Marchesi Maurizio, Biffoni Marco, Biancari Fausto, Berni Alberto, Campana Francesco Paolo
Division of General Surgery, Department of Surgical Sciences, University "La Sapienza", Rome, Italy.
Eur J Surg Suppl. 2003 Jul(588):46-50.
To identify the risk factors affecting the outcome of operations for differentiated and aggressive thyroid carcinoma which may indicate the need for a more aggressive surgical treatment.
Retrospective study.
University hospital.
143 patients underwent total thyroidectomy with or without central neck lymphadenectomy or modified neck dissection. There were 85 papillary, 34 follicular, 6 widely-invasive follicular, 6 insular, five oxyphilic, five tall cell, and two diffuse sclerosing papillary carcinomas.
Disease-related survival.
At 12-years, the survival was 96%, being 98% among patients with differentiated and 83% among those with aggressive carcinoma (p = 0.0006). Insular and oxyphilic carcinomas had the worst prognosis (at 10 years, 67% and 60%, respectively, p < 0.0001). The high-risk age, metastases, and extent score (AMES) group had worse survival than the low-risk group (12 years, 84% compared with 98%, p = 0.001). Among patients with differentiated carcinoma, the low-risk AMES group had also better outcome than those in the high-risk AMES group (at 12 years, 100% compared with 86%, p < 0.0001), but there was no such difference among patients with aggressive disease. Multivariate analysis showed that women (RR 14.28, 95% confidence interval (CI) 1.13 to 180.28), patients with tumours > or = 5 cm in size (RR 9.60, 95%CI 1.01 to 91.43) and AMES high-risk patients (RR 30.17, 95% CI 1.57 to 577.48) had the worst outcome.
In patients with differentiated thyroid carcinoma, total thyroidectomy and, if the AMES score indicates a high risk, central neck lymphadenectomy with or without modified neck dissection, is associated with a favourable outcome. Poorer outcome is expected if the carcinoma is aggressive, and an aggressive surgical approach is advocated as a routine.
确定影响分化型和侵袭性甲状腺癌手术预后的危险因素，这些因素可能提示需要采取更积极的手术治疗。
回顾性研究。
大学医院。
143例患者接受了全甲状腺切除术，伴或不伴中央区颈部淋巴结清扫术或改良颈部淋巴结清扫术。其中有85例乳头状癌、34例滤泡状癌、6例广泛侵袭性滤泡状癌、6例岛状癌、5例嗜酸性细胞癌、5例高细胞癌和2例弥漫性硬化性乳头状癌。
疾病相关生存率。
12年时，生存率为96%，分化型癌患者中为98%，侵袭性癌患者中为83%（p = 0.0006）。岛状癌和嗜酸性细胞癌预后最差（10年时，分别为67%和60%，p < 0.0001）。高风险年龄、转移和范围评分（AMES）组的生存率低于低风险组（12年时，分别为84%和98%，p = 0.001）。在分化型癌患者中，低风险AMES组的预后也优于高风险AMES组（12年时，分别为100%和86%，p < 0.0001），但在侵袭性疾病患者中无此差异。多因素分析显示，女性（风险比[RR]为14.28，95%置信区间[CI]为1.13至180.28）、肿瘤大小≥5 cm的患者（RR为9.60，95%CI为1.01至91.43）和AMES高风险患者（RR为30.17，95%CI为1.57至577.48）预后最差。
对于分化型甲状腺癌患者，全甲状腺切除术，如果AMES评分显示高风险，则行中央区颈部淋巴结清扫术，伴或不伴改良颈部淋巴结清扫术，预后良好。如果癌具有侵袭性，则预后较差，提倡常规采取积极的手术方式。
