Cushing Sharon L, Palme Carsten E, Audet Nathalie, Eski Spiro, Walfish Paul G, Freeman Jeremy L
Department of Otolaryngology, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5.
Laryngoscope. 2004 Dec;114(12):2110-5. doi: 10.1097/01.mlg.0000149442.22393.e2.
To test the prognostic significance of standard clinicopathologic factors in patients with well-differentiated thyroid carcinoma (WDTC).
A retrospective chart review of the thyroid cancer database at Mount Sinai Hospital (Toronto, Canada 1963-2000) was carried out.
All patients consecutively treated for WDTC with a follow-up period of at least 5 years were eligible for inclusion. Relevant patient, tumor, treatment, and outcome data were collected. The main outcome measures were recurrence rate, actuarial overall, and disease-specific survival at 20 years.
Three hundred and thirty-three patients (F 275, M 58) with a median age of 39.7 (range 9-82.9) years were eligible for inclusion in this study (median follow-up 10.4 years, range 5-34.4 years, minimum 5 years). The recurrence rate was 15.6% (52 /333). The overall and disease-specific survival at 10 years was 97.5% and 98.5%, respectively. Likewise, the overall and disease-specific survival at 20 years was 88.4% and 93.3%, respectively. Clinicopathologic factors significant on multivariate regression for the development of disease recurrence included family history of WDTC, advanced stage, and total thyroidectomy (all P < .05). Similarly, advanced stage on presentation was associated with a worse disease-specific survival on multivariate regression (all P < .05). There was a trend for age 60 or greater to predict disease-specific survival (P = .09).
WDTC is associated with a significant recurrence rate but good disease-specific survival. The most important prognostic factors are family history of WDTC, extent of surgical treatment (i.e., total thyroidectomy), and advanced initial stage of disease, with a trend for age 60 years and older.
检验标准临床病理因素对高分化甲状腺癌（WDTC）患者的预后意义。
对加拿大安大略省多伦多市西奈山医院1963年至2000年的甲状腺癌数据库进行回顾性图表分析。
所有接受WDTC连续治疗且随访期至少5年的患者均符合纳入标准。收集相关的患者、肿瘤、治疗及预后数据。主要结局指标为复发率、20年实际总生存率和疾病特异性生存率。
333例患者（女性275例，男性58例）符合本研究纳入标准，中位年龄39.7岁（范围9 - 82.9岁）（中位随访10.4年，范围5 - 34.4年，最短5年）。复发率为15.6%（52/333）。10年总生存率和疾病特异性生存率分别为97.5%和98.5%。同样，20年总生存率和疾病特异性生存率分别为88.4%和93.3%。多因素回归分析显示，与疾病复发相关的临床病理因素包括WDTC家族史、晚期及全甲状腺切除术（均P < 0.05）。同样，多因素回归分析显示，就诊时处于晚期与较差的疾病特异性生存率相关（均P < 0.05）。60岁及以上患者的疾病特异性生存率有预测趋势（P = 0.09）。
WDTC的复发率较高，但疾病特异性生存率良好。最重要的预后因素为WDTC家族史、手术治疗范围（即全甲状腺切除术）和疾病的初始晚期阶段，60岁及以上患者有一定趋势。
