Lo Chung-Yau, Chan Wai-Fan, Lam King-Yin, Wan Koon-Yat
Departments of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
Ann Surg. 2005 Nov;242(5):708-15. doi: 10.1097/01.sla.0000186421.30982.d2.
To evaluate the risk factors including tumor histomorphology for survival specific to follicular thyroid carcinoma (FTC) and to apply commonly employed staging systems in predicting survival for patients with FTC.
FTC is usually analyzed collectively with papillary thyroid carcinoma (PTC) in risk group analysis. Risk factors and risk group analysis are important in the management of patients with FTC, although current published therapeutic guidelines call for total thyroidectomy followed by radioactive iodine (I) ablation for all FTC patients.
Over a 40-year period, 156 patients surgically treated for FTC with an average follow-up of 14.4 years were retrospectively studied after histologic reclassification according to the type and degree of invasiveness of the tumor. Potential risk factors for survival were calculated using multivariate analysis, and the prognostic accuracy of AMES risk group stratification, UICC/AJCC pTNM staging, Degroot classification, and MACIS scoring schemes in predicting survival was compared.
Seventeen (11%) patients had distant metastases at presentation, and bilateral thyroid resection was performed for 131 (84%) patients. Seventeen (11%) patients died of recurrent or metastatic disease. The overall and cancer-specific survival (CSS) rates at 10 years were 79% and 88%, respectively. None of the patients with minimally invasive (n = 49) or angioinvasive (n = 23) carcinomas died compared with 17 of 84 patients with widely invasive carcinomas (P = 0.0007). Using the Cox proportional hazards model, old age, the presence of distant metastases, and incomplete tumor excision were independent prognostic factors for survival. For patients who underwent curative treatment, old age and widely invasive carcinoma were risk factors for poor survival. All staging systems studied accurately predicted CSS, and the pTNM UICC/AJCC staging system yielded the best prognostic information.
Commonly adopted staging systems can be applied specifically to patients with FTC. The distinction of FTC in minimally invasive and widely invasive carcinoma based on the extent of invasiveness rather than vascular invasion is important in identifying low-risk FTC patients for a more conservative management.
评估包括肿瘤组织形态学在内的影响滤泡状甲状腺癌（FTC）特异性生存的危险因素，并应用常用的分期系统预测FTC患者的生存情况。
在风险组分析中，FTC通常与乳头状甲状腺癌（PTC）一起进行分析。尽管目前已发表的治疗指南要求对所有FTC患者进行全甲状腺切除，随后进行放射性碘（I）消融，但危险因素和风险组分析在FTC患者的管理中仍很重要。
在40年的时间里，对156例接受手术治疗的FTC患者进行回顾性研究，平均随访14.4年，术后根据肿瘤的侵袭类型和程度进行组织学重新分类。使用多变量分析计算生存的潜在危险因素，并比较AMES风险组分层、UICC/AJCC pTNM分期、德格鲁特分类和MACIS评分方案在预测生存方面的预后准确性。
17例（11%）患者初诊时已有远处转移，131例（84%）患者接受了双侧甲状腺切除术。17例（11%）患者死于复发或转移性疾病。10年时的总生存率和癌症特异性生存率（CSS）分别为79%和88%。与84例广泛侵袭性癌患者中的17例相比，49例微侵袭性癌患者和23例血管侵袭性癌患者均无死亡（P = 0.0007）。使用Cox比例风险模型，高龄、远处转移的存在和肿瘤切除不完全是生存的独立预后因素。对于接受根治性治疗的患者，高龄和广泛侵袭性癌是生存不良的危险因素。所研究的所有分期系统均能准确预测CSS，pTNM UICC/AJCC分期系统提供了最佳的预后信息。
常用的分期系统可专门应用于FTC患者。根据侵袭范围而非血管侵袭区分微侵袭性和广泛侵袭性FTC对于识别低风险FTC患者以进行更保守的管理很重要。
