甲状腺乳头状癌组织学变型与临床预后的关系  

Relationship between histological variants and clinical prognosis in papillary thyroid carcinoma

作　　者：王立宏[1] 王雯[1] 祭美菊[2] 

机构地区：[1]商洛市中心医院病理科,陕西商洛726000 [2]西安交通大学医学院第一附属医院内分泌科,陕西西安710061

出　　处：《西部医学》2016年第7期939-942,共4页Medical Journal of West China

基　　金：国家自然科学基金(30973372)

摘　　要：目的探讨甲状腺乳头状癌组织学变型与临床预后的关系。方法回顾性分析2008年7月~2010年7月医院收治的340例甲状腺乳头状癌（PTC）患者临床资料,收集患者临床样本,按照WHO制定的组织分类标准分为：典型乳头状癌、滤泡型、嗜酸性细胞型、乳头状微癌、弥漫硬化型、高细胞型、实体型、透明细胞型8种类型。分析各组织变型间一般资料、预后及远期生存率的关系。结果各变型PTC患者性别、年龄等一般资料比较无差异（P〉0.05）。其中弥漫硬化型34例和高细胞型50例中的颈淋巴结转移率和侵出腺外率分别为82.4%、82.1%和35.3%,39.3%显著高于典型乳头状癌、滤泡型、嗜酸性细胞型、乳头状微癌、实体型和透明细胞型;5年生存率分别为76.5%和71.4%显著低于典型乳头状癌的97.5%、滤泡型的93.8%、嗜酸性细胞型的93.3%、乳头状微癌的100.0%、实体型的97.4%和透明细胞型的95.7%（P〈0.05）,其余各变型颈淋巴结转移率、侵出腺外率、远处转移率和5年生存率比较差异均无统计学意义（P〉0.05）。结论 PTC不同组织学变型其临床特征存在一定差异,其中弥漫硬化型、高细胞型的预后较差;临床需要根据不同组织变型危险度进行分层分析,选择合适的治疗方案,以提高患者预后。Objective To explore the relationship between histological variants and clinical prognosis in papillary thyroid carcinoma.Methods Clinical data of 170 papillary thyroid carcinomas patients were retrospectively analyzed.The patients were divided into typical papillary carcinoma,follicular type,eosinophilic cell type,papillary microcarcinoma,diffuse sclerosing variant,tall cell variant,solid type and clear cell carcinoma.The relationship between general information,prognosis and long-term survival rate and tissue types was analyzed.Results There was no significant difference in gender and age of PTC patients（P0.05）.The cervical lymph node metastasis and invasion gland rates of diffuse sclerosis and tall cell type were significantly higher than those of the typical papillary carcinoma,follicular,eosinophilic cell type and papillary microcarcinoma,solid type and clear cell type.5years survival rate of diffuse sclerosis and tall cell typewas significantly lower than that of the typical papillary carcinoma,follicular,eosinophilic cell type,papillary microcarcinoma,solid type and clear cell type（P0.05）.There were no significant differences in the cervical lymph node metastasis rate,the rate of invasion,the distant metastasis rate and the 5year survival rate in the rest of the variant（P0.05）.Conclusion clinical features of PTC different histological variants are different.The diffuse sclerosis type and tall cell type have a poor prognosis.

关 键 词：甲状腺乳头状癌 组织变型、预后 免疫组织化学染色 生物学特征 

分 类 号：R736.1[医药卫生—肿瘤]