Gimm Oliver, Heyn Viola, Krause Ulf, Sekulla Carsten, Ukkat Jörg, Dralle Henning
Department of General, Visceral, and Vascular Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany.
World J Surg. 2006 May;30(5):847-52. doi: 10.1007/s00268-005-0367-4.
Disseminated tumor cells in the connective tissue (CT-DTCs) do not have any connection to a primary tumor or the lymph nodes. They are identified quite often in patients with medullary thyroid carcinoma (MTC), but nothing is known regarding their prognostic significance.
Among 450 patients with MTC, 69 (15%) were identified as having CT-DTCs. A case-control group of patients without CT-DTCs was selected. The two groups were matched concerning TNM classification, age, heredity, and sex. Because many patients with CT-DTCs had extrathyroidal tumor extension (pT4 category), distant metastases (M1 category), or both, only 35 matched pairs could be identified. The TNM classification in both groups was as follows: pT1, n = 8; pT2, n = 15; pT3, n = 4; pT4, n = 8; pN0, n = 4; pN1, n = 31; M0, n = 30; M1, n = 5. The mean age was 46.8 +/- 17.0 years in the CT-DTC group and 44.4 +/- 15.0 years in the case-control group (NS).
In both groups, 23 patients had sporadic MTC, and 12 patients had hereditary MTC. Neither mean basal preoperative nor postoperative calcitonin levels differed significantly between the two groups. In contrast, none of the patients with CT-DTCs was biochemically cured (normal calcitonin level after pentagastrin stimulation) compared to eight patients without CT-DTCs (P < 0.005). The two groups did not differ concerning other parameters (basal calcitonin level > 3000 pg/ml, more than 10 lymph node metastases, more than two involved locoregional lymph node compartments, mediastinal lymph node metastases) that have been reported to correlate with the lack of or almost (< 10%) lack of biochemical cure.
In patients with MTC, disseminated tumor cells in the connective tissue correlate with advanced tumor stages and appear to be of prognostic significance.
结缔组织中的播散性肿瘤细胞（CT-DTCs）与原发性肿瘤或淋巴结没有任何联系。它们在甲状腺髓样癌（MTC）患者中经常被发现，但关于其预后意义却一无所知。
在450例MTC患者中，69例（15%）被确定有CT-DTCs。选择了一组无CT-DTCs的病例对照组。两组在TNM分类、年龄、遗传和性别方面进行了匹配。由于许多有CT-DTCs的患者有甲状腺外肿瘤扩展（pT4类别）、远处转移（M1类别）或两者皆有，因此仅能确定35对匹配病例。两组的TNM分类如下：pT1，n = 8；pT2，n = 15；pT3，n = 4；pT4，n = 8；pN0，n = 4；pN1，n = 31；M0，n = 30；M1，n = 5。CT-DTC组的平均年龄为46.8±17.0岁，病例对照组为44.4±15.0岁（无显著差异）。
两组中，23例患者为散发性MTC，12例患者为遗传性MTC。两组术前基础降钙素水平和术后降钙素水平的均值均无显著差异。相比之下，有CT-DTCs的患者无一例在生化上治愈（五肽胃泌素刺激后降钙素水平正常），而无CT-DTCs的患者有8例（P < 0.005）。两组在其他已报道与生化治愈缺乏或几乎（< 10%）缺乏相关的参数（基础降钙素水平> 3000 pg/ml、超过10个淋巴结转移、超过两个区域淋巴结分区受累、纵隔淋巴结转移）方面无差异。
在MTC患者中，结缔组织中的播散性肿瘤细胞与肿瘤晚期相关，似乎具有预后意义。
