多灶性甲状腺乳头状癌168例临床研究

目的:探讨多灶性甲状腺乳头状癌的临床特征及外科治疗方式.方法:回顾分析1997年1月至2006年12月间首次手术并经病理证实的甲状腺乳头状癌648例,其中多灶病例168例.比较单灶组与多灶组及多灶组间的临床病理学差异.结果:本组多灶性甲状腺乳头状癌发生率为25.9%,其中双侧甲状腺多发病灶者117例(69.6%).多灶组在男性(P=0.004)、甲状腺癌家族史(P=0.031)、体检(P=0.000)及B超发现颈部淋巴结肿大(P=0.001)、B超提示结节钙化灶(P=0.001)、颈淋巴结转移(P=0.008)及甲状腺外侵犯(P=0.001)发生率等方面叫显高于单灶患者.而单灶组在伴有良性甲状腺疾病的比例明显高于多灶组(P=0.000).多灶性甲状腺乳头状癌病例中,男性、体检颈部淋巴结大、肿瘤位于双侧及病灶数目≥3个倾向于肿瘤较大、颈部淋巴结转移或甲状腺外侵犯的比例较高;而伴有良性甲状腺疾病的多灶性癌恶性度相对较低.本组164例(97.6%)获得随访;平均随访46.1个月(2～127个月).随访中5例死亡,1例胸部X线片怀疑肺部转移,16个月健在;6例于术后3～41个月因颈淋巴结复发再次手术;2例于术后13个月、24个月残余腺体肿瘤复发手术切除.总的1、2、5、10年生存期分别为98.2%、97.4%、96.5%、96.5%.美国癌症联合会(AJCC)分期与预后相关(X<'2=168.832,P=0.000).结论:多发病灶是甲状腺乳头状癌的临床特征之一,其生物学恶性度更高.甲状腺全切+中央区淋巴结清扫可视为标准手术方式,在外侧区出现淋巴结肿大时需加行侧方清扫.AJCC分期仍是多灶性甲状腺乳头状癌的重要预后因素.

Multifocal papillary thyroid carcinoma: clinical analysis of 168 cases

Objective To investigate the clinical features and treatment of muhifocal papillary thyroid carcinoma (PTC). Methods A retrospective survey was carried out in 648 patients with PTC who underwent surgery from January 1997 to December 2006. One hundred and sixty-eight cases of the patients presented with multiple tumor masses (≥ 2 ). The risk factors, including sex of the patients, age at diagnosis, family history of thyroid tumor, multiplicity and bilaterality of tumor, extra-thyroidal extension, lymph node involvement and other were analyzed between solitary PTC and multifocal PTC group. Results The mean age of the patients was 42 years( range, 14-78 years), included 49 male and 119 female. Tumor foci were found in both thyroid lobes in 117 cases(69.6% ). Patients with multifocal PTC were characterized by a higher ratio of male (P=0.004 ), family history of thyroid tumor (P=0.031), neck lymph node metastasis (P=0.008) and extra-thyroidal extension (P=0.001 ). However, solitary PTC tended to be with a higher rate of benign goiters in pathologic examination. In muhifocal PTC group, male, neck lymphadenectasis, ≥3 tumor masses or bilaterality of tumor tended to presented with larger tumor, more neck lymph node metastasis and extra-thyroidal extension; And a less malignant tumor in the cases detected with benign goiters in histological examination. By the end of 2007, 164 cases (97.6%) completed follow-up with a mean period of 46. 1 months ( range, 2-127 months), 5 died in the meantime. One patient has been followed-up for 16 months for suspect of lung metastases by chest X-ray. Recurrence occurred in 8 patients and were re-resected, 2 in remnant thyroid and 6 in neck lymph nodes. The overall 1-, 2-, 5-, and 10-year survival rate was 98. 2%, 97.4%, 96. 5% and 96.5%, respectively. American Joint Committee on Cancer (AJCC) stage was associated with prognosis significantly (X<'2>=168.832, P = 0.000 ). Conclusions Muhifocus is one of the clinical features of PTC and is more malignant than solitary PTC. Total thyroidectomy with central compartment neck dissection could be standard treatment. Lateral nodal dissection is not necessary except for the cases with lymph node metastasis. AJCC stage is still the best prognostic factor.