目的:滤泡性甲状腺癌(FTC)易发生远处转移,远处转移的患者往往预后不良。在这项研究中,研究转移等相关因素对甲状腺滤泡癌预后的影响。
方法:这是一项回顾性研究。数据来自浙江省肿瘤医院,中山大学肿瘤防治中心,浙江大学医学院附属杭州市第一人民医院,从2009年1月到2021年6月,153名FTC患者。根据远处转移将患者分为三组:初始诊断时的远处转移(M1),随访期间远处转移(M2),并且在研究过程中没有远处转移的证据(M0)。收集数据并总结临床数据,实验室参数,成像特征,术后病理亚型,和转移。采用Cox比例风险模型进行单因素和多因素分析。Kaplan-Meier曲线用于评估癌症特异性存活(CSS)。
结果:基于转移,患者被分为三组,包括M1组中的31个,M2组中15个,M0组107。这些人平均随访了5.9年,该组包括46例远处转移患者(诊断时确认的31例,随访中发现的15例)。单因素Cox回归分析显示,年龄,桥本甲状腺炎(HT),手术方法,术后辅助治疗,组织学亚型,结节大小,钙化,TSH,远处转移均影响预后。多因素Cox回归分析提示组织学亚型(广泛侵入性;HR:7.440;95%CI:3.083,17.954;p<0.001),结节大小(≥40mm;HR:8.622;95%CI:3.181,23.369;p<0.001)和远处转移(阳性;HR:6.727;95%CI:2.488,18.186;p<0.001)是影响滤泡性甲状腺癌预后的独立危险因素。
结论:组织学亚型,结节大小,远处转移是影响滤泡性甲状腺癌预后的重要危险因素。转移性滤泡性甲状腺癌患者预后不良,特别是在最初诊断时的转移。因此,这组患者需要个体化治疗和密切随访.
OBJECTIVE: Follicular thyroid cancer (FTC) is prone to distant metastasis, and patients with distant metastasis often have poor prognosis. In this study, the impact of metastasis and other relevant factors on the prognosis of follicular thyroid carcinoma was examined.
METHODS: This was a retrospective study. Data were obtained from Zhejiang Cancer Hospital, Sun Yat-sen University Cancer Center and Hangzhou First People\'s Hospital affiliated with Zhejiang University School of Medicine, from January 2009 to June 2021 for 153 FTC patients. The patients were assigned into three groups according to their distant metastasis: distant metastasis at initial diagnosis (M1), distant metastasis during follow-up (M2), and no evidence of distant metastasis over the course of the study (M0). Data were collected and summarized on clinical data, laboratory parameters, imaging features, postoperative pathologic subtypes, and metastases. The Cox proportional hazard model was used to perform the univariate and multivariate analysis. Kaplan-Meier curves were used to evaluate cancer-specific survival (CSS).
RESULTS: Based on metastasis, the patients were assigned into three groups, including 31 in the M1 group, 15 in the M2 group, and 107 in the M0 group. These individuals were followed up for an average of 5.9 years, and the group included 46 patients with distant metastasis (31 confirmed at diagnosis and 15 found during follow-up). Univariate Cox regression analysis showed that age, Hashimoto\'s thyroiditis (HT), surgery method, postoperative adjuvant therapy, histologic subtype, nodule size, calcification, TSH, and distant metastasis all impacted prognosis. Multivariate Cox regression analysis suggested that histologic subtype (widely invasive; HR: 7.440; 95% CI: 3.083, 17.954; p < 0.001), nodule size (≥40 mm; HR: 8.622; 95% CI: 3.181, 23.369; p < 0.001) and distant metastasis (positive; HR: 6.727; 95% CI: 2.488, 18.186; p < 0.001) were independent risk factors affecting the prognosis of follicular thyroid cancer.
CONCLUSIONS: Histologic subtype, nodule size, and distant metastasis are important risk factors for the prognosis of follicular thyroid cancer. Patients with metastatic follicular thyroid cancer have a poor prognosis, especially with metastasis at the time of initial diagnosis. As a result, this group of patients requires individualized treatment and closer follow-up.