复发性甲状腺乳头状癌109例临床分析  

Clinical analysis of 109 cases of recurrent papillary thyroid carcinoma

作　　者：赵翠[1] 运新伟[1] 高健[1] 高明[1] 

机构地区：[1]天津医科大学附属肿瘤医院甲状腺颈部肿瘤科,天津市肿瘤防治重点实验室,天津300060

出　　处：《肿瘤》2013年第8期728-733,共6页Tumor

摘　　要：目的:探讨甲状腺乳头状癌复发相关因素及复发部位。方法:回顾性分析本院2008年1月—2012年1月的109例复发性甲状腺乳头状癌患者的临床和随访资料,并选择同期非复发性甲状腺乳头状癌患者350例作为对照。进行复发相关因素的单因素和多因素分析。结果:单因素分析结果显示,初次手术方式、TNM分期和病理亚型与复发显著相关(P<0.05),而肿瘤大小、年龄、性别、合并桥本氏甲状腺炎、淋巴结转移、腺外侵犯、病灶数和促甲状腺激素水平均与复发无关(P>0.05)。多因素分析结果显示,初次手术方式和病理亚型是影响复发的相关因素(P<0.05)。109例复发性甲状腺乳头状癌患者中,20例(18.3%)为肿瘤残留。复发部位包括淋巴结Ⅱ区34例、Ⅲ区54例、Ⅳ区58例、Ⅴ区12例、Ⅵ区68例,软组织Ⅱ区5例、Ⅲ区6例、Ⅳ区9例、Ⅴ区0例、Ⅵ区8例,颈前肌2例、喉外肌1例、胸锁乳突肌0例,甲状旁腺1例,喉返神经3例,侵犯食管1例,侵犯气管2例,肺转移5例,肝转移合并骨转移1例。结论:对于可能复发的甲状腺乳头状癌患者,初次治疗后应加强随访,定期复查时可重点检查易复发部位;一旦发现复发,应采取较为积极和规范的治疗方式。Objective： To explore the factors related to recurrence of PTC （papillary thyroid carcinoma） and the sites of recurrence,in order to seek for the proper treatment of these cases.Methods： The clinical and follow-up data of 109 cases of recurrent PTC in Tianjin Medical University Cancer Hospital from January 2008 to January 2012 were analyzed retrospectively,and 350 cases of PTC without recurrence in the same period were also collected as the controls.The univariate and multivariate analyses were performed to find out the recurrence-related factors.Results： The univariate analysis revealed that initial operative approach,TNM stage and pathological subtype were associated with recurrence （P〈0.05）,but the tumor size,age,gender,coexisted Hashimoto’s disease,lymphatic metastasis,extra thyroidal invasion,multifocality and thyroid stimulating hormone level were not associated with recurrence （P〈0.05）.Multivariate analysis indicated that initial operative approach and pathological subtype were the dependent factors for recurrence （P〈0.05）.Of 109 cases,20 （18.3%） were confirmed as residual carcinoma by pathology.The involved sites of recurrence included regions of lymph nodes （34 in group Ⅱ,54 in group Ⅲ,58 in group Ⅳ,12 in group Ⅴ,68 in group Ⅵ）,soft tissues （5 in group Ⅱ,6 in group Ⅲ,9 in group Ⅳ,0 in group Ⅴ,8 in group Ⅵ）,muscles （2 in anterior cervical muscle,1 in extrinsic laryngeal muscle,and 0 in sternocleidomastoid）,parathyroid （n = 1）,laryngeal recurrent nerve （n = 3）,esophagus （n = 1） and trachea （n = 2）.Five cases developed pulmonary metastasis,and 1 case developed liver and bone metastases.Conclusion： For the PTC patients who have the possibility of recurrence,the reinforced postoperative follow-up should be required.Furthermore,regular reexamination is also needed for possible recurrent regions.Once the recurrence occurres,active and standardized therapy is suggested for PTC.

关 键 词：甲状腺肿瘤 甲状腺乳头状癌 复发 

分 类 号：R736.1[医药卫生—肿瘤]