关于2015年美国甲状腺协会指南中甲状腺髓样癌(MTC)的全国性实践模式及其对生存的影响知之甚少。
使用监视,流行病学,和最终结果计划数据库(2000-2018年),在三个时间段(2000-2009年,2010-2015年和2016-2018年)内,根据对2015年美国甲状腺协会指南的依从性评估了MTC治疗模式。感兴趣的结果是指导方针一致性,处理利用趋势,疾病特异性生存率(DSS),总生存率(OS)。
总共3332例MTC患者被确定。其中,53.8%,33.2%,11.4%的患者有局限性,区域,和远处的疾病,分别。在患有局部疾病的患者中,随着时间的推移,指南一致的手术率从2000-2009年的63.0%提高到2016-2018年的76.0%(P<0.001).指南一致的治疗与局部疾病患者的OS增加(HR=1.85,95%CI:1.42-2.43,P<0.001)以及局部疾病患者的DSS增加(HR=1.65,95%CI:1.01-2.54,P<0.001)和OS增加(HR=1.89,95%CI:1.35-2.58,P<0.001)相关。远端疾病患者的中位OS和DSS分别为31和55个月,分别,化疗使用率从21.6%上升到39.2%(P=0.003)。
2015年指南公布后,局部MTC的指南一致手术率增加,观察到OS和DSS延长。随着时间的推移,远处疾病患者的化疗使用有所增加,但他们的预后仍然可变。
Little is known about nationwide practice patterns for the management
medullary thyroid cancer (MTC) in relation to the 2015 American Thyroid Association
guidelines and their impact on survival.
Using the Surveillance, Epidemiology, and End Results Program database (2000-2018), MTC treatment patterns were evaluated in terms of adherence to the 2015 American Thyroid Association
guidelines across three time periods (2000-2009, 2010-2015, and 2016-2018). Outcomes of interest were guideline concordance, treatment utilization trends, disease-specific survival (DSS), and overall survival (OS).
A total of 3332 patients with MTC were identified. Of which, 53.8%, 33.2%, and 11.4% of patients had localized, regional, and distant disease, respectively. In patients with locoregional disease, the rate of guideline-concordant surgery improved over time from 63.0% in 2000-2009 to 76.0% in 2016-2018 (P < 0.001).
Guideline-concordant care was associated with increased OS (HR = 1.85, 95% CI: 1.42-2.43, P < 0.001) in patients with localized disease and increased DSS (HR = 1.65, 95% CI: 1.01-2.54, P < 0.001) and OS (HR = 1.89, 95% CI: 1.35-2.58, P < 0.001) in patients with regional disease. The median OS and DSS in patients with distant disease were 31 and 55 mo, respectively, and the rate of chemotherapy use rose from 21.6% to 39.2% (P = 0.003).
The rate of
guideline-concordant surgery for locoregional MTC increased after
guideline publication in 2015, with an observed prolongment in OS and DSS. Chemotherapy use among patients with distant disease has increased over time, but their prognosis remains variable.