多灶性甲状腺乳头状癌168例临床研究  

Multifocal papillary thyroid carcinoma： clinical analysis of 168 cases

作　　者：林益凯[1] 盛建明[1] 赵文和[1] 王伟斌[1] 俞雄飞[1] 滕理送[1] 马志敏[1] 

机构地区：[1]浙江大学医学院附属第一医院肿瘤外科,杭州310003

出　　处：《中华外科杂志》2009年第6期450-453,共4页Chinese Journal of Surgery

摘　　要：目的探讨多灶性甲状腺乳头状癌的临床特征及外科治疗方式。方法回顾分析1997年1月至2006年12月间首次手术并经病理证实的甲状腺乳头状癌648例，其中多灶病例168例。比较单灶组与多灶组及多灶组问的临床病理学差异。结果本组多灶性甲状腺乳头状癌发生率为25．9％，其中双侧甲状腺多发病灶者117例（69．6％）。多灶组在男性（P=0．004）、甲状腺癌家族史（P=0．031）、体检（P=0．000）及B超发现颈部淋巴结肿大（P=0．001）、B超提示结节钙化灶（P=0．001）、颈淋巴结转移（P=0．008）及甲状腺外侵犯（P=0．001）发生率等方面明显高于单灶患者。而单灶组在伴有良性甲状腺疾病的比例明显高于多灶组（P=0．000）。多灶性甲状腺乳头状癌病例中，男性、体检颈部淋巴结大、肿瘤位于双侧及病灶数目≥3个倾向于肿瘤较大、颈部淋巴结转移或甲状腺外侵犯的比例较高；而伴有良性甲状腺疾病的多灶性癌恶性度相对较低。本组164例（97．6％）获得随访；平均随访46．1个月（2～127个月）。随访中5例死亡，1例胸部X线片怀疑肺部转移，16个月健在；6例于术后3～41个月因颈淋巴结复发再次手术；2例于术后13个月、24个月残余腺体肿瘤复发手术切除。总的1、2、5、10年生存期分别为98．2％、97．4％、96．5％、96．5％。美国癌症联合会（AJCC）分期与预后相关（x。=168．832，P=0．000）。结论多发病灶是甲状腺乳头状癌的临床特征之一，其生物学恶性度更高。甲状腺全切＋中央区淋巴结清扫可视为标准手术方式，在外侧区出现淋巴结肿大时需加行侧方清扫。AJCC分期仍是多灶性甲状腺乳头状癌的重要预后因素。Objective To investigate the clinical features and treatment of multifocal papillary thyroid carcinoma （PTC）. Methods A retrospective survey was carried out in 648 patients with PTC who underwent surgery from January 1997 to December 2006. One hundred and sixty-eight cases of the patients presented with multiple tumor masses （≥ 2 ）. The risk factors, including sex of the patients, age at diagnosis, family history of thyroid tumor, multiplicity and bilaterality of tumor, extra-thyroidal extension, lymph node involvement and other were analyzed between solitary PTC and multifocal PTC group. Results The mean age of the patients was 42 years（ range, 14-78 years） , included 49 male and 119 female. Tumor foci were found in both thyroid lobes in 117 cases（69.6% ）. Patients with multifocal PTC were characterized by a higher ratio of male （ P = 0. 004 ）, family history of thyroid tumor （ P = 0. 031 ）, neck lymph node metastasis （P = 0. 008 ） and extra-thyroidal extension （P = 0. 001 ）. However, solitary PTC tended to be with a higher rate of benign goiters in pathologic examination. In multifocal PTC group, male, neck lymphadenectasis, ≥3 tumor masses or bilaterality of tumor tended to presented with larger tumor, more neck lymph node metastasis and extra-thyroidal extension; And a less malignant tumor in the cases detected with benign goiters in histological examination. By the end of 2007, 164 cases （97. 6% ） completed follow- up with a mean period of 46. 1 months （range, 2-127 months）, 5 died in the meantime. One patient has been followed-up for 16 months for suspect of lung metastases by chest X-ray. Recurrence occurred in 8 patients and were re-resected, 2 in remnant thyroid and 6 in neck lymph nodes. The overall 1-, 2-, 5-, and 10-year survival rate was 98. 2% , 97.4%, 96. 5% and 96. 5% , respectively. American Joint Committee on Cancer （AJCC） stage was associated with prognosis significantly （X2 = 168. 832, P = 0. 000 ）. Conclusions Multifocus is one of the clinic

关 键 词：甲状腺肿瘤 甲状腺切除术 颈淋巴结清扫术 乳头状癌 

分 类 号：R686[医药卫生—骨科学]