45岁以上甲状腺乳头状腺癌患者临床治疗的前瞻性研究

目的探讨４５岁以上甲状腺乳头状腺癌的治疗情况及外照射参与治疗的临床价值。方法对１０３例患者随机分为单纯手术组和手术＋放射治疗组，放射治疗应用６０Ｃｏγ线外照射。结果单纯手术和手术＋放射治疗的５，１０年生存率分别为６５．３％，５２．７％和８７．１％，６１．２％；２个组５年生存率，手术后复发率间差异有显著意义（Ｐ＜０．０１，Ｐ＜０．０５）；带瘤生存时间与死亡原因构成间差异有显著意义（Ｐ＜０．０１）；１０年生存率与复发后再切除率间差异无显著意义（Ｐ＞０．０５）；手术后复发率、复发后再切除率、带瘤生存时间分别为３１％，６１％，３．４年和１９％，６３％，６．７年。死亡原因分析前者局部复发占６５％，远地转移占１９％；后者复发分别为２８％，７０％。结论４５岁以上甲状腺乳头状癌属于高危甲状腺乳头状腺癌组，预后不佳，外照射选择应用是有益的。

Treatment of papillary thyroid carcinoma in patients older than 45

Objective To evaluate the efficacy of operation and operation plus irradiation for patients older than 45 with papillary thyroid carcinoma .Methods From October 1986 to October 1992, 106 such patients were randomly divided into two groups: operation (O) group or postoperative radiotherapy (O R) group. Operation was carried out in form of regional radical resection plus functional or conventional neck dissection. Irradiation was given with a telecobalt machine.Results The 5 and 10 year survival rates were 65.3%,52.7% in the O group and 87.1%, 61.2% in the O R group (P<0.05 for the 5 year but not the 10 year survivals). The postoperative recurrence rates, re resection rates and tumor bearing survival periods were 31%, 61%,3.4 years in the O group and 19%, 63%, 6.7 years in the O R group. Causes of death:the local recurrence rate and distant metastasis rate in the O group were 65% and 19% in contrast with 28% and 70% of the O R group.Conclusions The prognosis of papillary thyroid carcinoma patients older than 45 years is poor. Postoperative external radiation is indicated for some specific patients.