局部晚期T4a甲状腺乳头状癌R0切除后复发危险因素及生存分析  

Risk factors for recurrence and survival analysis in locally advanced T4a papillary thyroid carcinoma after R0 resection

作　　者：陈佳铭 房居高[1] 钟琦[1] 林岩松[2] 侯丽珍[1] 马泓智[1] 冯凌[1] 何时知 时倩[1] 廉猛[1] 王茹[1] 沈茜茜 Chen Jiaming;Fang Jugao;Zhong Qi;Lin Yansong;Hou Lizhen;Ma Hongzhi;Feng Ling;He Shizhi;Shi Qian;Lian Meng;Wang Ru;Shen Xixi(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院核医学科,北京100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第9期1044-1051,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家重点研发计划(2020YFB1312805);首都卫生发展科研专项(2022-1-2051);北京市医院管理局“青苗”计划专项(QMS20210206)。

摘　　要：目的探讨T4a甲状腺乳头状癌(PTC)患者手术治疗效果及术后复发的危险因素。方法回顾性分析首都医科大学附属北京同仁医院2006年1月至2019年12月经治的185例局部晚期T4a PTC资料,女性127例,男性58例,年龄18~80岁,其中年龄≥55岁患者74例。甲状腺肿瘤分期Ⅰ期111例(T4aN0M026例,T4aN1aM035例,T4aN1bM050例),Ⅲ期74例(T4aN0M029例,T4aN1aM019例,T4aN1bM026例)。采用Kaplan-Meier法计算复发率和总生存率,对临床资料进行单因素及多因素Cox回归分析。结果185例局部晚期T4a PTC病变,累及喉返神经150例次、气管61例次、食管30例次、喉结构10例次,均完成R0切除。术后随访24~144个月,平均68.29个月;185例患者中共有18例复发或转移,9例因复发或转移死亡。5年总生存率为95.21%,10年总生存率为93.10%;5年无瘤生存率为89.65%,10年无瘤生存率为86.85%。单因素分析显示发病年龄、肿瘤大小、术前喉返神经麻痹、食管受侵、喉结构受累或气管受累Ⅱ-Ⅳ期以及颈侧区淋巴结转移是T4a PTC术后复发的危险因素(P值均<0.05)。多因素分析显示术前喉返神经麻痹(OR=3.27,95%CI:1.11~9.61,P=0.032)、颈侧区淋巴结转移(OR=4.71,95%CI:1.19~18.71,P=0.027)是T4a PTC复发的独立危险因素。生存分析显示T4a PTC患者中仅累及喉返神经或气管外膜者无复发生存率优于侵入气管者(P值均<0.05)。结论T4a PTC患者行R0切除仍能取得良好疗效,术前喉返神经麻痹以及颈侧区淋巴结转移是T4a PTC患者术后复发的独立危险因素。Objective To investigate the treatment outcomes and risk factors of postoperative recurrence in T4a papillary thyroid carcinoma(PTC).Methods A total of 185 patients with locally advanced T4a PTC treated in Beijing Tongren Hospital,Capital Medical University from January 2006 to December 2019 were retrospectively analyzed,including 127 females and 58 males,aged between 18 and 80 years,with 74 patients aged over 55 years.According to AJCC thyroid tumor staging,111 cases were stage I(T4aN0M026 cases,T4aN1aM035 cases,and T4aN1bM050 cases)and 74 cases were stageⅢ(T4aN0M029 cases,T4aN1aM019 cases,and T4aN1bM026 cases).Kaplan-Meier method was used to calculate the overall survival and the recurrence-free rate,and univariate and multivariate logistic regression analyses on the clinical data were performed.Results Recurrent laryngeal nerve invasion was observed in 150 cases,trachea invasion in 61 cases,esophagus invasion in 30 cases,and laryngeal structure invasion in 10 cases.Postoperative follow-up periods were 24-144 months,with an average of 68.29 months.Of the 185 patients,18(9.73%)had recurrences or metastases,including 9 cases(4.86%)died of recurrences or metastases.The 5-year and 10-year overall survival rates were respectively 95.21%and 93.10%.The 5-year and 10-year disease-free survival rates were respectively 89.65%and 86.85%.Univariate analysis showed that age of onset,tumor diameter,preoperative recurrent laryngeal nerve palsy,esophageal invasion and cervical lymph node metastasis were the risk factors for postoperative recurrence of T4a PTC(all P<0.05).Multivariate analysis showed that preoperative recurrent laryngeal nerve palsy(OR=3.27,95%CI:1.11-9.61,P=0.032)and lateral cervical lymph node metastasis(OR=4.71,95%CI:1.19-18.71,P=0.027)were independent risk factors for T4a PTC recurrence.Survival rate of patients with T4a PTC involving only the recurrent laryngeal nerve or the outer tracheal membrane was significantly better than that of patients with tracheal invasion(P<0.05).Conclusions T4a PTC patients

关 键 词：甲状腺肿瘤 局部晚期 复发 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]