男性性别是甲状腺髓样癌的不良预后因素:行为差异还是生理差异?

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM Minerva endocrinology Pub Date : 2023-12-01 Epub Date: 2022-02-01 DOI:10.23736/S2724-6507.22.03692-2
Cláudia S Costa, Pedro Souteiro, Sílvia Paredes, Rita Bettencourt-Silva, Jorge Pedro, Maria J Ferreira, Daniela Salazar, Manuel R Teixeira, Joana Oliveira, Ana P Santos, Isabel Torres
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引用次数: 3

摘要

背景:由于甲状腺髓样癌(MTC)发病率低且表现各异,其预后因素仍未得到很好的确定。虽然有几项大型研究调查了性别对分化型甲状腺癌(DTC)的影响,但性别在MTC预后中的作用仍存在争议。我们旨在确定 MTC 的预后特征,尤其关注性别的作用:本研究对1984年至2018年间在葡萄牙综合癌症中心确诊的76例MTC患者进行了回顾性分析:患者确诊时的中位年龄为49岁,其中27.6%的患者被确诊为多发性内分泌肿瘤2型(MEN2),这些患者的年龄明显更小(PConclusions:即使在调整了年龄和疾病分期之后,男性仍可独立预测 MTC 患者较差的生存率。有关该主题的少数较早研究指出了男性就医模式的行为解释,但我们的研究以及较新的遗传学和基础科学出版物提出了一种可能性,即在 MTC 的肿瘤发生过程中男女之间存在真正的生物学差异,这一点值得进一步研究。
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Male gender as a poor prognostic factor in medullary thyroid carcinoma: behavior or biological difference?

Background: Due to the low incidence and heterogeneous behavior of medullary thyroid carcinoma (MTC), its prognostic factors are still not well stablished. While several large studies have investigated the impact of gender in differentiated thyroid cancer (DTC), its role in MTC outcomes remains controversial. We aim to identify MTC prognostic features, specially focusing on the role of gender.

Methods: The present study is a retrospective analysis of 76 patients diagnosed with MTC between 1984 and 2018 at a Portuguese Comprehensive Cancer Center.

Results: Patients presented a median age at diagnosis of 49 years and multiple endocrine neoplasia type 2 (MEN2) was identified in 27.6% of them, with those individuals being significantly younger (P<0.001). Most cases were diagnosed as stage IV disease (46.9%), except for the subgroup detected through presymptomatic genetic screening (55.6% at stage I). The 5- and 10-year survival rates were 87.6% and 75.6%, respectively. Univariate analysis identified male gender (P=0.010), age ≥45 years (P=0.007), presence of distant metastasis at diagnosis (P<0.01), capsule invasion (P=0.004), extrathyroidal invasion (P=0.003) and absence of biochemical cure after surgery (P=0.042) as having a negative impact on prognosis. On multivariate analysis, male gender (P=0.046) remained an independent predictor of mortality, as well as an older age (P<0.001) and the presence of distant metastases (P=0.012).

Conclusions: Male gender independently predicted worse survival in MTC patients even after adjusting for age and disease stage. The few older studies on the topic pointed to a behavioral explanation regarding medical care seeking patterns by men, but our study and newer genetic and basic-science oriented publications raise the possibility of a true biological difference between genders in the tumorigenesis of MTC that should me further investigated.

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