单中心2038例甲状腺癌20年随访及危险因素分析  

Risk factor analysis of 20-year follow-up of 2038 cases of thyroid cancer: a single center study

作　　者：贺青卿 于芳 范子义 庄大勇 郑鲁明 朱见 胡金枝 刘燕 李小磊 曹宪娇 He Qingqing;Yu Fang;Fan Ziyi;Zhuang Dayong;Zheng Luming;Zhu Jian;Hu Jinzhi;Liu Yan;Li Xiaolei;Cao Xianjiao(Department of Thyroid and Breast Surgery,the 960th Hospital of the PLA Joint Logistic Support Force,Jinan 250031,China)

机构地区：[1]解放军联勤保障部队第九六〇医院甲状腺乳腺外科,济南250031

出　　处：《中华内分泌外科杂志》2022年第1期18-22,共5页Chinese Journal of Endocrine Surgery

基　　金：中国博士后科学基金第三批特别资助项目(201003759);国家重点研发计划(2019YFC0119205);原济南军区总医院院长基金资助项目(2016ZD02、2018ZX01)。

摘　　要：目的全球范围内甲状腺癌发病率逐渐升高,探讨我国真实世界中甲状腺癌长时间存活及危险因素分析。方法回顾性分析解放军联勤保障部队第九六〇医院甲状腺乳腺外科1998年4月至2018年12月初次手术的甲状腺癌患者临床资料,包括患者性别、年龄、手术记录,病理及后续住院记录并进行随访,按照预后分为无病生存组和复发转移死亡组,进行单因素分析及多因素回归分析影响甲状腺癌预后的危险因素,探讨我国甲状腺癌患者的临床特征和预后危险因素。采用统计软件SPSS 22.0进行分析。结果共收集2038例病例资料,最长随访时间超过20年,共纳入研究1876例病例,失访162例,失访率7.9%。其中存活1858例,总生存率为99.04%,死亡18例,总死亡率为0.96%。根据预后情况分为2组,无病生存组1808例,复发转移死亡组68例。研究发现两组之间在患者年龄[(45.40±11.02)岁,(51.53±15.20)岁,P<0.001)]、性别中男性比例(32.854%,48.529%,P=0.001)、癌灶突破甲状腺被膜(20.077%,33.823%,P=0.006)、中央区淋巴结转移(48.834%,70.588%,P=0.001)和侧区淋巴结转移(31.084%,55.882%,P<0.001)方面差异有统计学意义,在肿瘤的多灶性方面差别无统计学意义。结论甲状腺癌颈部淋巴结转移率高,预后较好;根据我国甲状腺癌患者的特征,临床上应走符合中国国情的甲状腺癌诊治之路,坚持早期诊断和规范性治疗。Objective To discuss the long-term survival and risk factors of thyroid cancer in the real world in China.Methods The clinical data of thyroid cancer patients who underwent initial surgery from Apr.1998 to Dec.2018 were retrospectively analyzed,including patients’sex,age,surgical records,pathology,hospitalization records and follow-up.According to the prognosis,the patients were divided into disease-free survival group and recurrence/metastasis/death group.Univariate analysis and multivariate regression analysis were conducted to analyze the risk factors affecting the prognosis of thyroid cancer.The clinical features and prognostic risk factors of thyroid cancer patients were investigated.Results A total of 2038 cases were collected,and the longest follow-up time was more than 20 years.A total of 1876 cases were included in the study,162 cases were lost,and the rate of follow-up was 7.9%.Among them,1858 survived,the overall survival rate was 99.04%;18 died,and the overall mortality rate was 0.96%.According to the prognosis of thyroid cancer,the patients were divided into 2 groups,including 1808 cases in the disease-free survival group and 68 cases in the relapsed-metastatic-death group.The study found that there were statistical differences between the two groups in terms of patients’age[(45.40±11.016)vs(51.53±15.199,P=0.000),the male ratio(32.854%,48.529%,P=0.001),whether tumor breaks through capsule(20.077%,33.823%,P=0.006),central lymph node metastasis(48.834%,70.588%,P=0.001)and lateral lymph node metastasis(31.084%,55.882%,P=0.000),and there was no difference between the number of tumor lesions.Conclusion Thyroid cancer has a good prognosis,but according to the characteristics of patients with thyroid cancer in my country,it should still be treated early in the clinic,and the standardization and thoroughness of surgery should be adhered to during the treatment.

关 键 词：甲状腺癌 随访 危险因素 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]