甲状腺微小乳头状癌延迟治疗对生存预后的影响:基于SEER数据库大样本真实世界研究

Effect of delayed treatment on survival and prognosis of papillary thyroid microcarcinoma:A large sample real world study based on SEER database

目的利用SEER数据库中甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的大样本真实世界数据,探讨延迟治疗对患者生存预后的影响。方法选取2000–2019年期间美国国家癌症研究所SEER数据库中符合研究条件的PTMC患者40761例作为研究对象,根据延迟治疗时间的不同(0、0~6个月,>6个月)分为3组。采用Kaplan-Meir法绘制生存曲线并计算5年累积疾病特异性生存(disease-specific survival,DSS)率和总生存(overall survival,OS)率,采用Cox比例风险回归模型分析PTMC患者延迟治疗时间与DSS及OS之间的关系以及预后的影响因素。结果在40761例患者中,男7575(18.58%),女33186例(81.42%),以女性患者居多;年龄3~97岁[(51.1±13.9)岁],其中<55岁患者24043例(58.99%),≥55岁患者16718例(41.01%)。30823例(75.62%)患者在确诊后立即进行了治疗,9734例(23.88%)患者在确诊后的6个月内进行了治疗,204例(0.50%)患者在确诊6个月后进行了治疗;3组患者在年龄、性别、种族、淋巴结分期、放疗、手术方式、病灶数以及侵犯甲状腺被膜方面的差异均有统计学意义(P<0.001)。3组患者的生存分析结果显示,延迟治疗时间对PTMC患者的DSS和OS均无影响(P>0.05)。多因素Cox比例风险回归模型分析结果显示:患者年龄≥55岁、男性、已婚、淋巴结转移、放疗、行甲状腺全切以及侵犯甲状腺被膜是影响PTMC患者DSS和OS的危险因素(P<0.05),延迟治疗不是影响PTMC患者DSS和OS的危险因素(P>0.05)。结论延迟治疗不是PTMC患者DSS和OS的独立危险因素,对于部分PTMC,主动监测是一种安全的替代手术治疗方法。

Objective To use real-world data from a large sample of papillary thyroid microcarcinoma(PTMC)in the SEER database to investigate the impact of delayed treatment on survival outcomes.Methods A total of 40761 patients with PTMC eligible for the study from the SEER database of the National Cancer Institute of the United States during 2000-2019 were selected as the study objects and divided into 3 groups according to the different delayed treatment time(0,0-6 months,>6 months).Kaplan-Meir method was used to plot the survival curve and calculate 5-year cumulative disease-specific survival(DSS)rate and overall survival(OS)rate.Cox proportional hazard regression model was used to analyze the relationship between delayed treatment time,DSS and OS in PTMC patients and the influencing factors of prognosis.Results Among the 40761 patients,7575(18.58%)were males and 33186(81.42%)were females,most of whom were females.The patients ranged in age from 3 to 97 years old[(51.1±13.9)years old],of which 24043(58.99%)were<55 years old and 16718(41.01%)were≥55 years old.Received treatment immediately after diagnosis in 30823 patients(75.62%),9734 patients(23.88%)received treatment within 6 months after diagnosis,204 patients(0.50%)received treatment 6 months after diagnosis.There were significant differences in age,sex,race,lymph node stage,radiotherapy,surgical method,number of lesions and invasion of thyroid capsule among the 3 groups(P<0.001).The survival analysis results of the 3 groups showed that the delayed treatment time had no effect on DSS and OS of PTMC patients(P>0.05).The multivariate Cox proportional hazard regression model analysis results showed that the patient's age≥55 years old,male,married,ymph node metastasis,radiotherapy,total thyroidectomy and thyroid capsule invasion were the risk factors affecting DSS and OS in PTMC patients(P<0.05),while delayed treatment was not risk factors for DSS and OS in PTMC patients(P>0.05).Conclusion Delayed treatment is not an independent risk factor for DSS and OS in patients with PTMC,and active monitoring is a safe alternative to surgery for some PTMCS.