Akslen L A, Myking A O, Salvesen H, Varhaug J E
Department of Pathology, Gade Institute, Haukeland Hospital, Bergen, Norway.
Eur J Cancer. 1992;29A(1):44-51. doi: 10.1016/0959-8049(93)90574-y.
The influence of various pathological features on tumour recurrences and cancer deaths has been studied in 173 consecutive cases of surgically treated papillary thyroid carcinoma recorded in 1971-1985. During the follow-up (median 7.3 years), 18.6% of the 161 radically treated patients had recurrent disease, and 8.7% died of thyroid cancer. In the univariate life-table analysis, recurrence-free survival was significantly related to age, pTNM category, tumour size, presence of certain growth patterns, tumour necrosis, tumour infiltration in surrounding thyroid tissue and thyroid gland capsule, lymph node metastases, presence of extra-nodal tumour growth and number of positive lymph nodes, whereas only tumour diameter, thyroid gland capsular infiltration and presence of extra-nodal tumour growth remained as significant prognostic factors in the multivariate analysis. Regarding thyroid cancer deaths, sex, age, pTNM category, radicality of surgical treatment, tumour diameter, macroscopic appearance, cellular atypia, tumour necrosis, thyroid gland capsular infiltration, vascular invasion, extra-thyroidal extension and lymph node metastases were all significant variables in the univariate analysis. However, only sex, age, radicality of surgical treatment and vascular invasion were found to be significant predictors of thyroid cancer deaths in the final multivariate Cox model, whereas cellular atypia and necrosis showed a borderline significance. Our study thus documents the independent importance of certain histological features for morbidity and mortality in surgically treated cases of papillary thyroid cancer.
对1971年至1985年记录的173例接受手术治疗的乳头状甲状腺癌连续病例，研究了各种病理特征对肿瘤复发和癌症死亡的影响。在随访期间（中位时间7.3年），161例接受根治性治疗的患者中有18.6%出现疾病复发，8.7%死于甲状腺癌。在单变量生命表分析中，无复发生存与年龄、pTNM分类、肿瘤大小、某些生长模式的存在、肿瘤坏死、肿瘤浸润周围甲状腺组织和甲状腺包膜、淋巴结转移、结外肿瘤生长的存在以及阳性淋巴结数量显著相关，而在多变量分析中，只有肿瘤直径、甲状腺包膜浸润和结外肿瘤生长的存在仍然是显著的预后因素。关于甲状腺癌死亡，在单变量分析中，性别、年龄、pTNM分类、手术治疗的根治性、肿瘤直径、宏观外观、细胞异型性、肿瘤坏死、甲状腺包膜浸润、血管侵犯、甲状腺外扩展和淋巴结转移都是显著变量。然而，在最终的多变量Cox模型中，只有性别、年龄、手术治疗的根治性和血管侵犯被发现是甲状腺癌死亡的显著预测因素，而细胞异型性和坏死显示出临界显著性。因此，我们的研究证明了某些组织学特征在乳头状甲状腺癌手术治疗病例中的发病率和死亡率方面的独立重要性。
