在2015年美国甲状腺协会指南更新后,甲状腺叶切除术的差异化利用
Patricia Gina Lu1, Zhi Ven Fong1, Patrick T Hangge1
1Department of General Surgery, Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA.
Endocrine oncology (Bristol, England)
|September 9, 2024
概括
2015年美国甲状腺协会 (ATA) 的指导方针推甲状腺叶切除术 (TL) 治疗低风险差异化甲状腺癌 (DTC). 尽管在指南发布后TL使用量增加,但年龄和农村影响治疗选择,大多数患者仍然接受全甲状腺切除术 (TT).
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 公共卫生 公共卫生
背景情况:
- 2015年美国甲状腺协会 (ATA) 准则更新了对差异化甲状腺癌 (DTC) 管理的建议.
- 甲状腺叶切除术 (TL) 被引入作为低风险DTC的适当治疗选择.
- 调查影响TL使用的人口层面因素对于了解准则遵守至关重要.
研究的目的:
- 根据2015年ATA指南,对低风险差异化甲状腺癌 (DTC) 的甲状腺叶切除术 (TL) 与全甲状腺切除术 (TT) 的利用趋势进行研究.
- 确定与TL和TT之间的选择相关的患者和社会经济因素.
- 评估年龄和地理因素对采用指南推的TL的影响.
主要方法:
- 利用监测,流行病学和最终结果 (SEER) 数据库来识别低风险DTC患者.
- 使用Cochrane-Armitage测试分析了TL和TT率的趋势.
- 采用多变量逻辑回归和差异分析,以确定影响治疗选择和控制时间趋势的因素.
主要成果:
- 总共有43526名低风险的DTC患者被分析,TL利用率从2015年后的11.6%增加到23.8% (P < 0.001).
- 尽管增加了,但全甲状腺切除术 (TT) 仍然是主要的手术 (76.2%).
- 老年 (>55) 和农村居住独立地与较高的TT率相关,而T1疾病与TL相关.
结论:
- 2015年ATA指南增加了对低风险DTC的TL使用,但TT仍然更常见.
- 患者的年龄和地理因素 (农村) 显著影响了接受符合指导方针的TL的可能性.
- 这些因素对T2期疾病患者尤其具有影响力,突显了护理方面的差异.
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