Wu H S, Young M T, Ituarte P H, D'Avanzo A, Duh Q Y, Greenspan F S, Loh K C, Clark O H
University of California at San Francisco, Mt Zion Medical Center, 94143-1674, USA.
J Am Coll Surg. 2000 Dec;191(6):600-6. doi: 10.1016/s1072-7515(00)00731-6.
Although patients with differentiated thyroid cancer (DTC) of follicular cell origin usually have an excellent prognosis, some patients die from progressive tumor. Numerous postoperative criteria have been used to predict prognosis in patients with DTC. The purpose of this investigation was to determine whether the TNM and metastases, age, completeness of resection, invasion, size (MACIS) classifications predicted survival time and why patients died from DTC. The extent of initial treatment and causes of death were also evaluated in these patients who died from thyroid cancer.
Between 1965 and 1995, 102 of 1,224 patients with DTC treated at the University of California at San Francisco (UCSF) and UCSF/Mount Zion Medical Centers died from DTC. Risk factors including age at diagnosis, gender, histologic characteristics, TNM and MACIS classifications, the intervals among initial treatment, recurrence, and death, and the initial and subsequent treatments were documented in these 102 patients.
Among the 102 patients who died of DTC 50% were men and 50% were women. The mean age of patients with DTC at diagnosis was 58 years at recurrence, 62 and 65 years at death. Thirty percent of these patients initially had unilateral thyroid operations and 70% had a bilateral operation. Tumors at presentation ranged from 0.6 to 13.0 cm (mean 4.4 cm); 46% of patients presented with late-stage tumors (TNM stage III, IV; MACIS score > 8). At presentation 46% of the patients had locally recurrent disease or regional metastases and 18% had distant metastases. Patients with persistent disease had a significantly shorter survival time than those with recurrent disease (p < 0.001). Both TNM and MACIS classifications were good predictors of survival time. Reoperations were performed in 51% of papillary, 26% of follicular, and 67% of Hürthle cell thyroid cancer patients. Fifty percent of patients with papillary thyroid cancer, 50% of patients with Hürthle cell thyroid cancer, and 11% of patients with follicular cell thyroid cancer died of locally advanced disease.
As expected, patients with local or regional recurrence and those with TNM stage I or MACIS score < 6 survived longer than patients with distant metastasis and TNM stage III or IV, MACIS score > 6, but some patients thought to be at low risk (TNM stage I; MACIS < 6) also died from thyroid cancer.
虽然滤泡细胞起源的分化型甲状腺癌（DTC）患者通常预后良好，但仍有一些患者死于肿瘤进展。许多术后标准已被用于预测DTC患者的预后。本研究的目的是确定TNM和转移情况、年龄、切除完整性、侵袭、大小（MACIS）分类能否预测生存时间，以及患者死于DTC的原因。还对这些死于甲状腺癌的患者的初始治疗范围和死亡原因进行了评估。
1965年至1995年间，在加利福尼亚大学旧金山分校（UCSF）和UCSF/锡安山医疗中心接受治疗的1224例DTC患者中有102例死于DTC。记录了这102例患者的危险因素，包括诊断时的年龄、性别、组织学特征、TNM和MACIS分类、初始治疗、复发和死亡之间的间隔，以及初始和后续治疗情况。
在这102例死于DTC的患者中，50%为男性，50%为女性。DTC患者诊断时的平均年龄为复发时58岁，死亡时62岁和65岁。这些患者中30%最初接受了单侧甲状腺手术，70%接受了双侧手术。就诊时肿瘤大小为0.6至13.0 cm（平均4.4 cm）；46%的患者就诊时为晚期肿瘤（TNM分期III、IV期；MACIS评分>8）。就诊时46%的患者有局部复发或区域转移，18%有远处转移。疾病持续存在的患者的生存时间明显短于复发患者（p<0.001）。TNM和MACIS分类都是生存时间的良好预测指标。51%的乳头状甲状腺癌患者、26% 的滤泡状甲状腺癌患者和67% 的许特莱细胞甲状腺癌患者接受了再次手术。50% 的乳头状甲状腺癌患者、50% 的许特莱细胞甲状腺癌患者和11% 的滤泡状甲状腺癌患者死于局部晚期疾病。
正如预期的那样，局部或区域复发的患者以及TNM分期I期或MACIS评分<6的患者比有远处转移以及TNM分期III期或IV期、MACIS评分>6的患者生存时间更长，但一些被认为低风险（TNM分期I期；MACIS<6）的患者也死于甲状腺癌。
