁)患者中存在肿块形状不规则、边界不清楚、微钙化、高血供及TI-RADS高等级的比例均高于年轻组(<45岁和<55岁),差异有统计学意义(P<0.05)。≥55岁组的肿块纵横比≥1和肿瘤直径<2 cm的比例高于<55岁组,差异有统计学意义(P<0.05);但这两项特征在≥45岁组与<45岁组间差异无统计学意义(P>0.05)。结论以55岁作为PTC患者风险分层的年龄节点,可以更好地对不同预后的患者进行分层,在临床分期中更有价值。

Objective To evaluate the stratification effect of increasing the age cut-off of papillary thyroid carcinoma(PTC)risk stratification from 45 to 55 years in the 8th Edition of the American Joint Committee on Cancer(AJCC)classification.Methods 127 patients with PTC who were treated in the Sir Run Run Hospital,Nanjing Medical University from June 2016 to December 2020 were selected.According to the age at the time of PTC diagnosis,all patients were divided into two groups according to two age cut-off(45 years old and 55 years old):53 cases in the group<45 years old,74 cases in the group≥45 years old;91 cases in the group<55 years old,and 36 cases in the group≥55 years old.Compare the differences between the clinicopathological characteristics and preoperative ultrasound characteristics of patients in each group.A univariate analysis was conducted by log-rank to evaluate the relationship between age,tumor stage and lymph node metastasis.Results There were statistically significant differences in pTNM staging,tumor staging and lymph node metastasis between the≥55 years old group and the<55 years old group(P<0.001).Meanwhile,there was a statistically significant difference in pTNM staging between the≥45 years old group and the<45 years old group(P<0.05),and the difference in tumor stage and lymph node metastasis was not statistically significant(P>0.05).Univariate analysis found that the risk of locally advanced tumors(pT3+pT4)and lymph node metastasis(pN1)in the≥45 years old group was not significantly different from that of the<45 years old group(P>0.05).The risk of locally advanced tumors(pT3+pT4)and lymph node metastasis(pN1)in the≥55 years old group was significantly higher than that in the<55 years old group(P<0.05).At the same time,according to the characteristics of preoperative ultrasound,in the older group(≥45 years old and≥55 years old),the rate of irregular shape,unclear boundary,microcalcification,high blood supply and high grade TI-RADS was higher than that in the younger group(<45 years old and<55 years old),the difference was statistically significant(P<0.05).The proportion of tumors with aspect ratio≥1 and tumor diameter<2 cm in the≥55 years old group was higher than that in the<55 years old group,and the difference was statistically significant(P<0.05);There was no significant difference between the≥45 years old group and the<45 years old group(P>0.05).Conclusions The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with different prognosis,indicating it is likely to be useful in clinical practice.