Saadi H, Kleidermacher P, Esselstyn C
Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
Surgery. 2001 Jul;130(1):30-5. doi: 10.1067/msy.2001.115364.
Total or near-total thyroidectomy for the treatment of follicular thyroid carcinoma (FTC). The prognosis of patients with low-risk FTC, however, is excellent, and thus total thyroidectomy may not be justifiable in such patients.
A retrospective review identified 61 patients diagnosed with intrathyroidal well-differentiated FTC between 1958 and 1991.
Median age at diagnosis was 42 years (range, 15-78 years). Most patients (90.2%) had a lobectomy or subtotal thyroidectomy. Median tumor size was 3.0 cm (range, 0.9-9.5 cm). Fifty-eight patients (95.1%) received thyroid hormone supplementation, and 5 (8.2%) received radioactive iodine ablation postoperatively. Median follow-up was 11 years (range, 3-35 years). Local recurrence, metastasis, or both developed in 3 patients (4.9%), and all subsequently died of thyroid cancer. The cumulative 10- and 15-year cancer-specific survival rate was 96.5%. Factors significantly related to worse survival were oxyphilic histology (log-rank, P =.00) and tumor size of more than 4 cm (P =.001). However, neither was found to be an independent predictor of outcome by Cox multivariate analyses (P =.7 and.9, respectively). The extent of initial operation (unilateral versus bilateral procedure) was not significantly related to survival (P =.52).
Conservative management consisting mainly of lobectomy or subtotal thyroidectomy and thyroid hormone supplementation is associated with favorable outcome of patients with intrathyroidal well-differentiated FTC.
全甲状腺切除或近全甲状腺切除术用于治疗滤泡状甲状腺癌（FTC）。然而，低风险FTC患者的预后良好，因此对这类患者进行全甲状腺切除术可能不合理。
一项回顾性研究确定了1958年至1991年间诊断为甲状腺内高分化FTC的61例患者。
诊断时的中位年龄为42岁（范围15 - 78岁）。大多数患者（90.2%）接受了甲状腺叶切除术或次全甲状腺切除术。肿瘤中位大小为3.0 cm（范围0.9 - 9.5 cm）。58例患者（95.1%）接受了甲状腺激素补充治疗，5例（8.2%）术后接受了放射性碘消融治疗。中位随访时间为11年（范围3 - 35年）。3例患者（4.9%）出现局部复发、转移或两者皆有，随后均死于甲状腺癌。10年和15年的累积癌症特异性生存率为96.5%。与较差生存显著相关的因素是嗜酸性组织学（对数秩检验，P = 0.00）和肿瘤大小超过4 cm（P = 0.001）。然而，通过Cox多因素分析，两者均未被发现是预后的独立预测因素（分别为P = 0.7和0.9）。初始手术范围（单侧与双侧手术）与生存无显著相关性（P = 0.52）。
主要包括甲状腺叶切除术或次全甲状腺切除术以及甲状腺激素补充治疗的保守治疗与甲状腺内高分化FTC患者的良好预后相关。
