119例甲状腺滤泡状癌患者的治疗及预后因素分析  

Management and prognostic factors for 119 patients with follicular thyroid carcinoma

作　　者：刘文胜[1] 张国芬 徐震纲[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所头颈外科,100021 [2]清华大学第一附属医院普外科

出　　处：《中华肿瘤杂志》2013年第10期778-782,共5页Chinese Journal of Oncology

摘　　要：目的 探讨甲状腺滤泡状癌的最佳治疗方案以及影响患者预后的相关因素.方法 回顾性分析119例甲状腺滤泡状癌患者的临床资料.采用Kaplan-Meier法计算生存率,影响患者预后的单因素分析采用Log rank检验,多因素分析采用Cox回归模型.结果 119例甲状腺滤泡状癌患者的5和10年总生存率分别为81.1％和66.7％,就诊时患者的远处转移率为16.0％,3、5、10年累积远处转移率分别为27.4％、29.6％和35.9％.术后行131Ⅰ治疗16例,治疗效果满意9例.单因素分析结果显示,年龄、肿瘤直径、肿瘤生长方式、临床分期和脉管瘤栓均与患者的远处转移情况有关（均P＜0.05）；年龄、肿瘤直径、肿瘤生长方式、pN分期、M分期、临床分期、有无脉管瘤栓和肿瘤切除程度均与患者预后有关（均P ＜0.05）.Cox回归分析结果显示,年龄是影响患者远处转移的独立危险因素（P＜0.05）；肿瘤直径、有无脉管瘤栓、肿瘤切除程度及有无远处转移是影响患者生存的独立因素（均P＜0.05）.结论 甲状腺滤泡状癌常呈弥漫性生长,伴有脉管瘤栓,预后相对不良.手术彻底切除是提高局部控制率和改善患者预后的关键.对于年龄≥45岁患者,建议行全甲状腺切除联合131Ⅰ治疗等.Objective To explore the optimal management and analyze the prognostic factors for follicular thyroid carcinoma. Methods The clinicopathological data of 119 patients with well-differentiated follicular thyroid carcinoma treated in our hospital from 1970 to 2008 were retrospectively reviewed. The overall survival （OS） rate was estimated by Kaplan-Meier method. Log rank and Cox regression analyses were used to identify the prognostic factors. Results The 5- and 10-year OS rates were 81. 1% and 66.7%, respectively. The 3- , 5- and 10-year cumulative distant metastasis rates were 27.4% ,29.6% and 35.9%, respectively. The age of ≥45 years old was one of the most important factors affecting survival rate （ P 〈 0.05 ） and an independent factor for distant matastasis. Conclusions Follicular thyroid carcinoma has some special features such as diffuse growth and vascular tumors thrombosis and with a relatively poor prognosis. The key measure to improve local control and prognosis is radical resection. Some aggressive management such as total thyroideetomy combined with 131I therapy and regular follow-up should be performed to improve the survival rate and to control postoperative distant metastasis for patients ≥45 years old.

关 键 词：甲状腺肿瘤 癌 乳头状 滤泡 治疗 预后 

分 类 号：R736.1[医药卫生—肿瘤]