适合手术的甲状腺微小乳头状癌患者临床病理特征  

Clinical pathological characteristics of resectable papillary thyroid microcarcinoma

作　　者：石臣磊[1] 郭勇[2] 吕一辰 南丁阿比雅思 高文超[1] 石铁锋[1] 秦华东[1] 刘绍严[4] 

机构地区：[1]哈尔滨医科大学附属第二医院普外四科,150086 [2]山东省菏泽市立医院乳腺甲状腺外科,274000 [3]哈尔滨医科大学附属第三医院病理科,150086 [4]国家癌症中心中国医学科学院北京协和医学院肿瘤医院头颈外科,100021

出　　处：《中华肿瘤杂志》2017年第5期361-366,共6页Chinese Journal of Oncology

基　　金：黑龙江省自然科学基金（D201228）;黑龙江省教育厅科学技术研究项目（12541490）

摘　　要：目的探讨甲状腺微小乳头状癌（PTMC）与大甲状腺乳头状癌（PTC）在预后影响因素和疾病复发率间的差异，分析适合手术的PTMC患者临床病理特征。 方法回顾性分析2011年10月至2013年10月间收治的251例PTC患者的临床病理资料、鼠类肉瘤滤过性毒菌致癌同源体B1（BRAF）V600E基因突变和色素上皮衍生因子（PEDF）的表达情况，以及术后随访结果。251例PTC患者中，PTMC 169例，大PTC（肿瘤直径〉1 cm） 82例。结果PTMC和大PTC患者的BRAF V600E突变率分别为65.1%（110/169）和78.0%（64/82），差异有统计学意义（P〈0.05）。PTMC患者的腺外侵袭率和淋巴结转移率分别为7.1%（12/169）和27.2%（46/169），大PTC患者的腺外侵袭率和淋巴结转移率分别为15.9%（13/82）和46.3%（38/82），差异有统计学意义（P〈0.01）。PTMC和大PTC的随访时间分别为（45.6±3.6）个月和（45.0±3.4）个月（P〉0.05）。PTMC和大PTC患者在性别、年龄、是否合并桥本氏甲状腺炎、PEDF表达和复发率间的差异无统计学意义（P〉0.05）。合并高危因素PTMC患者的复发率为1.6%（2/122），大PTC患者的复发率为4.9%（4/82）。结论腺外侵及、淋巴结转移和BRAF V600E基因突变是PTMC复发的高危因素，合并高危因素的PTMC应考虑采取与大PTC相同的治疗策略。对于出现BRAF V600E基因突变的PTMC，更建议早期手术治疗。对于具有BRAF V600E基因突变的、高细胞亚型的PTMC患者，初次手术建议行全甲状腺切除，以降低潜在的复发风险。ObjectiveTo investigate the difference of prognostic factors and recurrence rates between papillary thyroid microcarcinoma （PTMC） and lager papillary thyroid carcinoma （PTC） and analyze the clinical pathological characteristics of PTMC suitable for surgery.MethodsA retrospective analysis on the clinicopathological features, expression level of of v-raf murine sarcoma viral oncogene homolog B1 （BRAF） V600E gene mutation and pigment epithelium-derived factor （PEDF）, and postoperative follow-up results of the 251 PTC patients who underwent surgical treatment from October 2011 to October 2013, including 169 cases with PTMC and 82 with lager PTC （Tumor diameter〉1 cm）.ResultsThe BRAF V600E mutation rates of PTMC and lager PTC patients are 65.1%（110/169）and 78.0% （64/82） respectively, and the difference is statistically significant （P〈0.05）. The prevalence of extrathyroidal invasion （7.1%） and lymph nodes metastasis （27.2%） of the patients with PTMC were significantly lower than those of the patients with larger PTC （15.9% and 46.3%, respectively）（P〈0.01）. The follow-up durations for PTMC and lager PTC were （45.6±3.6） months and （45.0±3.4） months, respectively （P〉0.05）. There was no statistic significance for the difference in age, gender, coexistent hashimoto′s thyroiditis, PEDF expression, and recurrence rate between the patients with PTMC and with larger PTC （P〉0.05）. The recurrence rate of the patients who have the high risk factors of PTMC was 1.6%（2/122）and that of larger PTC was 4.9% （4/82）.ConclusionsExtrathyroid invasion, lymph node metastases and BRAF V600E gene mutation are the high risk factors of recurrent PTMC. The same treatment strategy should be considered for PTMC with coexistent high risk factors as that for larger PTC. For PTMC with BRAF V600E gene mutation, earlier surgical treatment is suggested. PTMC patients with BRAF V600E gene mutation and high cell subtype are suggested to undergo total thyroidectomy for the

关 键 词：甲状腺肿瘤 鼠类肉瘤滤过性毒菌致癌同源体B1 V600E 色素上皮衍生因子 预后 

分 类 号：R736.1[医药卫生—肿瘤]