分化型甲状腺癌危险组的划分及其意义

目的探讨分化型甲状腺癌各危险组的划分及其与治疗和预后的关系。方法回顾分析514例分化型甲状腺癌患者,借助于单和多变量分析确定有意义的预后因素,再根据这些因素将患者分成低、中和高三个危险组。应用Kaplan-Meier方法计算出各危险组患者以及各预后因素所表现出来的生存曲线。结果长期生存率在低、中和高危组分别为98．3%、83．6%和42．9%。在低危组和部分选择出来的中危组患者仅做腺叶及峡部切除,而在高危组及部分选择的中危组患者则做较广范围切除,术后再辅以内或外放射治疗。结论将分化型甲状腺癌分成三个危险组并借以制订治疗措施和判断预后是十分正确的。

Classification of the three risk groups in differentiated thyroid cancer and its significance in management and prognosis

OBJECTIVE To study the classification of the three risk groups in differentiated thyroid cancer and its significance in management and prognosis. METHODS In a retrospective review of 514 patients with differentiated thyroid carcinoma,various prognostic factors were studied with univariate and multivariate analysis.The significant prognostic factors were studied in detail and,based on these prognostic factors,the patients were divided into low,moderate and high risk groups.The survival rate curves were plotted by Kaplan-Meier method.RESULTS The long term survival rate in low,moderate and high risk groups were 98.3%,83.6%,and 42.9% respectively.In the low risk group and selected patients in the moderate risk group,only lobectomy with isthmus resection appeared satisfactory with excellent long-term outcome.In the high risk group and selected patients in the moderate risk group,aggressive surgery including removal of all gross disease and extrathyroidal extension with post- operative radiotherapy was performed.CONCLUSION It is reasonable to classify the differentiated thyroid cancer into three groups and to make the decision of the treatment,judge the prognosis based on the classification.