Györy F, Lukács G, Nagy E V, Juhász F, Mezösi E, Szakáll S, Máth J, Balázs G
Debreceni Egyetem Orvos- és Egészségtudományi Centrum I. sz. Sebészeti Klinika, 4012 Debrecen, Nagyerdei krt. 98. Pf. 27.
Magy Seb. 2001 Apr;54(2):69-74.
Factors influencing prognosis and long term outcome of thyroid cancer have been described by several groups. It is, however, not clear how the moderate iodine deficiency in Hungary can influence the previously described prognostic factors by other means than shifting differentiated cancer incidence toward the follicular type. Data of 423 out of 472 patients who had been operated on for papillary (372) and follicular (100) thyroid cancer between 1971 and 1997 at our institution have been analyzed retrospectively. Histological specimens were re-evaluated and, if needed, revised. Survival curves were compared using the Kaplan-Meier method. The overall 5 and 10 year survival rates were 93% and 89% for papillary, and 92% and 80% for follicular carcinoma. As an independent factor extrathyroidal invasion (papillary p = 0.000, follicular p = 0.000), lymph node involvement (papillary p = 0.000, follicular 0.011), distant metastases (papillary p = 0.000, follicular p = 0.000), and age over 40 years (papillary p = 0.000, follicular p = 0.000) had negative influence on survival. Multifocality, gender, type of surgery (total or near-total thyroidectomy vs. less than near-total thyroidectomy), and lymphocytic infiltration did not influence survival. Iodine intake did not influence survival, however, the incidence of follicular cancer was higher in iodine deficient regions. When analyzing the papillary and follicular groups separately by Cox regression, extrathyroidal invasion (p = 0.008), lymph node metastasis (p = 0.004), distant metastasis (p = 0.000), and age over 40 years (p = 0.000) were significant predictors in the papillary group, while only tumor extrathyroidal invasion (p = 0.019), and distant metastases (p = 0.000) were significant negative factors in the follicular group.
多个研究小组描述了影响甲状腺癌预后和长期转归的因素。然而，目前尚不清楚匈牙利的中度碘缺乏除了使分化型甲状腺癌的发病率向滤泡状癌转移外，还会如何通过其他方式影响上述预后因素。我们对1971年至1997年间在本机构接受手术治疗的472例甲状腺癌患者（其中乳头状癌372例，滤泡状癌100例）中的423例患者的数据进行了回顾性分析。对组织学标本进行了重新评估，并在必要时进行了修正。采用Kaplan-Meier法比较生存曲线。乳头状癌的5年和10年总生存率分别为93%和89%，滤泡状癌分别为92%和80%。作为独立因素，甲状腺外侵犯（乳头状癌p = 0.000，滤泡状癌p = 0.000）、淋巴结受累（乳头状癌p = 0.000，滤泡状癌0.011）、远处转移（乳头状癌p = 0.000，滤泡状癌p = 0.000）以及年龄超过40岁（乳头状癌p = 0.000，滤泡状癌p = 0.000）对生存有负面影响。多灶性、性别、手术类型（全甲状腺切除术或近全甲状腺切除术与次近全甲状腺切除术）以及淋巴细胞浸润对生存无影响。碘摄入量对生存无影响，然而，碘缺乏地区的滤泡状癌发病率较高。通过Cox回归分别分析乳头状癌组和滤泡状癌组时，甲状腺外侵犯（p = 0.008）、淋巴结转移（p = 0.004）、远处转移（p = 0.000）以及年龄超过40岁（p = 0.000）是乳头状癌组的显著预测因素，而在滤泡状癌组中，只有肿瘤甲状腺外侵犯（p = 0.019）和远处转移（p = 0.000）是显著的负面因素。
