甲状腺髓样癌预后因素探讨

目的探讨影响甲状腺髓样癌预后的因素。方法采用统计学单因素及多因素分析方法,研究64例甲状腺髓样癌的预后因素。结果根据Kaplan-Meier累积生存率算法,64例病人5年、10年、15年生存率分别为90.47％、82.47％、74.89％。单因素分析显示:年龄、T分期、颈部淋巴结转移与否、颈部淋巴结清扫术式、是否伴有内分泌症状均明显影响预后。多因素分析中,只有年龄、T分期和是否伴有内分泌症状是影响患者预后的独立因素。结论早期诊断和早期治疗能明显改善甲状腺髓样癌患者的预后。     

甲状腺髓样癌的外科治疗

甲状腺髓样癌在甲状腺癌中不多见，其恶性程度介于分化型与未分化甲状腺癌之间。国内外有关的临床论述很少。本材料回顾性总结了我院１９６７￣１９８７年外科治疗的５１例甲状腺髓样癌，对甲状腺髓样癌的临床特点和治疗原则进行了讨论，对其治疗效果进行了评价，５年和１０年生存率分别为７９．５％和６９．０％，我们认为恰当合理、早期积极的外科治疗能获得很好的生存效果。     

甲状腺髓样癌的外科治疗及预后分析

目的 探讨甲状腺髓样癌的临床特点及治疗方法,并对其预后及影响因素进行分析.方法 对1999年1月至2004年12月中国医学科学院肿瘤医院头颈外科收治的82例甲状腺髓样癌患者的临床资料进行回顾性分析.男性39例,女性43例;年龄16～77岁,中位年龄46岁.采用免疫组织化学方法,分别检测降钙素、嗜铬素、神经元烯醇化酶的表达水平,其中24例标本行降钙素水平检测.行患侧腺叶+峡部切除28例,甲状腺残叶切除24例,甲状腺全切除16例,单纯行颈清扫术及上纵隔淋巴清扫术14例.82例中行气管食管沟清扫68例;行单侧颈清扫53例,双侧颈清扫11例,经颈部上纵隔淋巴清扫13例,胸骨劈开上纵隔淋巴清扫5例.结果 所有病例均经病理证实为甲状腺髓样癌,免疫组织化学检查显示降钙素表达率最高,为95.8%,嗜铬素表达率为88.9%,神经元烯醇化酶表达率为80.0%.颈部淋巴转移率68.8%,Ⅱ区、Ⅲ区、Ⅳ区、Ⅴ区和Ⅵ区淋巴转移率分别为27.3%、47.7%、59.1%、11.4%和52.3%.总的5年生存率为87.8%,总的局部复发率为7.3%,对侧腺叶复发率为5.8%.单因素分析结果表明性别、年龄、TNM分期是影响预后的因素,多因素分析表明远处转移是影响预后的独立危险因素.结论 外科规范手术是甲状腺髓样癌治疗的主要方式;单侧散发型甲状腺髓样癌首次治疗时应行患侧腺叶+峡部切除,术后应密切随访,而对于双侧病灶或家族型者应行甲状腺全切除术.监测降钙素水平在甲状腺髓样癌预后有重要意义.

Abstract：

Objective To study the clinical characteristics, the surgical treatments and the prognostic factors of medullary thyroid carcinoma. Methods Eighty-two cases of medullary thyroid carcinoma undergoing surgeries between January 1999 and December 2004 were reviewed. There were 39 males and 43 females. Age ranged from 16 to 77 years old, with a median of 46 years old. The calcitonin, chronogranin A and neuron-specific enolase were analysed by immunohistochemistry in samples,and calcitonin was detected in 24 cases. Of them, 28 cases underwent lobectomy with isthmectomy, 24 for remained lobe dissection, 16 for total thyroidectomy, and 14 only for neck and upper mediastinal lymph node dissection. Of the 82 cases, 68 cases underwent trachea esophageal ditch dissection, 53 for unilateral neck dissection, 11 for bilateral neck dissection, 13 for upper mediastinal lymph node dissecion through transcervical approach, and 5 for mediastinal lymph node dissecion through inverted T-shaped incision. Results Immunohistochemical examination revealed that the expression rates of calcitonin, chronogranin A and neuron-specific enolase were 95.8%, 88.9% and 80. 0% respectively. Total metastasis rate of neck lymph nodes was 68.8%, and the rates in level Ⅱ, Ⅲ, Ⅳ, Ⅴ andⅥ were 27.3%, 47.7%, 59.1%, 11.4% and 52.3% respectively. The overall five-year survival rate was 87.8%. The recurrent rate of contralateral lobes was 5.8% and local recurrent rate was 7.3% respectively. Univariate analysis showed that gender, age and TNM stage were significant prognostic factors. Multivariate analysis revealed that distant metastasis was an independent prognostic factor. Conclusions Standard radical surgery of the primary and metastatic lesion is key to the treatment of medullary thyroid carcinoma. Lobectomy with isthmectomy should be applied to sporadic medullary thyroid carcinoma, with regular postoperative follow-up, and total thyroidectomy to familial or bilateral medullary thyroid carcinoma. Therefore. detecting the calcitonin is very imoortant for medullary thyroid carcinoma patients' prognosis.     

术前血清降钙素检测在评估甲状腺髓样癌不同区域淋巴结转移中的临床价值

目的 探讨术前血清降钙素(calcitonin,Ctn)在评估甲状腺髓样癌(medullary thyroid carcinoma,MTC)不同区域淋巴结转移中的临床应用价值.方法 回顾性研究2009年1月～2020年1月在浙江省肿瘤医院头颈外科接受初次手术的128例MTC的病例资料,分析术前血清Ctn和不同区域淋巴结...     

VEGF—C在甲状腺髓样癌和甲状腺滤泡状癌中的表达差异

目的：研究甲状腺髓样癌和甲状腺滤泡状癌中血管内皮生长因子C（VEGF-C）的表达差异，探讨VEGF-C与甲状腺髓样癌淋巴道转移的关系。方法：对49例甲状腺髓样癌（MTC）（其中36例伴颈淋巴结转移）；21例甲状腺滤泡状癌（FTC）；21例正常甲状腺组织（NT）用免疫组化ABC法进行VEGF-C在甲状腺髓样癌原发灶中的表达高于甲状腺滤泡状癌，差异有统计学意义。结论：VEGF-C在甲状腺髓样癌中高表达可能与该病的高区域淋巴结转移有关。     

甲状腺髓样癌预后因素探讨

目的 探讨影响甲状腺髓样癌预后的因素。方法 采用统计学单因素及多因素分析方法，研究64例甲状腺髓样癌的预后因素。结果 根据Kaplan-Meier累积生存率算法，64例病人5年、10年、15年生存率分别为90．47％、82．47％、74．89％。单因素分析显示：年龄、T分期、颈部淋巴结转移与否、颈部淋巴结清扫术式、是含伴有内分泌症状均明显影响预后。多因素分析中，只有年龄、T分期和是否伴有内分泌症状是影响患者预后的独立因素。结论 早期诊断和早期治疗能明显改善甲状腺髓样癌患者的预后。     

甲状腺髓样癌治疗进展

甲状腺髓样癌（medullary thyroid carcinoma,MTC）是一种较少见的恶性神经内分泌肿瘤,约占甲状腺癌的5%~10%,起源于分泌降钙素（ct）的甲状腺滤泡旁C细胞。C细胞位于甲状腺叶的中上部,属于神经内分泌细胞,与甲状腺滤泡细胞无关,不摄取碘（I）。现已证实应用131I治疗是无效的,生长抑素类似物也未得到推荐应用,而MTC对传统的放疗和化疗也不甚敏感,所以手术治疗仍是目前MTC的首选根治方式。最近的临床试验研究发现的靶向药物治疗已初显成效,可能会成为MTC新的有效治疗手段。本文主要综述MTC现有的治疗方式及相关进展。     

甲状腺髓样癌生物治疗的研究进展

甲状腺髓样癌（medullary thyroid carcinoma，MTC）起源于甲状腺滤泡旁细胞（又称C细胞），其最早表现为C细胞增生，继而发展为结节样增生和（或）微小的MTC，最后形成MTC，外科手术是其主要治疗手段。对于晚期MTC，单靠手术难以彻底清除肿瘤，同时由于其对放射线不敏感，而且邻近器官如甲状软骨、气管、脊髓等对放射线耐受性低，一般情况下外放射治疗效果差。同时MTC源于滤泡旁细胞，不具备摄碘能力，[第一段]     

遗传型甲状腺髓样癌的精准化治疗

甲状腺髓样癌(medullary thyroid carcinoma,MTC)是来源于神经嵴的神经内分泌肿瘤,约占所有甲状腺癌的3％ ～5％,恶性程度在甲状腺癌中较高,预后相对较差.其临床表现以腹泻(≥3次/d)、脸部潮红、瘙痒症为主(与滤泡旁细胞分泌的降钙素或降钙素基因相关肽有关).根据疾病的遗传特征,甲状腺髓样癌可分为散发型(sporadic MTC,约占70％ ～ 80％)和遗传型(hereditary MTC,约占25％).     

甲状腺髓样癌的超声鉴别诊断及临床意义

目的　总结甲状腺髓样癌的超声特征。方法  回顾性分析经病理证实的40例甲状腺髓样癌（42个结节）的超声声像图特征,以甲状腺乳头状癌（40例,44个结 节）和良性结节（结节性甲状腺肿,44例,48个结节）做对照。结果　甲状腺髓样癌超声主要表现为低或极低回声（92.86%）,实性（90.48%）,位于中上极（76.19%）,呈圆形或卵圆形（61.90%）,边界清晰（59.52%）,微小钙化多见（70.00%）;与甲状腺乳头状癌相比,甲状腺髓样癌多呈圆形或椭圆形,边界清晰,回声均匀,内部血流丰富,易发生淋巴结转移。结论　甲状腺髓样癌超声表现不同于乳头状癌,呈圆形或椭圆形,边界清晰,位于中上极,容易与甲状腺 良性结节相混淆。     

Biochemical results of reoperations for medullary thyroid carcinoma

BACKGROUND: The calcitonin is a sensitive marker for the presence of medullary thyroid carcinoma, therefore, invaluable in the follow-up of patients who have been treated. Biological cure of the medullary thyroid cancer refers to a basal plasma calcitonin of less than 10 ng/l without elevation after stimulation tests. STUDY DESIGN: Biochemical results of reoperations for medullary thyroid carcinoma were reviewed from a series of 35 patients who underwent 47 reinterventions. RESULTS: The indications for reoperation were: hypercalcitoninemia with clinical evidence of the disease (32 cases); hypercalcitoninemia after an inadequate primary surgery (6 cases); persistent hypercalcitoninemia with biochemical evidence of the disease (2 cases); liver metastases (1 case); and palliative surgery for relieving symptoms (1 case). Only three patients of the series had biochemical cure after reoperation (patients with an inadequate primary surgery). CONCLUSIONS: This study is consistent with the bibliographic reviews supporting that the cervical reoperation, eventually mediastinal, for residual hypercalcitoninemia after primary surgical treatment is indicated when the initial intervention did not follow the French Calcitonin Tumour Study Group (GETC) recommendations or when a specific lesion is evidenced by imaging studies without systemic dissemination.     

Diagnostic and surgical dilemmas in hereditary medullary thyroid carcinoma

Medullary thyroid carcinoma (MTC) is a rare malignancy arising from the parafollicular C cells within the thyroid gland. The majority of cases are sporadic, but at least 30% are hereditary in nature. Inherited forms of MTC occur as familial MTC or as a manifestation of multiple endocrine neoplasia type 2. Early diagnosis and aggressive surgical management, including prophylactic thyroidectomy, improve the prognosis of patients with hereditary MTC. Several issues regarding the diagnosis and treatment of MTC remain controversial. Genetic penetrance and virulence are variable. We present an index case of familial MTC to illustrate common difficulties in the initial diagnosis and dilemmas in the surgical approach, followed by a review of current literature relevant to the management of hereditary MTC. Laryngoscope, 2009     

Prognostic variables and calcitonin in medullary thyroid cancer

OBJECTIVES/HYPOTHESIS: Medullary thyroid cancer (MTC) is a nonepithelial, neuroendocrine tumor with a more aggressive clinical behavior than differentiated thyroid cancer. The purpose of the study was to review a single institution's experience with MCT since 1969. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective review of 30 patients treated for MTC at a tertiary care referral center between 1969 and 2000. There were 17 female and 13 male patients, median age at presentation was 38 years, and median follow-up for survivors was 12.4 years. RESULTS: Seventy percent of patients had sporadic MTC, 6.7% had familial MTC, 16.7% had multiple endocrine neoplasia syndrome type IIA, and 6.7% had multiple endocrine neoplasia syndrome type IIB. The cumulative overall survival rates at 5, 10, and 20 years were 97%, 88%, and 84%, respectively; disease-free survival rates were 97%, 74%, and 29%, respectively. Advanced tumor stage (P = .014) and multiple endocrine neoplasia syndrome type IIB predicted decreased disease-specific survival. Variables affecting disease-free survival were post-thyroidectomy calcitonin level (P = .001), vascular invasion (P = .005), perineural invasion (P = .010), extrathyroidal extension (P < .001), and the presence of nodal metastases (P = .001). Locoregional control rates were 83% at 5 years and 70% at 10 years. Vascular invasion (P = .004), extrathyroidal extension (P = .008), and post-thyroidectomy basal calcitonin level (P = .003) predicted locoregional failure. Many patients in the series experienced prolonged survival despite elevated calcitonin levels. CONCLUSION: Long-term disease-free survival is uncommon in MTC, but the study data indicate that the majority of patients with MTC live for prolonged periods, despite biochemical evidence of persistent disease. Adverse pathological features such as extrathyroidal extension and vascular and perineural invasion were predictors of disease recurrence. The use of serum markers in the follow-up of patients with MTC must be interpreted within the clinical context.     

Significance of neck dissection for the treatment of clinically-evident medullary thyroid carcinomas: A systematic review

Objective

The survival benefit of prophylactic lateral neck dissection in medullary thyroid carcinomas remains unclear; thus, recent clinical guidelines have deferred the recommendation of lateral neck dissection. This review is to assess the role of lateral neck dissection in treatment of clinically overt medullary thyroid carcinoma.

STAT3蛋白活化与甲状腺乳头状癌上皮间质转化的关系及意义

目的：探讨STAT3、p-STAT3蛋白在甲状腺乳头状癌（PTC）中的表达及其与上皮间质转化的关系及意义。方法：采用免疫组织化学方法检测56例PTC组织中STAT3、p-STAT3蛋白及上皮标志物E—cadherin和间质标志物Vimentin蛋白的表达,分析其与PTC临床病理特征间的关系及相互之间的相关性。结果：PTC组织中STAT3、p—STAT3蛋白的阳性表达率为78．6％和83．9％,明显高于癌旁甲状腺组织中的阳性表达率33．3％和20．8％（P〈0．01）。PTC组织中E-cadherin的阳性表达率为37．5％,明显低于癌旁甲状腺组织中的阳性表达率91．7％（P〈0．01）,PTC组织中Vimentin蛋白的阳性表达率为85．7％,明显高于癌旁甲状腺组织中的阳性表达率8．3％（P〈0．01）。STAT3、p-STAT3、E—cadherin、Vimentin蛋白的表达与性别、年龄无明显相关性（P〉0．05）,而均与PTC淋巴结转移、临床分期明显相关（P〈0．05）。STAT3、p-STAT3蛋白的表达和E—cadherin蛋白的表达呈负相关（r=-0．494,r=-0．364,均P〈0．01）,STAT3、p—STAT3蛋白的表达与Vimenin蛋白的表达呈正相关（r=0．533,P=0．000;r=0．377,均P〈0．01）。结论：PTC组织中存在STAT3蛋白活化及EMT,且与PTC淋巴结转移密切相关;STAT3通路激活可能通过介导PTC细胞EMT促进PTC侵袭转移。     

甲状腺乳头状癌钙化的临床意义

目的:探讨钙化在甲状腺乳头状癌中表达的意义.方法:回顾性分析甲状腺乳头状癌患者88例,探讨甲状腺乳头状癌内钙化灶与患者年龄、TSH水平、癌灶大小和肿瘤TNM分期有无相关性.结果:钙化与患者年龄、TNM分期和TSH水平没有明显相关性,而与肿瘤大小呈正相关,肿瘤直径越大,发生钙化的可能性越高(P<0.05).统计发现TSH水平与肿瘤大小也没有明显相关性.结论:钙化尤其是微钙化对提示甲状腺乳头状癌有一定的指导意义,而钙化的发生与肿瘤大小成正比,肿瘤越大,发生钙化的可能性越高.