甲状腺滤泡癌的临床病理特征和预后分析  

Clinicopathologic characteristics and prognostic analysis of follicular thyroid carcinomas

作　　者：王红群 宋欣[1] 刘鹏[1] 巩幼洁 李莹[3] 石怀银[1] Wang Hongqun;Song Xin;Liu Peng;Gong Youjie;Li Ying;Shi Huaiyin(Department of Pathology,the First Medical Center of Chinese People’s Liberation Army General Hospital,Beijing 100853,China;Department of Pathology,the Third People’s Hospital of Bengbu City,Bengbu 233099;Department of Pathology,Guang An’men Hospital of China Academy of Chinese Medical Science,Beijing 100053,China)

机构地区：[1]解放军总医院第一医学中心病理科,北京100853 [2]蚌埠市第三人民医院病理科,蚌埠233099 [3]中国中医科学院广安门医院病理科,北京100053

出　　处：《临床与实验病理学杂志》2025年第1期51-59,共9页Chinese Journal of Clinical and Experimental Pathology

基　　金：蚌埠医学院自然科学重点项目(2021byzd219)。

摘　　要：目的 探讨甲状腺滤泡癌(follicular thyroid carcinomas, FTC)的临床病理特征及预后。方法 收集205例FTC的临床资料,分析FTC的临床病理特点及其对预后的影响。结果 FTC的骨转移患者最多(25.4%,主要是椎骨和骨盆),其次是肺(15.6%)。影响远处转移的因素有:患者年龄(≥55岁)、肿瘤≥2灶、临床分期(Ⅲ~Ⅳ期)、广泛浸润型、复发癌及术后/治疗后的复发转移,完整切除的患者远处转移少(P均<0.05)。影响癌灶数的因素:分期、年龄、广泛浸润型、复发癌、远处转移和高血压病史,再复发转移率高(P均<0.05)。单因素生存分析显示,影响FTC总生存率(overall survival, OS)和癌症特异性生存率(cancer-specific survival, CSS)的预后因素如下:癌灶数、分期、年龄、手术方式、广泛浸润型、远处转移、吸烟史及术后/治疗后的再复发转移情况(P均<0.05)。Cox多因素回归分析显示,分期、吸烟和远处转移均影响OS及CSS;分期、亚型及复发癌影响无复发生存率(relapse-free survival, RFS)。伴有未分化癌的FTC组与不伴有未分化癌的FTC相比,分期晚(Ⅲ~Ⅳ期,100.0%vs 32.0%)、年龄大(≥60岁,87.5%vs 37.6%)、体积较大(>4 cm, 100.0%vs 44.2%),均为广泛浸润型(100.0%vs 33.3%),生存时间较短[CSS(4.429±1.152)月vs(120.415±5.765)月,P<0.001]。结论 FTC远处转移的好发部位是骨,年龄大、广泛浸润型及复发癌的患者易发生多灶及远处转移。影响FTC预后的因素较多,伴有未分化癌的FTC预后很差。Purpose To investigate the clinicopathologic characteristics and prognostic factors of follicular thyroid carcinomas(FTC).Methods The clinical and pathological data of 205 FTC patients were collected,and the clinicopathologic characteristics of FTC and its impact on prognosis were analyzed.Results The most common site of metastasis of FTC was bone(25.4%),which were mainly vertebrae and pelvis,followed by lung(15.6%).The factors that affecting distant metastasis(DM)were as follows:≥2 tumor foci,stage(Ⅲ-Ⅳ),patients’age(≥55 years),extensive invasive type,recurrent FTC,postoperative/post-treatment recurrence and metastasis,and patients with complete tumor resection had less DM(P<0.05,respectively).The factors that affecting the number of tumor foci included age,stage(Ⅲ-Ⅳ),extensive invasive type,recurrent FTC,distant metastasis and history of hypertension,more recurrence and metastasis after surgery/treatment(P<0.05,respectively).Univariate survival analysis showed that factors affecting the overall survival(OS)and cancer-specific survival(CSS)of FTC were as follows:the number of tumor foci,stage,patients’age,surgical mode,extensive invasive type,DM,smoking,and postoperative/post-treatment recurrence.Cox multivariate regression analysis showed that stage,smoking and distant metastasis affected OS and/or CSS,and stage,extensive invasive type and recurrent FTC affected relapse-free survival(RFS).Compared with the group of FTC without undifferentiated carcinoma(UTC),the group of FTC with UTC had later stage(Ⅲ-Ⅳ,100.0%vs 32.0%),older age(≥60 years old,87.5%vs 37.6%),bigger size(>4 cm,100.0%vs 44.2%),higher proportion of extensive infiltration type(100.0%vs 33.3%),shorter survival time[CSS(4.429±1.152)months vs(120.415±5.765)months,P<0.001].Conclusion The most common site of distant metastasis of FTC is bone.Older patients,extensively invasive type and recurrent cancer are prone to multifocal and distant metastases.There were many prognostic factors affecting of FTC.The group of FTC with UTC has wo

关 键 词：甲状腺肿瘤 甲状腺滤泡癌 伴有未分化癌的甲状腺滤泡癌 远处转移 癌灶数 预后 

分 类 号：R736.1[医药卫生—肿瘤]