甲状腺微小乳头状癌与乳头状非微小癌的临床特点及131I疗效的比较研究

目的研究比较甲状腺微小乳头状癌（PTMC）和除PTMC以外的甲状腺乳头状癌（PTC）的临床特点及131I疗效。方法将369例行甲状腺全切术后拟行131I治疗的PTC患者，按照肿瘤直径分为PTMC组（≤ 1.0 cm）和PTC组（>1.0 cm）。回顾性分析两组患者的临床资料并评估患者的预后，应用SPSS22.0统计软件对结果进行t检验和卡方检验统计分析。结果PTMC组发生淋巴结转移和中央区淋巴结转移的患者比例均低于PTC组，且转移的淋巴结数量更少，差异有统计学意义（χ2=44.23、23.56、42.80，均P<0.05）。与PTC组相比，PTMC组患者大多单叶发病（χ2=45.94，P<0.05）且更少发生包膜侵犯（χ2=11.22，P<0.05），PTMC组有更多的患者合并桥本氏甲状腺炎，两者间的差异有统计学意义（χ2=9.08，P<0.05）。2组患者发生远处转移及合并毒性弥漫性甲状腺肿和结节性甲状腺肿等良性疾病的情况之间的差异无统计学意义（χ2=8.09、2.16、0.21，均P>0.05）。2组共197例患者经过治疗达到临床缓解，其中PTMC组患者治疗后的缓解率（67.53%）高于PTC组（37.71%）。197例达到临床缓解的患者中有102例经首次治疗即达到临床缓解。虽然PTMC组经首次治疗即达到临床缓解的患者多于PTC组，但两组间差异无统计学意义（χ2=3.18，P>0.05）。结论PTMC患者的临床特点不同于乳头状非微小癌患者，经131I治疗后PTMC总体治愈率更高。在临床工作中，建议对PTMC患者制定个体化的治疗方案，从而达到更好的治疗效果及预后。

Clinical characteristics and 131I efficacy of papillary thyroid microcarcinoma and papillary thyroid non-micro carcinoma

ObjectiveTo compare the clinical features and 131I efficacy of papillary thyroid microcarcinoma (PTMC) and papillary thyroid carcinoma (PTC) except for PTMC.MethodsPTC patients who were undergoing 131I treatment after total thyroidectomy were divided into the PTMC group (≤ 1.0 cm) and the papillary non-microcarcinoma group (>1.0 cm) according to tumor diameter. The clinical data of both groups were retrospectively analyzed, and the prognoses of the patients were evaluated. The statistical software SPSS Statistics 22.0 was used to analyze the results via t test and chi-squared (χ2) test.ResultsThe proportion of patients with lymph node and central lymph node metastases in the PTMC group was lower than that in the PTC group. The number of metastatic lymph nodes was less, and the difference was statistically significant (χ2=44.23, 23.56, 42.80, all P<0.05). Most of the patients in the PTMC group demonstrated unilateral morbidity (χ2=45.94, P<0.05) and less extranodal infiltrations (χ2=11.22, P<0.05) compared with the patients in the PTC group. The PTMC group included more patients with Hashimoto's thyroiditis than the PTC group, and the difference between the two groups was statistically significant (χ2=9.08, P<0.05). No significant difference was observed between the two groups with regard to the occurrence of distant metastases and benign diseases, such as diffuse toxic goiter and nodular goiter (χ2=2.16, 0.21, both P>0.05). A total of 197 patients in the two groups achieved clinical remission after treatment. The remission rate in the PTMC group was higher than that in the PTC group. Among the 197 clinical remission cases, 102 patients achieved clinical remission after the first treatment. Although more patients achieved clinical remission in the PTMC group than in the PTC group after the first treatment, no significant difference was noted between the two groups (χ2=3.18, P>0.05).ConclusionsThe clinical features of PTMC patients differ from those of PTC patients. The overall cure rate of PTMC after 131I treatment is higher than that of PTC. The development of individualized treatment plans for PTMC patients is recommended to achieve good therapeutic effect and prognosis.