分化型甲状腺癌患者预后影响因素分析(附125例报告)

目的:探讨不同手术方式、组织学分型及肿瘤分期对分化型甲状腺肿瘤患者预后的影响。方法:回顾性分析1994年7月-2005年7月分化型甲状腺癌患者125例,中位随访时间为9年。采用Kaplan-M eier生存分析和COX多因素回归模型分析颈部淋巴结清除、甲状腺切除、病理学类型和癌症分期等临床因素与无病生存率及总生存率的关系。结果:经过平均99.7个月的随访,无病生存率为77.5%,总生存率为93.6%。癌症分期与病患的无病生存率成反比(P=0.025);滤泡状肿瘤的无病生存率和总生存率均低于乳头状肿瘤的无病生存率(P0.05),而颈部淋巴结清扫与否以及是否切除甲状腺对预后的影响差异无统计学差异(P0.05)。结论:肿瘤分期与组织学分型是分化型甲状腺癌预后的主要影响因素。     

影响分化型甲状腺癌预后的多因素分析

目的探讨影响分化型甲状腺癌(DTC)预后的因素。方法回顾性分析9年间治疗的DTC患者429例的临床资料,对其预后进行单因素和多因素分析。结果全组5,10年生存率分别为95.2%和88.7%。单因素分析显示:患者年龄、肿瘤大小、T分期、远处转移、治疗方式、复发和临床病理分期等为影响预后的因素(P<0.05);而性别、病理类型、淋巴结转移等因素的组间差异均无显著性(P>0.05)。Cox多因素分析表明,T分期、治疗方式和临床病理分期3个因素均有统计学意义(P<0.05)。结论年龄、肿瘤大小、T分期、复发、远处转移和临床病理分期是影响分化型甲状腺癌预后的主要因素,其中T分期、治疗方式和临床病理分期为独立的预后因素。     

提高甲状腺癌患者的治疗效果及生活质量

甲状腺癌的发病率近年来有增高趋势。甲状腺癌虽然仅占全身癌症的1.3％～1．5％，但它却是内分泌肿瘤中最常见的一种恶性肿瘤。1998年Ladies报道，甲状腺癌占内分泌恶性肿瘤的91.5％。与其他内分泌肿瘤早期即可引起明显的内分泌紊乱的临床表现不同，甲状腺癌一般不会引起甲状腺功能的改变，因此早期不易明确诊断。Byar等研究发现，患者的年龄、性别、肿瘤的细胞类型、病变范围及有无淋巴结转移或远处转移都是影响预后的因素，但并不都是独立预后因素。影响患者预后的主要因素为甲状腺癌的病理类型、肿瘤大小、病变范围和患者年龄。不同组织学类型的甲状腺癌其生物学行为有很大差异，所幸81％～87％甲状腺癌属于分化良好的类型．尤以乳突状癌多见，其预后良好。而预后差的未分化癌仅占5％。     

分化型甲状腺癌外科手术方式探讨

目的探讨不同条件下分化型甲状腺癌(DTC)手术方式的选择与预后的关系。方法收集DTC患者325例的临床资料,采用分层Cox回归分析的方法 ,回顾性分析其影响预后的因素。校正其他因素后,评价不同的手术方式与分化型甲状腺癌预后的关系。结果患者性别、年龄、复发与否、临床病理分期、肿瘤大小、手术治疗方式均为预后的影响因素(P0.05);Cox多因素分析表明,年龄、治疗方式和临床病理分期对其预后影响有统计学意义(P0.05)。对年龄分层分析表明,与甲状腺全切组比较,高龄组单侧腺叶或加峡部切除为最佳手术方式(OR=0.320),低龄组不同手术方式OR值差异无统计学意义。根据临床病理分期分层,Ⅰ期采用单侧腺叶切除预后较好(OR=0.228),高分化期患者甲状腺次全切预后较好(OR=0.561)。结论年龄、治疗方式和临床病理分期是影响分化型甲状腺癌预后的主要因素,针对患者不同年龄、临床病理分期及患者耐受情况,采取最优的手术方式。     

40岁以下青年人直肠癌的外科治疗及预后分析

目的探讨青年直肠癌的外科治疗效果及影响其预后的因素。方法回顾性分析中国医学科学院肿瘤医院1990年1月至2000年1月收治的40岁以下青年直肠癌患者138例的临床资料。结果全组患者均经根治性手术治疗,其中腹会阴联合根治术81例,直肠前切除术54例,经肛直肠癌局部切除术3例。全组总的3年及5年生存率分别为67.7%及50.4%。单因素分析显示Dukes分期、淋巴结转移状况、性别、围手术期输血、肿瘤T分期、组织学类型及脉管瘤栓为影响预后的主要因素,而多因素分析显示肿瘤T分期、淋巴结转移是影响预后最重要的独立因素。结论对于青年直肠癌患者,根治性手术治疗是获得长期生存的惟一方法,肿瘤T分期和淋巴结转移情况是影响预后的最重要因素。     

青年甲状腺癌的临床病理特点及复发因素分析

目的:探讨青年甲状腺癌患者临床病理特点以及影响复发的主要因素。方法 :回顾性分析1995年1月-2006年12月163例18~30岁青年甲状腺癌患者临床病理资料,分析临床病理特征与复发间的关系。结果:青年甲状腺癌复发与肿瘤大小、淋巴结转移、手术方式、TSH抑制水平、复发危险度分层及是否行~(131)I治疗相关(P0.05);与性别、是否为多灶性、肿瘤分期、病理类型及包膜是否完整无明显相关(P0.05)。多因素分析显示,淋巴结转移和术后TSH抑制水平是影响青年甲状腺癌患者复发的危险因素。结论:青年甲状腺癌预后较好,依据肿瘤大小、包膜浸润情况、淋巴结转移等进行个体化手术方案,结合分化型甲状腺癌复发危险度分层规范随访监测及术后治疗,可降低患者复发率。     

甲状腺癌全切除治疗的预后影响因素的分析

目的分析经甲状腺全切术治疗的甲状腺癌患者预后的影响因素。方法回顾性分析本院从2005年8月至2009年8月收治的经甲状腺全切术治疗的150例甲状腺癌患者年龄、性别、吸烟、饮酒、病理类型、肿瘤大小、是否有淋巴结转移等临床资料,随访患者术后10年内的肿瘤复发情况,并分析全切术后甲状腺癌患者的预后影响因素。结果本研究中甲状腺癌患者的10年复发率为22.7%(34/150),且年龄、吸烟、淋巴结转移、包膜外侵犯是甲状腺癌术后复发的独立危险因素(P0.05),而性别、饮酒、病理类型这些因素对预后影响无统计学意义(P0.05)。结论经甲状腺全切术后的甲状腺癌患者预后与年龄、吸烟、淋巴结转移、包膜外侵犯这些因素有直接关系,以此来判断患者的预后情况,通过控制可控因素,达到改善患者预后的目的。     

T4胃癌根治切除术患者预后的分析

目的：探讨T4胃癌根治切除术患者的生存情况及预后影响因素。 方法：对2007年1月—2011年12月收治的有完整临床及随访资料的183例T4胃癌根治切除术患者行回顾性分析。 结果：全组患者1,3,5年累积生存率分别为92%,60%,42%,单因素分析显示,淋巴结转移率、pN分期、肿瘤浸润深度、组织学类型与患者术后生存率有关（均P<0.05）;多因素分析显示,淋巴结转移率、pN分期、肿瘤浸润深度是影响患者预后的独立危险因素（均P<0.05）。 结论：淋巴结转移率、pN分期、肿瘤浸润深度是影响T4胃癌根治切除术患者生存的独立预后因素。     

胃癌根治术预后影响因素分析

目的 探究胃癌根治术预后的影响因素。方法 选取2006年1月至2011年1月,本院诊治的150例进展期胃癌患者,所有患者均行胃癌根治术进行治疗。研究分析患者的年龄、性别、肿瘤大小、组织学分型、Bommann分型、TNM分期等一般资料,采用COX回归分析胃癌根治术预后的影响因素。结果 所有胃癌患者均在3年内保持随访,胃癌根治术后1年的生存率为84%(126/150),术后3年的生存率为52%(78/150);根据单因素分析的结果,肿瘤大小、组织学分型、Bommann分型、淋巴结清扫、辅助化疗、TNM分期、淋巴结清扫等因素能够影响胃癌根治术患者的预后,且有显著的统计学差异(P<0.05);经COX回归分析,TNM分期、肿瘤大小、组织学分型及血管侵犯能够独立影响胃癌根治术患者的预后,且有显著的统计学差异(P<0.05)。结论 TNM分期、肿瘤大小、组织学分型及血管侵犯等因素能够显著影响胃癌根治术患者的预后。因此,制定早期胃癌筛查模式对于显著改善胃癌患者的预后有着重要的临床意义。     

786例乳腺癌的病理与临床

目的:探讨乳腺癌病理与临床治疗及预后的相关因素.方法:随访并回顾性分析近年来我院收治的乳腺癌病人的病理与临床分期、治疗方法、预后情况.结果:乳腺癌的预后与肿瘤大小、组织学类型、分期、激素等多种因素有关.结论:早发现、早诊断、早治疗、合理有效的综合治疗是乳腺癌预后好的关键因素.     

基于文献计量学的甲状腺癌诊疗进展历程的循证可视化研究

背景与目的：甲状腺癌是全球最常见的内分泌系统恶性肿瘤,其发病率逐年剧增,已位居女性恶性肿瘤的第四位,其卫生负担逐年加重。近年来,随着医疗技术的发展及甲状腺癌诊疗模式的转变,甲状腺癌患者的生存预后得到明显改善。本文通过结合本研究团队既往针对甲状腺癌的文献计量学研究的基础,运用聚类分析和主题挖掘的方法,以不同时间范围作为研究对象,分析世界范围内甲状腺癌的发展历程与诊治模式的动态演进过程,以期预测未来甲状腺癌研究热点,以及为后续甲状腺癌诊疗的发展方向提供参考。方法：回顾性收集Web of Science Core Collection (Wo SCC)数据库中甲状腺癌相关的研究,应用VOSviewer 1.6.18软件对纳入文献的研究主题、关键词、作者信息、发表年份等变量提取后进行聚类及时序分析和主题挖掘,通过文献计量学的方法探索已发表甲状腺癌相关的研究主题,以及不同时间范围内甲状腺癌诊疗模式的动态演变过程,并预测未来研究热点。结果：最终共纳入甲状腺癌相关研究主题的文献32 074篇,其中,最早的文献发表于1955年。随着时间的推移,发文量迅速增加。世界范围内,基于已发表文献的甲状腺癌发展聚...     

Thyroid disorders. Part III: neoplastic thyroid disease.

This paper is part III of the series on thyroid disorders. Thyroid tumors are the most common endocrine neoplasms. Most of these tumors are benign hyperplastic or colloid nodules or benign follicular adenomas. However, 5% to 10% of the lesions that come to medical attention are carcinomas. A major clinical challenge is establishing which nodules are hyperplastic, benign, or malignant. History, clinical findings, ultrasonography, and fine-needle aspiration biopsy are the mainstays for diagnosis. There are 3 main histologic types of thyroid cancer: differentiated, medullary, and anaplastic. Differentiated lesions are subdivided into papillary, follicular, and Hurthle cell carcinomas. In addition, primary lymphoma may occur in the thyroid gland and other cancers may metastasize to the thyroid. An important neoplastic syndrome, multiple endocrine neoplasia type 2 (MEN2), involves medullary carcinoma of the thyroid gland. In 2002 there were 10 cases of thyroid cancer per 100 000 population. During the past 10 years the rate of thyroid cancer has been increasing 5% per year. The overall 10-year survival for papillary carcinoma is 80% to 90%, follicular carcinoma 65% to 75%, and medullary carcinoma 60% to 70%. The prognosis for anaplastic carcinoma is very poor and 5-year survival is rare. The dentist by inspection and palpation of the neck in the area of the thyroid gland may detect single or multiple lesions that may be benign or malignant. Patients with identified nodules or enlarged thyroid glands should be referred for diagnosis and treatment. Patients with thyroid cancer will benefit from the early detection and treatment of their lesions as early detection can lead to a cure or prolongation of their life.     

甲状腺癌外放射治疗研究进展

多数甲状腺癌预后较好,但是部分分化型甲状腺癌、髓样癌和未分化癌预后较差。¹³¹I治疗由于肿瘤不吸收碘而无效,近年来外放射治疗在局部残留甲状腺癌取得较好的局部控制效果。外放射治疗在部分甲状腺癌患者中有一定适应证,如果严格选择患者、个体化使用,治疗后局部控制效果较好。     

儿童及青少年甲状腺癌分子生物学研究进展

甲状腺癌在儿童及青少年中是较为罕见的恶性肿瘤,但其发病率在逐年上升。与成人相比,儿童及青少年甲状腺癌的恶性程度更高,因此,研究其基因背景具有重要意义。点突变、融合突变及基因扩增等是驱动甲状腺肿瘤发生发展的关键因素。儿童及青少年甲状腺癌病人中基因融合的发生率明显高于成人,且与单核苷酸点突变相比,融合基因的出现与肿瘤高侵袭性的临床病理特征及不良预后相关。这种分子生物学背景差异可能是导致两者临床表现和预后不同的重要原因之一。随着高通量测序及基因芯片针对儿童及青少年甲状腺癌研究的深入,不仅识别了新的基因改变,而且对分子事件与儿童及青少年甲状腺癌病人生物学行为、靶向治疗和预后之间的相关性有了更新的认识。因此,全面认识儿童及青少年甲状腺癌病人的分子生物学特征可以更好地为其提供个体化的临床诊疗。     

Diagnosis and treatment of differentiated thyroid carcinoma

Thyroid cancer is the most common endocrine malignancy. More than 90% of primary thyroid cancers are differentiated papillary or follicular types. The prognosis for patients with differentiated thyroid carcinomas is favorable. Female gender and younger age (<50 years) are good prognostic factors. The diagnosis of papillary thyroid cancer is not difficult with ultrasonography and fine-needle aspiration cytology under ultrasonography, whereas that of follicular cancer is difficult, especially of minimally invasive follicular carcinoma. The diagnosis of most follicular cancer is made by pathologic diagnosis postoperatively. The primary treatment of differentiated thyroid carcinoma is thyroid surgery with lymph node dissection. The extent of resection of the thyroid gland depends on size the of the thyroid cancer and area of invasion. If a patient has distant metastasis, total thyroideectomy and radioactive iodine ablation therapy, followed by L-thyroxine therapy, should be offered. The extent of initial surgery, indications for radioiodine ablation therapy, and the degree of thyroid-stimulating hormone (TSH) suppression are all issues that are still being debated. The aim of TSH-suppressive therapy is to restore euthyroidism and to decrease serum TSH levels to reduce the growth and progression of thyroid cancer.     

Total thyroidectomy in the management of differentiated thyroid cancer: a review of 258 cases

Controversy continues to surround the management of differentiated thyroid cancer. For the past 20 years, a standardized protocol of total thyroidectomy followed by radioiodine ablation has been followed at Royal North Shore Hospital. During the period 1966-83, 327 cases of thyroid malignancy were treated surgically and, of these, 258 were differentiated thyroid cancer. Following total thyroidectomy, the incidence of recurrent nerve palsy was 2.8% and that of permanent hypoparathyroidism 3.2%. The overall 10 year cumulative survival for these patients was 87%. Whilst there were apparent differences in survival depending on the pathological type of tumour (papillary, follicular, mixed), further analysis shows that most of the differences in prognosis can be explained on the basis of age and sex alone. Young patients (less than 60 years) have an excellent 10 year survival (96%) whilst that for the elderly is only 61%. Males have a worse prognosis at 10 years than females. Total thyroidectomy is a safe procedure for the treatment of differentiated thyroid cancer. It allows the subsequent evaluation and treatment of unrecognized metastatic disease and offers the young patient a potentially normal lifespan.     

The significance of lymph node status in papillary and follicular thyroid gland carcinoma for the nuclear medicine physician

The impact of lymph node metastases on prognosis of differentiated thyroid cancer is discussed controversially. Therefore the data of 596 patients with papillary or follicular thyroid cancer are analysed retrospectively, which have been treated between 1980 and 1995 at the Clinic and Policlinic for Nuclear Medicine of the University of Würzburg. The influence of lymph node metastases on prognosis with respect to survival is analysed with the univariate Kaplan-Meier-method and with the multivariate discriminant analysis. In addition, the influence of the prognostic factor "lymph node involvement" on distant metastases is analysed by a stratified comparison and an univariate test. In papillary thyroid cancer, the 15 year-survival-rate for stage pN1 is significantly lower (p < 0.001) with 88.7% as compared to stage pN0 (99.4%). In patients with follicular thyroid cancer this difference is even more pronounced (64.7% versus 97.2%, p < 0.001). However, the multivariate discriminant analysis shows that the only prognostic factors are tumour stage and distant metastases, and--in papillary thyroid cancer--patient's age. So lymph node metastases are not an independent prognostic factor concerning survival. However, lymph node metastases have a prognostic unfavourable influence with respect to distant metastases especially in papillary thyroid cancer stage pT4 (distant metastases in patients with negative lymph nodes 0% and in patients with positive lymph nodes 35.3% [p < 0.001]).     

Anaplastic Thyroid Carcinoma: Biology, Pathogenesis, Prognostic Factors, and Treatment Approaches

Background Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors known to affect humans and carries a dismal prognosis. Our primary aim was to review its epidemiology, biology, risk factors, and prognostic indicators. We also reviewed the individual and combined roles of surgery, radiotherapy, chemotherapy, and newer therapeutic options in the management of ATC. Methods An extensive literature review was conducted to include all published reports on ATC. The changing trends in the management of anaplastic thyroid cancer were analyzed to summarize the current practice of management of ATC. Results Although ATC is rare, there has been a decline in its incidence worldwide. ATC accounts for more than half of the 1200 deaths per year attributed to thyroid cancer. Long-term survivors are rare, with >75% and 50% of patients harboring cervical nodal disease and metastatic disease, respectively, at presentation. ATC can arise de novo or from preexisting well-differentiated thyroid cancer. Surgical management has shifted from tracheostomy only for palliation to curative resection when possible. Tracheostomy is performed for impending obstruction rather than for prophylaxis. Radiotherapy has evolved from postoperative administration only to preoperative treatment, combining preoperative and postoperative treatment and using higher doses, along with hyperfractionating and accelerating dose schedules. Chemotherapy has changed from monotherapy to combination therapy, and newer drugs such as paclitaxel show promise. Similarly, novel angiogenesis-inhibiting agents are currently being used, with early reports of some benefit. Conclusions Despite multimodality approaches, ATC still carries a dismal prognosis. This should provoke innovative strategies beyond conventional methods to tackle this uniformly lethal disease.     

Follicular carcinoma of the thyroid

Background. Follicular carcinomas of the thyroid are less common than papillary carcinomas of the thyroid, and the available data on prognostic factors are relatively scant. A retrospective study covering four decades was undertaken to evaluate clinical and pathologic findings with regard to their effect on prognosis. Methods. In 195 cases of follicular carcinoma treated from 1954 to 1991 age, sex, histologic type (minimally invasive vs. widely invasive), tumor size, and local, regional, and distant spread as well as the contribution of treatment to survival were evaluated in relation to prognosis. Results. Age was a significant prognostic factor: there was 100% survival of patients younger than 20 years of age at diagnosis and only one death in the 20-39 year age group. Sex was not a significant prognostic factor, although there was a tendency to a better prognosis in females. Tumor size was significant, more than 6 cm having a poor prognosis. Blood vessel invasion influenced prognosis for the first 10 years. The presence of distant metastases was significant regarding survival. Lymph node involvement had a negative effect on the outcome. Conclusions. The factors of age, tumor size, invasion of blood vessels, and distant metastases are significant predictors of survival for patients with follicular carcinoma, whereas sex is not; regional spread needs to be evaluated further. © 1994 John Wiley & Sons, Inc.     

Sternal metastasis as first manifestation of a papillary thyroid carcinoma: A case report

IntroductionPapillary thyroid carcinomas (PTC) are differentiated forms of thyroid carcinoma. Sternal metastases from differentiated thyroid cancers (DTCs) are rare and are of particular prognostic interest. Radioiodine therapy has traditionally been the treatment of choice for metastases from differentiated thyroid cancers; however, bone metastases are known to be resistant to this form of treatment. Surgical resection of distant metastases from DTCs offers a better chance of achieving long survival and a better quality of life. We report the case of a 59-year-old women who presented a presternal mass for one year revealing metastatic papillary thyroid carcinoma, a total thyroidectomy with lymph node dissection and reconstruction of the sternal defect were performed. Overall, we demonstrate that radical resection of sternal metastases can be performed safely even in patients with poor prognosis to achieve palliation and potentiation of Radioiodine therapy.Case reportThis is a 59-year-old women referred by the endocrinology service for a sternal metastasis of a papillary thyroid carcinoma, who presented a painless, firm and fixed presternal mass for one year, a total thyroidectomy with lymph node dissection was performed with En-bloc resection and reconstruction as a one-stage procedure. Reconstruction of the chest wall was obtained by the rigid reconstruction with titanium bars and coverage with polymesh dual prosthesis, followed by radioiodine therapy and substitution with L-thyroxine. The patient is currently in good health condition, and does not present any complications and was in euthyroidism under substitution for the long term follow up.DiscussionThyroid cancer is the fastest increasing cancer in the United States, It is expected to replace colon cancer as the fourth leading cancer by 2030.2 More than 90% of thyroid carcinoma cases are classified as papillary or follicular carcinoma, both referred to as differentiated thyroid carcinomas (DTCs) and are associated with a 97%–98% 10-year survival rate. However, this rate can decrease to 14%–21% when patients present with bone metastases. Bone metastases have been reported to occur in 2%–13% of patients with DTC (Osorio et al. [1]). Several techniques have been used to repair after wide sternal resection for metastatic malignancies. Furthermore, choice of the reconstruction techniques depends on the size and the site of the defect and the preference of the surgeon (Lequaglie et al. [2]).ConclusionSternal metastases from papillary thyroid carcinomas are rare,few cases of sternal metastasis as first presentation of a well-differentiated PTC are described in the literature. Operative management of these metastases is still controversial, but radical resection offer patients an optimal probability of long-term survival.