临床病理和突变特征对甲状腺髓样癌长期生存和复发的不同影响

IF 3.9 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrinology and Metabolism Pub Date : 2024-11-05 DOI:10.3803/EnM.2024.2027
Moon Young Oh, Kyong Yeun Jung, Hoonsung Choi, Young Jun Chai, Sun Wook Cho, Su-Jin Kim, Kyu Eun Lee, Eun-Jae Chung, Do Joon Park, Young Joo Park, Han-Kwang Yang
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引用次数: 0

摘要

背景:与分化型甲状腺癌相比,甲状腺髓样癌(MTC)的预后较差;然而,有关MTC长期预后的综合数据仍然很少。本研究调查了MTC的长期临床预后,并旨在确定预后因素:方法:对 1980 年至 2020 年间确诊为 MTC 的患者进行回顾性研究。分析了他们的临床特征、长期临床结果以及复发和死亡的预后因素:研究共纳入 226 名患者(144 名女性,82 名男性)。所有 MTC 患者 5 年、10 年、20 年和 30 年的疾病特异性生存率(DSS)分别为 92.7%、89.4%、74.3% 和 68.1%。在这些时间间隔内,无复发生存率(RFS)分别为 71.1%、56.1%、40.2% 和 32.1%。1980-2009年和2010-2020年两组的DSS相当(P=0.995);但1980-2009年组的无复发生存率明显较低(P=0.031)。2010-2020 年组的手术和淋巴结清扫范围更大(P=0.003),肿瘤更小(P=0.003)。多变量分析发现,甲状腺外扩展是RFS和DSS的最强预后因素。年龄大于55岁和肿瘤大小≥2厘米也是DSS的重要预后因素,而遗传性疾病和淋巴结转移则是RFS的重要预后因素。对转染过程中重排(RET)阴性组和未筛查的RET阳性组进行倾向分数匹配后的生存分析显示,RET阴性组的DSS相当,但RFS更长:甲状腺外扩展被认为是影响RFS和DSS的最强预后因素。年龄越大、肿瘤体积越大,DSS越低,而RET突变和淋巴结转移则对RFS有显著影响。
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Distinct Impacts of Clinicopathological and Mutational Profiles on Long-Term Survival and Recurrence in Medullary Thyroid Carcinoma.

Background: Medullary thyroid carcinoma (MTC) has a poorer prognosis than differentiated thyroid cancers; however, comprehensive data on the long-term outcomes of MTC remain scarce. This study investigated the extended clinical outcomes of MTC and aimed to identify prognostic factors.

Methods: Patients diagnosed with MTC between 1980 and 2020 were retrospectively reviewed. Their clinical characteristics, longterm clinical outcomes, and prognostic factors for recurrence and mortality were analyzed.

Results: The study included 226 patients (144 women, 82 men). The disease-specific survival (DSS) rates for all MTC patients at 5-, 10-, 20-, and 30-year intervals were 92.7%, 89.4%, 74.3%, and 68.1%, respectively. The recurrence-free survival (RFS) rates were 71.1%, 56.1%, 40.2%, and 32.1% at these intervals. DSS was comparable between the groups from 1980-2009 and 2010-2020 (P=0.995); however, the 1980-2009 group had significantly lower RFS rates (P=0.031). The 2010-2020 group exhibited greater extents of surgical and lymph node dissection (P=0.003) and smaller tumors (P=0.003). Multivariate analysis identified extrathyroidal extension as the strongest prognostic factor for both RFS and DSS. Age >55 years and tumor size of ≥2 cm were also significant prognostic factors for DSS, while hereditary disease and lymph node metastasis were significant for RFS. Survival analysis after propensity-score matching of rearranged during transfection (RET)-negative and non-screened RET-positive groups showed comparable DSS but longer RFS in the RET-negative group.

Conclusion: Extrathyroidal extension was identified as the strongest prognostic factor for RFS and DSS. Older age and larger tumor size were associated with decreased DSS, while RET mutation and lymph node metastasis significantly impacted RFS.

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来源期刊
Endocrinology and Metabolism
Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.60
自引率
5.90%
发文量
145
审稿时长
24 weeks
期刊介绍: The aim of this journal is to set high standards of medical care by providing a forum for discussion for basic, clinical, and translational researchers and clinicians on new findings in the fields of endocrinology and metabolism. Endocrinology and Metabolism reports new findings and developments in all aspects of endocrinology and metabolism. The topics covered by this journal include bone and mineral metabolism, cytokines, developmental endocrinology, diagnostic endocrinology, endocrine research, dyslipidemia, endocrine regulation, genetic endocrinology, growth factors, hormone receptors, hormone action and regulation, management of endocrine diseases, clinical trials, epidemiology, molecular endocrinology, neuroendocrinology, neuropeptides, neurotransmitters, obesity, pediatric endocrinology, reproductive endocrinology, signal transduction, the anatomy and physiology of endocrine organs (i.e., the pituitary, thyroid, parathyroid, and adrenal glands, and the gonads), and endocrine diseases (diabetes, nutrition, osteoporosis, etc.).
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