文章摘要

基于SEER数据库的甲状腺髓样癌预后因素分析

作者: 1王 俊男, 1闫 枫尚, 2徐 拯, 3熊 睿, 4胡 薇, 4盛 湲, 4李 恒宇
1 海军军医大学基础医学院,上海 200433
2 海军军医大学科研学术处,上海 200433
3 海军军医大学长海医院外科规培基地,上海 200433
4 海军军医大学长海医院甲乳外科,上海 200433
通讯: 李 恒宇 Email: drlhy@foxmail.com
DOI: 10.3978/.2018.05.004
基金: 第二军医大学精准医学创新培育基金资助项目(2017JZ37)。

摘要

目的:探讨甲状腺髓样癌(MTC)患者预后的影响因素。
方法:通过SEER*Stat软件收集SEER数据库中2010—2014年病理明确诊断为MTC的602例患者资料。采用Kaplan-Meier法与Log-rank检验分析患者的生存率,用单变量与多变量Cox回归模型分析影响患者生存的危险因素。
结果:602例患者的平均生存时间为(54.914±1.209)个月,1、3年生存率分别为96.9%、90.8%。单变量分析显示,诊断年龄(χ2=33.232,P<0.001)、性别(χ2=4.030,P<0.045)、原发灶大小(χ2=37.06,P<0.001)、病灶数目 (χ2=6.786,P=0.009)、临床分期(χ2=116.467,P<0.001)、原发肿瘤分期(χ2=72.482,P<0.001)、区域淋巴结受累(χ2=14.803,P<0.001)、远处转移(χ2=94.976,P<0.001)、手术情况(χ2=80.536,P<0.001)以及检出淋巴结阳性数(χ2=18.700,P<0.001)与患者生存时间有关。多变量Cox分析表明,诊断年龄(HR=2.777,95% CI=1.800~4.285,P<0.001)、原发肿瘤分期(HR=1.675,95% CI=1.289~2.176,P<0.001)及远处转移(HR=5.401,95% CI=2.720~10.725,P<0.001)是影响MTC患者预后的独立危险因素。
结论:诊断年龄、原发肿瘤分期及远处转移等临床病理参数是预测甲状腺髓样癌患者生存情况的独立指标。
关键词: 甲状腺肿瘤;癌,髓样;预后;危险因素;SEER规划

Analysis of prognostic factors for medullary thyroid carcinoma based on SEER database

Authors: 1WANG Junnan, 1YAN Fengshang, 2XU Zheng, 3XIONG Rui, 4HU Wei, 4SHENG Yuan, 4LI Hengyu
1 School of Basic Medicine, Navy Medical University, Shanghai 200433, China
2 Department of Scientific and Academic Research, Navy Medical University, Shanghai 200433, China
3 Base for Standardized Training of Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
4 Department of Thyroid and Breast Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China

CorrespondingAuthor:LI Hengyu Email: drlhy@foxmail.com

Abstract

Objective: To investigate the factors affecting the prognosis of patients with medullary thyroid carcinoma (MTC).
Methods: The data of 602 patients with definite pathological diagnosis of MTC were collected from SEER database within 2010 to 2014 by using SEER*Stat software. The survival rates of the patients were analyzed by Kaplan-Meier method and Log-rank test, and the risk factors for survival of the patients were determined by univariate analysis and multivariate Cox regression model.
Results: Of the 602 patients, the mean survival time was (54.914±1.209) months, and the 1- and 3-year overall survival rate was 96.9% and 90.8%, respectively. The results of univariate analysis showed that age at diagnosis (χ2=33.232, P<0.001), sex (χ2=4.030, P<0.045), size of primary tumor (χ2=37.060, P<0.001), number of lesions (χ2=6.876, P=0.009), clinical stage (χ2=116.467, P<0.001), primary tumor stage (χ2=72.482, P<0.001), regional lymph node involvement (χ2=14.803, P<0.001), distant metastasis (χ2=94.976; P<0.001), surgical procedure (χ2=80.536, P<0.001) and number of positive lymph nodes (χ2=18.700, P<0.001) were significantly related to the survival rate of the patients. The results of multivariate Cox analysis revealed that age at diagnosis (HR=2.777, 95% CI=1.800–4.285, P<0.001), primary tumor stage (HR=1.675, 95% CI=1.289–2.176, P<0.001) and distant metastasis (HR=5.401, 95% CI=2.720–10.725, P<0.001) were independent risk factors for the prognosis of the patients.
Conclusion: The clinical variables that include age at diagnosis, primary tumor stage and distant metastasis can be used as the independent predictive indicators for the prognosis of the MTC patients.
Keywords: Thyroid Neoplasms; Carcinoma Medullary; Prognosis; Risk Factors; SEER Program