局部进展期分化型甲状腺癌临床病理学分析及预后因素评价  

Clinicopathologic features and prognostic factors of locally advanced differentiated thyroid carcinoma

作　　者：李红强[1] 王龙龙 马润声 唐艺峰[1] 苌群刚 殷德涛[1] LI Hong-qiang;WANG Long-long;MA Run-sheng(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province,Key Medicine Laboratory of Thyroid Cancer of Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院甲状腺外科,河南省甲状腺癌多学科诊疗工程研究中心,河南省甲状腺癌医学重点实验室,河南郑州450052

出　　处：《中国实用外科杂志》2023年第8期889-893,共5页Chinese Journal of Practical Surgery

基　　金：河南省自然科学基金面上项目(No.222300420568);河南省医学科技攻关重大计划项目(No.SBGJ202101014);河南省中医药研究重大专项(No.20-21ZYZD14);河南省中青年医学科技创新领军人才项目(No.YXKC2020015)。

摘　　要：目的 探讨局部进展期分化型甲状腺癌(DTC)的临床病理学特征及影响复发的风险因素。方法 回顾性分析2017年1~12月郑州大学第一附属医院甲状腺外科收治的1071例早期DTC和228例局部进展期DTC病人的临床病理学特征及术后随访资料,筛选其中影响局部进展期DTC复发的危险因素,基于筛选结果建立列线图预测模型,并评价模型的准确性。结果 局部进展期DTC与早期DTC病人在年龄≥55岁、合并桥本甲状腺炎、BRAFV600E基因突变的比例方面差异无统计学意义(P均>0.05)。与早期DTC相比,局部进展期DTC病人男性、肿瘤长径>2 cm、多灶、中央区淋巴结转移比例更高,差异有统计学意义(P均<0.05)。Cox回归单因素及多因素分析结果显示,年龄≥55岁、肿瘤长径>2 cm,侵犯周围器官是局部进展期DTC复发的独立危险因素(P均<0.05)。基于以上独立危险因素建立列线图模型,绘制1年、3年、5年无病生存概率的受试者特征曲线,曲线下面积分别为0.767(95%CI 0.623-0.911)、0.717(95%CI 0.582-0.852)、0.744(95%CI 0.617-0.872),提示模型有良好的区分度。结论 男性、肿瘤长径>2 cm、多灶、中央区淋巴结转移的DTC病人更有可能出现局部进展;年龄≥55岁、肿瘤长径>2 cm,侵犯周围器官的局部进展期DTC更易复发,建议制定更积极的治疗和随访方案。Objective To investigate the clinicopathologic characteristics of locally advanced differentiated thyroid carcinoma(DTC)and the risk factors that affecting its recurrence.Methods The clinicopathological characteristics and postoperative follow-up data of 1071 patients with early DTC and 228 patients with locally advanced DTC admitted to the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January to December 2017 were retrospectively analyzed.The risk factors affected the recurrence of locally advanced DTC were screened.A nomogram model was established based on the screening results,and the prediction accuracy of the model was evaluated.Results There was no significant difference in the proportion of patients between locally advanced DTC and early DTC in age≥55,concomitant Hashimoto thyroiditis,and BRAFV600E mutations(all P>0.05).Compared with early DTC patients,the proportion of male,tumor length>2cm,multifocal,and central lymph node metastasis was higher in locally advanced DTC patients(all P<0.05).Univariate and multivariate Cox regression analysis showed that age≥55 years,tumor length>2cm and surrounding organ invasion were independent risk factors for the recurrence of locally advanced DTC(all P<0.05).A nomogram model was established based on the above independent risk factors.The Receiver Operating Characteristic curves of 1-year,3-year,and 5-year disease-free survival probability were plotted,and the areas under the curves were 0.767(95%CI 0.623-0.911),0.717(95%CI 0.582-0.852)and 0.744(95%CI 0.617-0.872),respectively,indicating that the model has a good degree of differentiation.Conclusion Male DTC patients,DTC with tumors length>2cm,multifocal,central cervical lymph node metastases are more likely to become locally advanced DTC.Locally advanced DTC with age≥55 years old,tumor length>2cm,and surrounding organ invasion are more likely to recurrence;more aggressive treatment and follow-up programs are recommended.

关 键 词：分化型甲状腺癌 局部进展期甲状腺癌 复发 列线图 

分 类 号：R6[医药卫生—外科学]