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以大型单中心医院登记为基础的5.5万例甲状腺癌患者的生存情况及死因分析
Survival and cause-of-death analysis of 55 thousand thyroid cancer cases in China from a large single institution hospital-based cancer registry database
- 中国癌症杂志 2025年35卷第1期 页码：68-76
- 作者机构：
1. 复旦大学附属肿瘤医院肿瘤预防部，复旦大学上海医学院肿瘤学系，上海 200032
2. 复旦大学附属肿瘤医院头颈外科，复旦大学上海医学院肿瘤学系，上海 200032
3. 复旦大学公共卫生学院，上海 200032
4. 上海肿瘤疾病人工智能工程技术研究中心，上海 200032
- 作者简介：
[ "沈洁（ORCID: 0000-0003-2504-4491），主管医师。" ]
王宇（ORCID: 0000-0003-2622-294X），主任医师，复旦大学附属肿瘤医院头颈外科主任；
[ "郑莹，复旦大学附属肿瘤医院肿瘤预防部主任，主任医师，教授，硕士研究生导师。曾担任上海市重点公共卫生项目《社区居民大肠癌筛查项目》的技术负责人，组织编写和发布上海市抗癌协会《居民常见恶性肿瘤筛查和预防推荐》。发表论文100余篇，其中第一作者或通信作者发表90余篇，主编和参编20余部专著，获中华预防医学科技奖2项、上海市科技进步奖1项、上海医学科技奖1项、上海抗癌科技奖1项。主要学术兼职：上海市抗癌协会常务理事、癌症预防与筛查专业委员会主任委员，中国抗癌协会乳腺癌专业委员会康复学组组长，中国临床肿瘤学会肿瘤大数据专家委员会常务委员，中国抗癌协会多原发和不明原因肿瘤专业委员会常务委员，中国抗癌协会乳腺癌专业委员会、科普专业委员会、肿瘤流行病学专业委员会、筛查和早诊早治专业委员会委员，中国控制吸烟协会控烟与肺癌防治专业委员会常务委员。" ]
- 基金信息：上海市加强公共卫生体系建设三年行动计划（2023—2025年）(JKKPZX-2023-A04);上海市申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC22022308);上海市公共卫生研究专项(2024GKM32)
DOI：10.19401/j.cnki.1007-3639.2025.01.008
中图分类号： R736.1收稿：2024-12-20，
修回：2025-01-15，
纸质出版：2025-01-30
- 稿件说明：
移动端阅览
沈洁, 刘婉琳, 王泽洲, 等. 以大型单中心医院登记为基础的5.5万例甲状腺癌患者的生存情况及死因分析[J]. 中国癌症杂志, 2025,35(1):68-76.
Jie SHEN, Wanlin LIU, Zezhou WANG, et al. Survival and cause-of-death analysis of 55 thousand thyroid cancer cases in China from a large single institution hospital-based cancer registry database[J]. China Oncology, 2025, 35(1): 68-76.
沈洁, 刘婉琳, 王泽洲, 等. 以大型单中心医院登记为基础的5.5万例甲状腺癌患者的生存情况及死因分析[J]. 中国癌症杂志, 2025,35(1):68-76. DOI： 10.19401/j.cnki.1007-3639.2025.01.008.
Jie SHEN, Wanlin LIU, Zezhou WANG, et al. Survival and cause-of-death analysis of 55 thousand thyroid cancer cases in China from a large single institution hospital-based cancer registry database[J]. China Oncology, 2025, 35(1): 68-76. DOI： 10.19401/j.cnki.1007-3639.2025.01.008.
摘要
背景与目的：
甲状腺癌是最常见的内分泌系统恶性肿瘤，在亚洲人群中尤为高发。甲状腺癌患者整体生存率较高，但不同患者的生存差异较大，本研究基于医院登记为基础的5.5万例甲状腺癌患者的随访资料，了解甲状腺癌患者的长期观察总生存（overall survival，OS）率，分析甲状腺癌患者死亡的特征及死因分布，为甲状腺癌患者的生存管理提供真实世界数据支持。
方法：
纳入2005年1月1日—2021年12月31日在复旦大学附属肿瘤医院接受治疗的甲状腺癌患者共55 343例，通过查阅病史了解患者的临床信息，并通过复诊病史、电话随访和死因数据链接等方式收集患者的生存随访资料和死亡信息，随访统计时间截至2024年10月31日。采用Kaplan-Meier法估计患者的OS率，并在不同性别、年龄组、治疗时期、肿瘤分期及病理学特征等亚组中分别描述。以上海市人口死亡为参照计算标准死亡比（standardized mortality ratio，SMR）和绝对超额风险（absolute excess risk，AER），并在不同性别、诊断时年龄及组织学亚型中分别描述死亡风险。
结果：
甲状腺癌患者经中位随访63.01个月后，共发生1 256例（2.27%）死亡，1、3、5和10年OS率分别为99.67%（95% CI：99.62%~99.72%）、99.11%（95% CI：99.03%~99.19%）、98.48%（95% CI：98.36%~98.60%）和95.81%（95% CI：95.50%~96.11%）；Ⅰ、Ⅱ、Ⅲ和Ⅳ期甲状腺癌患者的10年OS率分别为97.99%（95% CI：97.70%~98.28%）、89.80%（95% CI：87.24%~92.37%）、77.84%（95% CI：70.76%~84.92%）和62.95%（
95% CI：55.37%~70.54%）。不同性别、年龄、组织学分型的患者生存存在显著差异。1 256例死亡患者中，234例（18.63%）因甲状腺癌而死亡，最常见的死因为其他肿瘤（
n
=639，50.88%），另有92例（7.32%）死亡归因于心脑血管疾病（cardiovascular disease，CVD）。甲状腺癌各个亚型患者的全死因死亡率都比一般人群高，并在甲状腺乳头状癌、甲状腺滤泡癌、甲状腺髓样癌和甲状腺未分化癌/低分化型甲状腺癌中死亡风险逐步递增，甲状腺乳头状癌患者的死亡风险是一般人群的2.24倍（95% CI：2.06~2.44），甲状腺滤泡癌和甲状腺髓样癌的死亡风险分别为一般人群的9.94倍（95% CI：6.79~14.09）和12.16倍（95% CI：8.05~17.69），甲状腺未分化癌/低分化型甲状腺癌患者的死亡风险最高[SMR=79.67（95% CI：58.38~106.31），AER=766.01/1 000人年
]
。
结论：
报告国内单中心甲状腺癌患者的10年生存结果及不同组织学类型的死因分析，组织学亚型、肿瘤分期是影响甲状腺癌患者生存的重要因素，早期诊断和个体化治疗对改善预后至关重要。
Abstract
Background and purpose:
Thyroid cancer is the most common malignant endocrine tumor
particularly prevalent among the Asian population. The overall survival for thyroid cancer patients is relatively high
but there are significant survival differences among patients. Based on long-term hospital-based cancer registry database
this study analyzed the 10-year observed overall survival (OS) rate of thyroid cancer cases and the distribution of causes of death
providing real-world evidences to further survival management of thyroid cancer in China.
Methods:
A total of 55343 thyroid cancer patients who underwent treatment at Fudan University Shanghai Cancer center from 2005 to 2021 were included in this study. Clinical information and the follow-up endpoint data were collected through medical records review
telephone visits and death registry data linkage. The last follow-up date was October 31
2024. Kaplan-Meier method was applied in evaluating the OS rate
and survival data were described by different subgroups as age group
gender
treatment period
tumor staging and pathological characteristics. The standardized mortality ratio (SMR) and absolute excess risk (AER) were calculated using general Shanghai population as the reference
and the mortality risk was described by gender
age at diagnosis and histological subtype.
Results:
With a median follow-
up time of 63.01 months
the overall 1-
3-
5- and 10-year OS rates of thyroid cancer patients were 99.67% (95% CI: 99.62%-99.72%)
99.11% (95% CI: 99.03%-99.19%)
98.48% (95% CI: 98.36%-98.60%) and 95.81% (95% CI: 95.50%-96.11%)
respectively. The 10-year OS rates of stage Ⅰ
Ⅱ
Ⅲ and Ⅳ were 97.99% (95% CI: 97.70%-98.28%)
89.80% (95% CI: 87.24%-92.37%)
77.84% (95% CI: 70.76%-84.92%) and 62.95% (95% CI: 55.37%-70.54%)
respectively. The differences in OS among patients with different age
gender and histological classification were significant. 1256 (2.27%) deaths occurred
of which 18.63%
50.88% and 7.32% were attributable to thyroid cancer
other cancers and cardiovascular disease (CVD)
respectively. Compared with the general population
patients with different subtypes of thyroid cancer had higher all-cause mortality rates
progressively increasing with papillary
follicular
medullary and anaplastic thyroid carcinoma/poorly differentiated carcinoma. Compared with general population
the death risk was 2.24 times higher in papillary thyroid cancer patients (95% CI: 2.06-2.44)
9.94 times higher in follicular thyroid cancer patients (95% CI: 6.79-14.09)
12.16 times higher in medullary thyroid cancer patients (95% CI: 8.05-17.69)
and the highest risk was observed in patients with anaplastic thyroid carcinoma/poorly differentiated carcinoma [SMR=79.67 (95% CI: 58.38-106.31)
AER=766.01/1 000 person-years
]
.
Conclusion:
The 10-year long survival data and cause of death for thyroid cancer patients with different histological types were reported in China based on a large single institution hospital-based cancer registry database. Staging and histological characteristics were the most important factors directly affected the survival. Early diagnosis and individualized treatment are crucial for improving prognosis.
关键词
Keywords
references
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