【作者】 石阳；

【导师】 张平；

【作者基本信息】 中国医科大学 ， 外科学（专业学位）， 2025， 硕士

【摘要】 目的:关于甲状腺嗜酸细胞癌(Oncocytic Cell Carcinoma of the Thyroid,OCA)的死亡风险和条件生存率(Conditional Survival,CS)知之甚少。本文通过探寻OCA患者预后的影响因素,描述患者特定时间的死亡危险,计算OCA患者的疾病特异性生存率(Disease Specific Survival,DSS)和CS,进而了解OCA患者术后生存期的动态变化。研究方法:收集2004-2019年美国国立癌症研究所“监测、流行病和结果”(Surveillance,Epidemiology,and End Results,SEER)数据库OCA患者的临床病理资料。通过单因素和多因素COX回归分析,筛选出有统计学意义的因素。利用核平滑化方法绘制OCA患者的死亡风险曲线,使用寿命表计算DSS并绘制Kaplan-Meier曲线,利用条件生存率公式CS=S(x+y)/S(x)计算患者的CS。结果:诊断时年龄、SEER肿瘤分期和化学治疗被确定为DSS的独立危险因素(P<0.001)。在随访期间,整体人群的死亡风险曲线呈下降趋势,但是在OCA患者诊断后第3年和第10年时出现两个峰值。对于存在远处转移的患者,死亡风险曲线最陡峭,下降迅速且明显。在整个研究人群中,CS随着时间的推移呈上升趋势。同时,存在远处转移的患者比其他患者变化更为显著。结论:在DSS方面上,不同SEER分期之间存在显著的统计学差异,其中存在远处转移的OCA患者DSS最差。OCA患者的预后随着时间的推移而改善。CS的改善在存在远处转移的OCA患者中最为显著。与传统生存估计相比,条件生存率可能提供更相关的预后信息,并为患者个体化的随访和诊疗计划的制定提供更有意义的帮助。更多还原

【Abstract】 Objective:Little is known about the death hazard and conditional survival of oncocytic cell carcinoma of the thyroid(OCA).This study aimed to investigate prognostic factors in OCA patients,describe disease-specific mortality risks at specific time points,and calculate disease-specific survival(DSS)and conditional survival(CS),thereby elucidating the dynamic changes in postoperative survival outcomes for OCA patients.Methods:Patients diagnosed with OCA between 2004 to 2019 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Statistically significant prognostic factors were identified through univariate and multivariate Cox regression analyses.The annual hazard rate of death was depicted employing the hazard function.The Kaplan-Meier method was used to estimate the actuarial DSS.Based on the life-table method.The CS formula CS=S(x+y)/S(x)was used to calculate the patient’s CS.Results:Age at diagnosis,SEER tumor stage,and chemotherapy were identified as independent risk factors for DSS(P<0.001).Annual hazard curves for mortality from OCA in the entire study participants demonstrated an overall decreasing tendency with two peaks at 3 and 10 years.In patients with distant disease,the death risk curve was the steepest and decreased quickly and evidently.CS tended to increase over time in the entire study population.Patients with distant disease showed more significant alterations than those patients with local or regional disease.Conclusions:In terms of DSS rates,there were statistically significant differences among the different stages,with OCA patients exhibiting distant metastasis demonstrating the poorest DSS.Prognosis improved over time in patients with OCA.The largest increase in CS was observed in patients with distant disease.CS may provide more relevant prognostic information than conventional survival estimates and allow personalized follow-up and counseling.更多还原