甲状腺乳头状癌外科治疗分析

目的 分析甲状腺乳头状癌患者外科治疗后的复发和生存情况,以探讨规范化治疗方案.方法 收集和分析1994-1999年中国医学科学院肿瘤医院头颈外科收治的600例甲状腺乳头状癌患者的临床资料和随访资料.600例患者中,原发灶位于甲状腺左叶188例,右叶290例,峡部8例,双侧同时发生109例,单侧同时多发病灶5例.TNM分期为Ⅰ期385例,Ⅱ期37例,Ⅲ期17例,Ⅳ期161例.患者均接受手术治疗,其中术后放疗19例,131Ⅰ治疗71例,同时行放疗和131Ⅰ治疗1例.结果 术后复发94例.随访期内死亡27例,以复发和转移为主要死因.600例患者的中位生存时间为96个月,10年生存率为93.2％.Ⅰ期患者10年生存率为99.1％,Ⅱ期为94.7％,Ⅲ期为93.8％,Ⅳ期为78.5％,差异有统计学意义(P＜0.01).年龄＜45岁组10年生存率为99.4％,≥45岁组为82.1％,差异有统计学意义(P＜0.01).气管受侵者10年生存率为66.5％,气管未受侵者为95.1％,差异有统计学意义(P＜0.01).高分化乳头状癌患者10年生存率为94.9％,低分化乳头状癌为38.9％,差异有统计学意义(P＜0.01).多因素Cox回归分析显示,TNM分期、病理分级和手术切除彻底性是甲状腺乳头状癌患者预后的独立影响因素,相对危险度分别为2.380、7.057和2.751.结论 甲状腺乳头状癌患者生存率较高,TNM分期、病理分级和手术切除彻底性是患者预后的独立影响因素.

Analysis of surgical treatment of papillary thyroid carcinoma

Objective To present the treatment results and to analyze the causes of recurrence in patients with papillary thyroid carcinoma.Methods A retrospective review of 600 patients with papillary thyroid carcinoma treated between 1994 and 1999 was conducted.The primary lesions were originated from the left lobe in 188 cases,the right lobe in 290 cases,the isthmus in 8 cases,and multicentric in 114 cases.From the 600 cases,584 were well-differentiated and 16 poorly differentiated.TNM stage:385 cases of stage Ⅰ,37 cases of stage Ⅱ,17 cases of stage Ⅲ,and 161 cases of stage Ⅳ.Three hundred and one patients was N1b stage.All patients received surgical treatment.Among them,19 cases received radiotherapy,71 received 131Ⅰ-therapy and one case received concomitant radiotherapy and 131 Ⅰ-therapy.Results There were 94 recurrent cases.Twenty-seven cases died of recurrence,metastasis and other diseases.The overall 10-year survival rate was 93.2％.The overall 10 year survival rates of stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ patients were 99.1％,94.7％,93.8％,and 78.5％,respectively(P ＜0.01).The 10-year survival rate of lower-age group(＜45 years)was99.4％ and higher-age group(≥45 years)82.1％(P＜0.01).The 10-year survival rate of patients with trachea invasion was 66.5％,significantly lower than the 95.1％ in patients without trachea invasion(P ＜ 0.01).The 10-year survival rate of well-differentiated cases was 94.9％,significantly higher than the 38.9％ in the poorly differentiated cases(P ＜ 0.01).Multivariate analysis showed that the TNM stage,differentiation degree and the thoroughgoing surgical operation were independent risk factors for the prognosis of papillary thyroid carcinoma.Conclusions The TNM stage,differentiation degree and the thoroughgoing surgical operation are independent risk factors for the prognosis of papillary thyroid carcinoma.