老年甲状腺癌的临床特点及预后分析

目的:探讨老年甲状腺癌的临床特点、治疗方法及预后情况,以期提高患者的生存时间及生存质量。方法:回顾性分析辽宁省肿瘤医院2000-2010年手术治疗的111例老年甲状腺癌的临床病理资料。对病理类型、是否存在淋巴结转移、临床分期、是否存在远处转移、是否为二次手术、是否存在甲状腺腺外侵袭以及腺外侵袭的程度、器官等因素进行检验。生存分析采用Kaplan-Meier法和Log-Rank检验。结果:全组5年累积生存率84.2%,10年累积生存率79.6%。IV期病例达58.97%(63/111),5年累积生存率50.4%。存在甲状腺腺外侵袭病例比例达52.25%(58/111),5年累积生存率68.5%。经Log-Rank检验甲状腺腺外侵袭(P=0.000)、肿瘤的侵袭程度(P=0.046)、气管食道侵犯(P=0.028)、喉返神经侵犯(P=0.046)、临床分期(P=0.009)均影响预后。原发灶数目与淋巴结转移有关(P=0.029),与甲状腺腺外侵袭无关(P=0.8)。结论:老年甲状腺癌病变以腺外侵袭为主,预后差。晚期病例比例高,采用手术、促甲状腺素抑制治疗、三维适形放疗、放射性核素的个体化治疗可取得较好疗效。

Clinical features and treatment of thyroid carcinoma in elderly people

Objective:To investigate clinical characteristics,therapy and prognosis of thyroid carcinoma in elderly people.Methods: Data of 111 cases of thyroid carcinoma treated from 2000 to 2010 were retrospectively reviewed.The data included pathologic type,lymph nodes metastasis,AJCC stage,distant metastasis,re-operation of thyroidectomy,extrathyroid extension(ETE),the degree of extrathyroid extension and organ.For the bivariate analysis,the Kaplan-Meier method and the log-rank test were used to identify significant prognostic factors.Bivariate analyses of the independent variables were performed by using chi-square statistical analyses for multifocal thyroid carcinoma.Results: The 5-year and 10-year cumulative survival rates were 84.2%and 79.6%respectively in all patients.The percentage of stage IV and ETE were 58.97%(63/111) and 52.25%(58/111),5-year cumulative survival rates were 50.4% and 68.5%.Log-Rank test indicated ETE,the degree of ETE,trachea and esophagus invasion,recurrent laryngeal nerve invasion and AJCC stage were the significant prognostic factors.Multifocal carcinoma patients were more likely to have lymph nodes metastasis.Conclusion: Old patients are more likely to have extrathyroid extension and poor prognosis.The percentage of advanced disease is high.The tailored treatment including surgery,TSH suppression treatment,three dimensional conformal radiotherapy,radioiodine ablation and therapy are benefical to the elderly thyroid carcinoma patients.