Differentiated thyroid carcinoma: prognostic factors

Factors influencing prognosis and long term outcome of thyroid cancer have been described by several groups. It is, however, not clear how the moderate iodine deficiency in Hungary can influence the previously described prognostic factors by other means than shifting differentiated cancer incidence toward the follicular type. Data of 423 out of 472 patients who had been operated on for papillary (372) and follicular (100) thyroid cancer between 1971 and 1997 at our institution have been analyzed retrospectively. Histological specimens were re-evaluated and, if needed, revised. Survival curves were compared using the Kaplan-Meier method. The overall 5 and 10 year survival rates were 93% and 89% for papillary, and 92% and 80% for follicular carcinoma. As an independent factor extrathyroidal invasion (papillary p = 0.000, follicular p = 0.000), lymph node involvement (papillary p = 0.000, follicular 0.011), distant metastases (papillary p = 0.000, follicular p = 0.000), and age over 40 years (papillary p = 0.000, follicular p = 0.000) had negative influence on survival. Multifocality, gender, type of surgery (total or near-total thyroidectomy vs. less than near-total thyroidectomy), and lymphocytic infiltration did not influence survival. Iodine intake did not influence survival, however, the incidence of follicular cancer was higher in iodine deficient regions. When analyzing the papillary and follicular groups separately by Cox regression, extrathyroidal invasion (p = 0.008), lymph node metastasis (p = 0.004), distant metastasis (p = 0.000), and age over 40 years (p = 0.000) were significant predictors in the papillary group, while only tumor extrathyroidal invasion (p = 0.019), and distant metastases (p = 0.000) were significant negative factors in the follicular group.     

Well-differentiated thyroid carcinoma in Hong Kong Chinese patients under 21 years of age: a 35-year experience

Background:

Sporadic well-differentiated thyroid cancer is an uncommon condition in children, adolescents, and young adults. It is associated with distinct clinicopathologic features and prognosis. The present study reviews our experience in management of this condition in ethnic Chinese in Hong Kong.

Study Design:

A retrospective study was performed to review the clinicopathologic features and outcomes of 34 patients less than 21 years of age with well-differentiated thyroid carcinoma over a 35-year period. Median followup was 15.2 years (range 1 to 32.5 years).

Results:

There were 27 girls and 7 boys with a median age of 19 years (range 10 to 21 years). None had previous history of irradiation. Twenty-eight patients had papillary and six had follicular carcinomas. Operative procedures included total thyroidectomy (n = 27) and unilateral lobectomy (n = 7) with concomitant neck dissection performed in nine patients. The median tumor size was 2 cm and extrathyroidal invasion was present in 19 tumors. Adjuvant radioactive iodine treatment was administered to 18 patients after total thyroidectomy. Disease progression or recurrence rate was 24% and 27% at 5 and 10 years, respectively. The presence of lymph node metastases was associated with a higher incidence of disease recurrence. One patient with advanced local disease died from tumor bed recurrence with anaplastic transformation 18 years after the initial operation.

Conclusions:

Well-differentiated thyroid carcinoma is a relatively indolent tumor associated with good prognosis in young patients. Although death from this condition is rare, recurrence is frequent and longterm followup is necessary.     

Insular carcinomas of the thyroid exhibit poor prognosis and long-term survival in comparison to follicular and papillary T4 carcinomas

Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore, in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer. Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic factors. Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%). Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage who have follicular or papillary thyroid carcinoma.     

Outcome in cervical recurrences of papillary or follicular thyroid cancer]

The aim of this study was to evaluate the treatment and outcome of patients with local recurrence (LR) of differentiated thyroid carcinoma. This retrospective study concerned patients treated between 1974 and 1990 for papillary or follicular thyroid cancer. Our patients had at least one LR. LR diagnosed within 6 months after thyroidectomy and patients with increased serum thyroglobulin levels were excluded. Thirty one patients (80% female) aged 15 to 84 years had at least one LR. LR was diagnosed 7 to 200 months after thyroidectomy (mean 63.7). There were 25 papillary and 6 follicular cancers. There were 1.5 LR per patient (range 1-6). LR were treated by radioiodine in 21 cases and by surgery in 22 cases. Among the 22 surgically treated patients, 7 had nodal recurrences, 7 had nodes and tumor, 3 had only tumor, 1 had recurrence in the remnant thyroid. After a mean follow-up of 75.8 months, 11 patients had distant metastases, 11 had died from their thyroid carcinoma (7 after metastases). Three of the 7 patients with nodal recurrence died. In one third of cases, LR announced distant metastases. Node recurrence had a poor prognosis.     

Multivariate analysis of clinicopathologic parameters for the insular subtype of differentiated thyroid carcinoma

HYPOTHESIS: Insular carcinoma represents a more aggressive subtype of differentiated thyroid cancer on multivariate analysis after controlling for various clinicopathologic parameters. DESIGN: Retrospective analysis. SETTING: Tertiary referral center at a university hospital. PATIENTS: One hundred twenty-seven consecutive patients having a histological diagnosis of the follicular variant of papillary thyroid carcinoma or follicular thyroid carcinoma. MAIN OUTCOME MEASURE: A logistic regression model was used to examine the relationship between various clinicopathologic parameters and the insular subtype. RESULTS: The insular subtype involved 14 of 127 tumors. Unlike extrathyroidal extension and nodal metastasis, primary tumor diameter (> 40 mm vs < or = 40 mm; P = .008) and distant metastasis (P = .003) correlated with the insular subtype. Both parameters were interrelated since tumors greater than 40 mm displayed distant metastasis more often (30% vs 8%; P = .008) than tumors measuring 40 mm or less. CONCLUSIONS: These findings suggest that an unidentified somatic event may induce an accelerated proliferation of the transformed thyrocytes, which may ultimately result in enhanced rates of distant metastasis with increasing tumor volume.     

The prevalence and prognostic value of BRAF mutation in thyroid cancer

OBJECTIVE: To examine the prevalence of BRAF mutation among thyroid cancer histologic subtypes and determine the association of BRAF mutation with indicators of poor prognosis for papillary thyroid cancer and patient outcome. SUMMARY BACKGROUND DATA: The appropriate extent of surgical treatment, adjuvant therapy and follow-up monitoring for thyroid cancer remains controversial. Advances in the molecular biology of thyroid cancer have helped to identify candidate markers of disease aggressiveness. A commonly found genetic alternation is a point mutation in the BRAF oncogene (BRAF V600E), which is primarily found in papillary thyroid cancer and is associated with more aggressive disease. METHODS: BRAF V600E mutation status was determined in 347 tumor samples from 314 patients with thyroid cancer (245 with conventional papillary thyroid cancer, 73 with follicular thyroid cancer, and 29 with the follicular variant of papillary thyroid cancer). Univariate and multivariate analyses were performed to determine the association of BRAF V600E with clinicopathologic factors and patient outcome. RESULTS:: The prevalence of BRAF V600E mutation was higher in conventional papillary thyroid cancer (51.0%) than in follicular variant of papillary thyroid cancer (24.1%) and follicular thyroid cancer (1.4%) (P < 0.0001). In patients with conventional papillary thyroid cancer, BRAF V600E mutation was associated with older age (P = 0.0381), lymph node metastasis (P = 0.0323), distant metastasis (P = 0.045), higher TNM stage (I and II vs. III and IV, P = 0.0389), and recurrent and persistent disease (P = 0.009) with a median follow-up time of 6.0 years. Multivariate analysis showed that BRAF V600E mutation [OR (95% CI) = 4.2 (1.2-14.6)] and lymph node metastasis [OR (95% CI) = 7.75 (2.1-28.5)] were independently associated with recurrent and persistent disease in patients with conventional papillary thyroid cancer. CONCLUSIONS: BRAF V600E mutation is primarily present in conventional papillary thyroid cancer. It is associated with an aggressive tumor phenotype and higher risk of recurrent and persistent disease in patients with conventional papillary thyroid cancer. Testing for this mutation may be useful for selecting initial therapy and for follow-up monitoring.     

P300/CBP在甲状腺乳头状癌中的表达及其临床意义

目的 探讨组蛋白乙酰转移酶分子p300/CBP在甲状腺乳头状癌中的表达及其临床意义。方法 利用免疫组化技术检测142例甲状腺乳头状癌组织及22例正常甲状腺组织中p300/CBP蛋白表达情况,并分析其与临床相关因素的关系。结果 p300/CBP蛋白在甲状腺乳头状癌组织中表达水平升高,但与患者性别、年龄、病理分期、T分期、N分期、M分期、复发均无关。Cox多因素分析显示年龄和远处转移是影响甲状腺乳头状癌预后的独立因素。结论 本研究显示p300/CBP蛋白在甲状腺乳头状癌组织中存在高表达,但没有发现与甲状腺乳头状癌的预后有关。     

Downregulation of p27KIP1 and Ki67/Mib1 labeling index support the classification of thyroid carcinoma into prognostically relevant categories.

The cyclin-dependent kinase inhibitor p27KIP1 has been proposed as a valuable prognostic indicator for a variety of human neoplasms. Immunohistochemical reactivity for p27KIP1 and the proliferation marker Ki67/Mib1 were investigated in 90 thyroid carcinomas of follicular cell origin. The neoplasms were divided into three prognostic groups on the basis of their morphologic features: group 1, well-differentiated papillary or follicular carcinomas with favorable pathologic features (43 papillary carcinomas and 4 minimally invasive follicular carcinomas); group 2, papillary or follicular carcinomas with unfavorable pathologic features (21 poorly differentiated carcinomas and 2 papillary carcinomas, tall cell variant); and group 3, undifferentiated, or anaplastic, carcinomas. p27KIP1 expression (p = 0.007) and Ki67/Mib1 labeling index (p = 0.02) showed a strong correlation with the subdivision of the thyroid carcinomas in the three prognostic groups with a significant linear trend for tumors with low p27KIP1 (p = 0.002) and high Ki67/Mib1 labeling index (p = 0.005) to segregate into the unfavorable categories (groups 2 and 3). Low p27KIP1 expression, but not cellular proliferation, was related to adverse prognostic factors, such as large tumor size (p = 0.03) and extrathyroidal extension (p = 0.01), but the correlation was not independent of the subdivision in the three groups. Low p27KIP1 expression (p = 0.03) and high proliferative rate (p = 0.02) were associated with poor survival, reflecting the close association between patient morbidity and mortality rates and tumor differentiation. No significant association could be seen between p27KIP1 or cellular proliferation and clinicopathologic parameters (e.g., age, sex, tumor size, extrathyroidal extension, vascular invasion, lymph node metastases, distant metastases, tumor stage, and survival rate) within any of the groups, or the histologic diagnosis of papillary versus follicular carcinoma irrespective of their degree of differentiation. Modulation of p27KIP1 and cellular proliferation patterns in thyroid carcinoma correlate with tumor differentiation and support the morphologic classification of thyroid carcinoma into prognostically relevant categories.     

Clinical Relevance of Vascular Endothelial Growth Factor for Thyroid Neoplasms

Angiogenesis is of vital importance during the development and progression of solid tumors. Vascular endothelial growth factor (VEGF) is a major regulator of angiogenesis and could be produced by some cancer cells. To investigate the clinical relevance of VEGF in the tumorigenesis of human thyroid, an immunohistochemical study was performed on archival materials of follicular adenomas (n= 13), Hürthle cell adenomas (n= 6), papillary carcinomas (n= 76), follicular carcinomas (n= 12), Hürthle cell carcinomas (n= 2), and anaplastic carcinomas (n= 8). Patterns of VEGF expression were analyzed in relation to histologic subtypes of thyroid tumors and were correlated to biologic indicators of papillary carcinoma. All papillary carcinomas and Hürthle cell neoplasms revealed a strong, diffuse staining reaction, whereas anaplastic carcinoma usually exhibited weak and infrequent immunoreactivity. VEGF levels were usually higher in follicular adenomas than in follicular carcinomas. With regard to prognostic value, VEGF expression did not correlate with tumor size, extent of invasion, or scores on the AGES system (i.e., patient age, tumor size, histologic grade, tumor extent, distant metastasis) or the MACIS system (i.e., metastasis, age, completeness of resection, invasion, tumor size) for papillary carcinomas (p > 0.05, respectively). The results of the current study indicate that VEGF may play a role in the development of human thyroid cancer. Determination of the angiogenic phenotype may have limited prognostic value for patients with papillary carcinoma.     

Extremely high level of serum thyroglobulin after surgery in a patient with follicular thyroid carcinoma. Recurrence, distant metastasis, or other etiology?

A 67-year-old female patient with a tumor of the thyroid underwent right lobectomy of the thyroid. The tumor was histologically diagnosed as a follicular carcinoma of the thyroid. Serum studies revealed very high (> 8,000 ng/ml) levels of thyroglobulin after surgery. We suspected distant metastases from follicular carcinoma or recurrence in the left lobe of the thyroid. She therefore underwent left lobectomy of the thyroid. No recurrence of follicular carcinoma was recognized in the resected thyroid tissue, but severe autoimmune thyroiditis was diagnosed histologically. Total-body 131I scintigraphy did not show abnormal distant uptake. Serum studies revealed very low levels of thyroglobulin (< 2.0 ng/ml) after the second surgery. We speculate that silent thyroiditis might have occurred after the first surgery, resulting in the high levels of serum thyroglobulin. Silent thyroiditis should be considered as a possible cause of high serum thyroglobulin levels.     

A population-based analysis of survival factors in differentiated and medullary thyroid carcinoma.

OBJECTIVE: The study purpose was to determine survival and prognostic factors for differentiated thyroid carcinoma (DTC). METHODS: Cases of DTC were extracted from the Surveillance, Epidemiology and End Results database from 1988 through 1998. Kaplan-Meier survival analysis was conducted for papillary, follicular, and medullary histologies. Cox proportional hazard analysis was used to examine the influence of age, gender, tumor size, local extension, and cervical node involvement on overall survival. RESULTS: A total of 18,118 cases were identified, including 15,820 (87.3%) papillary carcinomas, 1799 (9.9%) follicular carcinomas, and 499 (2.8%) medullary carcinomas. Mean survival (10-year survival) was 122 (87.7%), 117 (80.2%), and 108 (73.7%) months for papillary, follicular, and medullary tumors, respectively. For each histology, increasing age, male gender, and degree of local extension substantially reduced survival. Cervical metastasis did not influence survival for papillary or follicular carcinomas but approached significance for medullary carcinoma (P = 0.065). CONCLUSIONS: Degree of local extension in thyroid carcinoma should be subclassified to more accurately determine prognosis. Treatment of the neck should be considered for medullary thyroid carcinoma.     

A case with poorly differentiated follicular carcinoma of the thyroid produced and secreted CEA

Detection of thyroglobulin, CEA, and calcitonin in serum and tissue is very useful to make differential diagnosis among papillary, follicular, and medullary carcinoma of the thyroid. The case was a 70-year-old woman with a nodule of the thyroid, presenting elevated serum level of thyroglobulin and CEA (22.0 ng/ml). Both serum level of thyroglobulin and CEA decreased after surgery. One year and nine months after surgery, she died from systemic metastases of thyroid carcinoma. Histological examination of the tumor presented to be poorly differentiated type of follicular carcinoma, presenting positive of both thyroglobulin and CEA, and negative of calcitonin in the cytoimmunochemistry. This case was identified to be a rare case that tumor cells of poorly differentiated follicular carcinoma produced and secreted both thyroglobulin and CEA.     

Significance of tumor capsular invasion in well-differentiated thyroid carcinomas

This study examines the influence of tumor capsular invasion on the biological behavior of papillary (PTC) and follicular thyroid carcinoma (FTC) and the prognosis of surgically treated patients. This retrospective cohort study included 350 cases of PTC or FTC from a university teaching hospital. Patient charts were randomly selected and reviewed. The study population was divided into PTC and FTC groups. Each group was subdivided into CI+ (with tumor capsular invasion) and CI- subgroups (without tumor capsule or without capsular invasion). The long-term prognosis was assessed using the American Joint Committee on Cancer pTNM staging and the prognostic index was elaborated by the European Organization for Research and Treatment of Cancer. There were 284 women and 66 men (ages 19-89 years, mean of 44) with an incidence of 53.1 per cent for CI+ tumors. There were no significant differences between the PTC subgroups regarding the short-term clinical outcome and the long-term prognosis. Although patients with CI+ FTC showed lower incidence of lymph node metastasis than patients with CI- FTC, the FTC subgroups were comparable regarding the short-term clinical outcome and the long-term prognosis. Our results suggest that presence of tumor capsular invasion does not adversely influence biological behavior or survival of PTC or FTC. Moreover, the presence of tumor capsular invasion appears to not have significance for the long-term prognosis of patients with PTC or FTC.     

Prognostic factors of papillary carcinomas of the thyroid gland--retrospective multivariate analysis of 227 patients with median follow-up 130 months]

I carried out the retrospective analysis of the prognostic factors of papillary carcinoma of the thyroid gland by using Cox's proportional hazard model using SAS program, and obtained the following conclusions. Two hundred and twenty seven patients who received surgical treatment under the diagnosis of carcinoma of the thyroid in the 1st Department Surgery of Yokohama City University during 24 years from 1964 to 1987 were subjected to this study. As prognostic factors, sex, age at the diagnosis, size of the tumor, presence of lymph node metastasis, number of the metastatic lymph nodes, presence of the local infiltration, presence of the distant metastasis and thyroidectomy were investigated. From these results, age at the diagnosis (chi 2 = 18.93, p < 0.0001, beta = 0.06, risk ratio = 0.203), presence of the local infiltration (chi 2 = 14.55, p < 0.0001, beta = 0.75, risk ratio = 0.175) and sex (chi 2 = 7.63, p < 0.01, beta = -0.91, risk ratio = 0.175) were considered statistically significant. Patients over 50 years of age at the diagnosis and presence of the local infiltration had high risk of death from papillary carcinoma of the thyroid gland. Particularly, age at the diagnosis was the most important prognostic factor. Therefore, it was considered that therapeutic approach taking age into consideration is important for the treatment of papillary carcinoma of the thyroid.     

Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute

PURPOSE: To compare and contrast the clinical presentation and treatment outcome of patients with papillary and follicular thyroid carcinoma and to study the pattern of practice of treatment of differentiated thyroid carcinoma in Hong Kong. METHOD: The clinical presentation and treatment outcomes were reviewed for 1057 patients with differentiated thyroid cancers who were treated at the Queen Elizabeth Hospital, Hong Kong, from 1960 to 1997. Eight hundred forty-two patients had papillary thyroid carcinomas (PTC), and 215 had follicular thyroid carcinomas (FTC). The mean follow-up was 9.2 years. RESULTS: The differences in the clinical factors of PTC to FTC were as follows: PTC had a higher incidence (3.9:1); these patients were younger at presentation (median age, 44 vs 49), showed a higher female-male ratio (4.5 vs 2.9) and smaller primary tumor size (median 2 cm vs 3.5 cm), and a higher incidence of multifocal disease (28.3% vs 18.1%), extrathyroidal extension (39.4% vs 14%), and more lymph node metastases (33.3% vs 12.1%). The incidence of distant metastases was higher for patients with FTC (28.8% vs 8.9%), and cause-specific survival rates were lower (p =.001). The locoregional control rates were not significantly different (p =.2). The 10-year cause-specific survival, freedom from distant metastasis, and locoregional failure figures for PTC compared with FTC were 92.1% vs 81%, 90.8% vs 72.3%, and 78.5% vs 83%. CONCLUSIONS: Although patients with PTC tend to have more advanced locoregional disease compared with those with FTC, the likelihood of locoregional control is similar, and the probability of cure is better.     

Follicular carcinoma of the thyroid with massive angioinvasion: extension of tumor thrombus to the heart

Angioinvasion is a well documented microscopic characteristic of follicular carcinoma of the thyroid. Patients with untreated tumors may die from local invasion or metastases to the lungs, bones, or other organs. A less well recognized cause of morbidity and death from this neoplasm is angioinvasion of cervical veins with direct extension into the great veins of the chest, to the heart. Six instances of this complication have been reported previously. The most common clinical presentation of patients with neoplastic thrombus within the great veins is the superior vena cava syndrome. In each case the patient died as a result of the vascular or cardiac involvement, shortly after diagnosis. The patient reported is the first in which follicular carcinoma with extensive angioinvasion was treated. A clinical diagnosis of superior vena cava syndrome was confirmed by angiographic studies. Resection of the primary thyroid tumor and the angioinvasive extension to the heart plus 131I therapy have controlled the malignancy for at least 3 years.     

Occult Papillary Thyroid Carcinoma: Diagnostic and Clinical Implications in the Era of Routine Ultrasonography

BACKGROUND: Papillary carcinoma with clinically apparent node metastasis but lacking a primary carcinoma lesion in the thyroid is designated as occult papillary carcinoma. In the era of routine ultrasonographic examination, occult papillary carcinoma is defined as papillary carcinoma with clinically apparent node metastasis but showing a primary lesion that is microscopic or overlooked by ultrasonography. In this study we investigated the prevalence and clinicopathologic features, including prognosis, of occult papillary carcinoma. METHODS: This is a retrospective series study of all patients with occult papillary thyroid carcinoma who underwent initial surgery at a single institution over 14 years. RESULTS: Between 1990 and 2004, 5400 patients underwent surgery for papillary thyroid carcinoma at Kuma Hospital, Japan. Seventeen (0.3%) were regarded as having occult papillary carcinoma and were enrolled in the study. Clinically apparent node metastasis was detected in the lateral compartment in 16 patients and in the mediastinal compartment in 1 patient. Multiple metastatic nodes were detected in 5 patients (29%). Primary lesions of papillary carcinoma were intraoperatively detected in 3 of 14 patients (21%) who underwent thyroidectomy, but there were no apparent carcinoma lesions in the thyroid in 5 patients (36%), even on pathologic examination. Six patients (35%) showed extranodal tumor extension to adjacent organs and two of these patients showed recurrence. None of the patients showed distant metastasis or died of carcinoma over the study period. CONCLUSIONS: Patients with occult papillary thyroid carcinoma were found to have a favorable overall prognosis. However, occult papillary carcinoma is automatically classified as N1b in the UICC classification, and in our series it is also likely to show other aggressive clinicopathologic features. In particular, extranodal tumor extension portends a worse prognosis for patients with occult papillary carcinoma. Therefore, careful total thyroidectomy with lymph node dissection is recommended except for elderly or high-risk patients.     

Is the new WHO's histological typing clinically useful for the diagnosis of follicular cancer of the thyroid?]

We tried to re-diagnose our 57 cases of thyroid follicular cancer between 1965 and 1988 in accordance with Histological Typing of Thyroid Tumours published by WHO in 1988. 1) The incidence of follicular cancer in differentiated cancers was decreased from 17.9% to 8.3% (26 cases). The number of widely invasive type and minimally invasive type was 13 cases equally. 2) Twenty four cases were diagnosed as papillary cancer. The reason was that 20 cases had a small focus of papillary structure, and other 4 cases had features of follicular variant type of papillary cancer. These 24 cases had good prognosis as our 262 cases of papillary cancer, in contrast to 26 cases of follicular cancer having worse prognosis. 3) The incidence of distant metastasis in follicular carcinoma was increased from 28.1% to 42.3%; 23.9% in minimally invasive type and 61.5% in widely invasive type, respectively. New WHO classification is acceptable according to this clinical study of our cases. We would have to treat more aggressively the patient diagnosed follicular cancer by WHO classification because of high incidence of distant metastasis.     

微小乳头状癌淋巴结转移及预防性淋巴结清扫的价值

目的探讨微小乳头状癌颈侧区淋巴结转移的危险因素及预防性清扫的价值。方法选取2010年2月至2016年2月收治的172例甲状腺微小乳头状癌患者进行回顾性分析,根据颈淋巴结分区有92例淋巴结转移阴性患者,其中50例采取了预防性单侧或双侧淋巴结清扫(预防组),42例未行预防性淋巴结清扫(未预防组),比较两组预后。应用SPSS 19.0进行分析,住院时间等计量资料用均数±标准差(x珋±s)表示,比较采用独立样本t检验;性别、年龄、肿瘤大小、包膜浸润、侧别、肿瘤位置、肿瘤数目、中央区转移、并发症发生率、肿瘤局部复发或远处转移率、病死率等计数资料计算构成比(%),采用χ2检验;危险因素的预测采用多因素Logical回归,P0.05为差异有统计学意义。结果颈侧区淋巴结转移阳性患者中年龄≤45岁、肿瘤0.5~1.0 cm、包膜浸润、肿瘤位于甲状腺上极、中央区转移者占67.5%、72.5%、45.0%、87.5%、67.5%,均高于阴性患者(P0.05)。中央区转移、肿瘤位于甲状腺上极为颈侧区淋巴结转移的危险因素。预防组患者随访期间未见肿瘤局部复发、远处转移与死亡情况,未预防组病死率2.4%(P0.05),肿瘤局部复发或远处转移率为9.5%(P0.05)。结论肿瘤位于甲状腺上极、存在中央区转移的微小乳头状癌患者更易出现颈侧区淋巴结转移。颈侧区淋巴结转移阴性患者行预防性淋巴结清扫术可有效改善远期预后,且术后并发症未明显增加。     

多灶性甲状腺乳头状癌的生物学特性及治疗分析

目的 探讨多灶性甲状腺乳头状癌的临床特性及治疗.方法 回顾性分析1995-1997年间在天津市肿瘤医院手术治疗并经病理证实的86例多灶性甲状腺乳头状癌的临床资料,研究其临床生物学特征.结果 多灶性甲状腺乳头状癌者共86例,占同期甲状腺乳头状癌的23.4%.病灶位于单侧12例,位于双侧74例;颈部淋巴结转移51例(59.3%);病灶中含微小癌者46例(53.5%);合并桥本甲状腺炎者23例(26.7%);周围组织侵犯19例(22.1%);发生远处转移者1例(1.2%);10年生存率95.3%.美国癌症联合会(AJCC)分期与预后相关(x2=63.395,P=0.000).结论 多灶性甲状腺乳头状癌多发生于双侧甲状腺,病灶中含微小癌者及合并桥本甲状腺炎者较多,AJCC分期是多灶性甲状腺乳头状癌的重要预后因素.