Kikuchi Shoichi, Perrier Nancy D, Ituarte Philip, Siperstein Allan E, Duh Quan-Yang, Clark Orlo H
Department of Surgery, UCSF Affiliated Hospitals, 94143-1674, USA.
Ann Surg. 2004 Apr;239(4):536-43. doi: 10.1097/01.sla.0000118752.34052.b7.
To determine the temporal sequence for developing benign and malignant thyroid neoplasms after radiation.
Therapeutic radiation is associated with thyroid neoplasms in humans and animals. Some question whether thyroid cancers develop de novo or from benign thyroid neoplasms. Little information, however, is available concerning the time to development of benign and malignant thyroid neoplasms after radiation exposure.
We retrospectively analyzed the records of 171 consecutive patients who had a history of exposure to radiation and were treated surgically at University of California, San Francisco-affiliated hospitals for thyroid neoplasms between 1960 and 1999.
There were 66 men and 105 women aged 9 to 80 years (mean, 47.0 years). One hundred patients had benign and 71 had malignant tumors (58 papillary cancers, 10 follicular cancers, 1 Hurthle cell cancer, 1 medullary cancer, and 1 carcinosarcoma). The mean latency period for benign tumors was longer than that for malignant lesions (mean, 34.1 and 28.4 years, P = 0.018; median, 38.0 years and 30.0 years, P = 0.001). Follicular carcinomas developed sooner (mean, 20.5 years; median, 20 years) than did follicular adenomas (mean, 35.3 years; median, 36.5 years; P = 0.003, P = 0.0009). Patients with papillary thyroid cancers presenting as occult papillary cancers (<1 cm) and as a dominant nodule had similar latency periods (mean, 34.0 and 28.0 years P = 0.29; median, 37.5 and 30.5 years, P = 0.09), respectively.
Although there could be selection bias regarding referral of patients, our data document that malignant thyroid tumors after radiation exposure, including follicular carcinomas, present earlier than do benign thyroid tumors. Occult and manifest papillary thyroid cancers present at about the same time interval after radiation exposure. Our findings question whether benign thyroid neoplasms progress to malignant thyroid neoplasms and that most occult thyroid cancers do not progress to malignant thyroid cancers in radiation-exposed patients.
确定放疗后良性和恶性甲状腺肿瘤发生的时间顺序。
治疗性放疗与人类和动物的甲状腺肿瘤有关。一些人质疑甲状腺癌是新发的还是由良性甲状腺肿瘤发展而来。然而，关于放疗后良性和恶性甲状腺肿瘤发生时间的信息很少。
我们回顾性分析了1960年至1999年间在加利福尼亚大学旧金山分校附属医院接受手术治疗的171例有放疗史的甲状腺肿瘤患者的记录。
共有66名男性和105名女性，年龄在9至80岁之间（平均47.0岁）。100例患者患有良性肿瘤，71例患有恶性肿瘤（58例乳头状癌、10例滤泡状癌、1例许特耳细胞癌、1例髓样癌和1例癌肉瘤）。良性肿瘤的平均潜伏期长于恶性病变（平均34.1年和28.4年，P = 0.018；中位数38.0年和30.0年，P = 0.001）。滤泡状癌比滤泡状腺瘤发展得更快（平均20.5年；中位数20年）（平均35.3年；中位数36.5年；P = 0.003，P = 0.0009）。表现为隐匿性乳头状癌（<1 cm）和优势结节的乳头状甲状腺癌患者的潜伏期相似（平均34.0年和28.0年，P = 0.29；中位数37.5年和30.5年，P = 0.09）。
尽管在患者转诊方面可能存在选择偏倚，但我们的数据表明，放疗后包括滤泡状癌在内的恶性甲状腺肿瘤比良性甲状腺肿瘤出现得更早。隐匿性和显性乳头状甲状腺癌在放疗后的出现时间间隔大致相同。我们的研究结果质疑良性甲状腺肿瘤是否会发展为恶性甲状腺肿瘤，以及大多数隐匿性甲状腺癌在放疗患者中是否不会发展为恶性甲状腺癌。
