甲状腺乳头状癌术后复发相关因素的真实世界研究

A Real-World Study of Factors Associated with Postoperative Recurrence of Papillary Thyroid Carcinoma

摘要: 目的：探讨真实世界背景下甲状腺乳头状癌(papillary thyroid carcinoma, PTC)术后复发的相关危险因素。方法：回顾性分析2014年1月~2019年1月于青岛大学附属医院行首次手术治疗的460例PTC患者的临床资料，根据术后是否出现复发将上述460例PTC患者分为两组，对相关因素进行单因素及COX回归分析，绘制Kaplan-Meier无复发生存曲线。结果：460例患者中45例(9.8%)出现术后肿瘤复发，平均复发时间15.9 ± 14.4个月。单因素分析结果显示两组患者在性别、是否合并桥本氏病方面无明显差异(P > 0.05)，而在年龄、合并BRAFV600E基因突变、肿瘤多发病灶、肿瘤最大直径、有淋巴结转移、被膜外侵犯、有远处转移方面存在差异(P > 0.05)。本研究对BRAFV600E进一步分层，对BRAFV600E (+)组及BRAFV600E (−)组行COX回归分析，探究影响PTC术后复发的危险因素。COX回归结果显示合并BRAFV600E (+)、存在淋巴结转移、被膜侵犯、远处转移均是导致PTC术后复发的独立危险因素。结论：PTC总体预后较好，但复发风险较高，临床上应对合并上述危险因素的患者加强警惕，密切随访，以期降低术后复发率。

Abstract: Objective: To investigate the related risk factors for postoperative recurrence of papillary thyroid carcinoma (PTC) in a real world research. Methods: Retrospective analysis was performed on the clinical data of 460 PTC patients who received first surgical treatment in the Affiliated Hospital of Qingdao University from January 2014 to January 2019. The patients were divided into two groups according to whether there was postoperative recurrence. Single factor and COX regression analysis was performed on the related factors and the Kaplan-Meier survival curve was drawn. Results: Among 460 patients, 45 (9.8%) had tumor recurrence after surgery, with an average recurrence time of 15.9 ± 14.4 months. The results of univariate analysis showed that there was no significant difference between the two groups of patients in terms of gender and whether they have Hashimoto’s disease (P > 0.05); however, there are differences in age, combined BRAFV600E gene mutation, multiple tumor foci, maximum tumor diameter, lymph node metastasis, extracapsular invasion, and distant metastasis (P > 0.05). In this study, the BRAFV600E group was further stratified, and COX regression analysis was conducted for the BRAFV600E (+) group and the BRAFV600E (−) group, respectively, to explore the risk factors affecting the recurrence after PTC. COX regression results showed that combined BRAFV600E (+), the presence of lymph node metastasis, extracapsular invasion, and distant metastasis were independent risk factors for recurrence after PTC. Conclusion: The overall prognosis of PTC is good, but the risk of recurrence is higher. Clinically, patients with the above risk factors should be vigilant and closely followed up to reduce the recurrence rate after surgery.