Survival from Differentiated Thyroid Cancer: What Has Age Got to Do with It?

被引：132

作者：

Ganly, Ian ^{[1
]}

Nixon, Iain J. ^{[1
]}

Wang, Laura Y. ^{[1
]}

Palmer, Frank L. ^{[1
]}

Migliacci, Jocelyn C. ^{[1
]}

Aniss, Ahmad ^{[3
]}

Sywak, Mark ^{[3
]}

Eskander, Antoine E. ^{[4
]}

Freeman, Jeremy L. ^{[4
]}

Campbell, Michael J. ^{[5
]}

Shen, Wen T. ^{[6
]}

Vaisman, Fernanda ^{[7
]}

Momesso, Denise ^{[8
]}

Corbo, Rossana ^{[7
]}

Vaisman, Mario ^{[8
]}

Shaha, Ashok ^{[2
]}

Tuttle, R. Michael ^{[2
]}

Shah, Jatin P. ^{[1
]}

Patel, Snehal G. ^{[1
]}

机构：

[1] Mem Sloan Kettering Canc Ctr, Dept Surg Head & Neck Serv, Serv Endocrinol, New York, NY 10065 USA

[2] Mem Sloan Kettering Canc Ctr, Dept Med, Serv Endocrinol, New York, NY 10065 USA

[3] Univ Sydney, Endocrine Surg Unit, Sydney, NSW 2006, Australia

[4] Mt Sinai Hosp, Dept Otolaryngol Head & Neck Surg, Toronto, ON M5G 1X5, Canada

[5] Univ Calif Davis, Med Ctr, Dept Surg, Sacramento, CA 95817 USA

[6] Univ Calif San Francisco, Dept Surg, San Francisco, CA USA

[7] Inst Nacl Canc, Endocrine Serv, Rio De Janeiro, Brazil

[8] Univ Fed Rio de Janeiro, Endocrine Serv, Rio De Janeiro, Brazil

来源：

THYROID | 2015年 / 25卷 / 10期

关键词：

UNITED-STATES; INCREASING INCIDENCE; PROGNOSTIC-FACTORS; RISK-GROUP; CARCINOMA; EPIDEMIOLOGY; SURVEILLANCE; NOMOGRAM; SYSTEMS; COHORT;

D O I：

10.1089/thy.2015.0104

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: In most staging systems, 45 years of age is used to differentiate low risk thyroid cancer from high risk thyroid cancer. However, recent studies have questioned both the precise 45 year age point and the concept of using a binary cut off as accurate predictors of disease specific mortality. Methods: A cohort of 3664 thyroid cancer patients that received surgery and adjuvant treatment at Memorial Sloan Kettering Cancer Center (MSKCC) from the years 1985 to 2010 were analyzed to determine the significance of age at diagnosis as a categorical variable at a variety of age cutoffs (5 year intervals between 30 and 70 years of age). The unadjusted and adjusted hazard ratio for the association between disease-specific survival and age was determined using a Cox proportional hazards model adjusted for other predictive variables sex, histology, and pathological T, N, and M status. Furthermore, predictive nomograms of disease-specific mortality were created and validated on an external dataset of 4551 patients to evaluate the impact of age at diagnosis as both a categorical and continuous variable. Results: In the MSKCC cohort, with a median follow-up time of 54 months (range 1-332), there were 59 deaths from thyroid cancer with a 10 year disease-specific survival of 96%. Adjusted hazard ratios for all age cutoffs from age 30 to age 70 years were significant. There was no specific cutoff age which risk stratifies patients with differentiated thyroid cancer (DTC). Categorizing age into five strata (<40, 40-49, 50-59, 60-69 and >70 years) showed a 37-fold increase in hazard ratio from age <40 years to age >70 years. A predictive nomogram using age as a continuous variable with other predictive variables had a high concordance index of 96%. Validation on the external cohort had a concordance index of 73%. Conclusions: Mortality from DTC increases progressively with advancing age. There is no specific cutoff age which risk stratifies patients with DTC. A predictive nomogram using age as a continuous variable may be a more appropriate tool for stratifying patients with DTC and for predicting outcome.

引用

页码：1106 / 1114

页数：9

共 28 条

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