Lai Hung-Wen, Lee Chen-Hsen, Chen Jui-Yu, Tseng Ling-Ming, Yang An-Hang
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, School of Medicine, Taipei, Taiwan, ROC.
J Am Coll Surg. 2006 Nov;203(5):715-22. doi: 10.1016/j.jamcollsurg.2006.07.008. Epub 2006 Sep 20.
Insular thyroid carcinoma is a distinctive clinicopathologic entity with aggressive behavior and frequent lethal disease. But because it is rare, no single institute has sufficient experience with the clinicopathologic features and treatment effect of radioiodine. A literature review and collective analysis might facilitate patient management.
From January 1991 to December 2005, 9 patients with insular thyroid carcinoma were diagnosed in Taipei Veterans General Hospital. Clinicopathologic data were collected for analysis. The English literature about insular carcinoma was searched in Medline. Patients with detailed descriptions of treatment and followup were enrolled. Clinicopathologic features, rate of lymph node and distant metastasis, and prognostic factors were analyzed.
Seventy-three of 486 patients collected from 23 articles with detailed description of treatment and followup were combined with our 9 patients for analysis, making a total of 82 patients in this article. The mean period of patient followup was 84.5 months. There were 26 (31.7%) men and 56 (68.3%) women. The rate of lymph node metastasis was 49%, and distant metastasis was 57.5%. Disease-specific death rate was 37.8%. The 5- and 10-year survival rates of insular carcinoma were 72.2% and 52%, respectively. Patient age older than 45 years (p=0.0004) and distant metastasis (p<0.0001) were poor prognostic factors. Use of radioiodine therapy (p=0.9789) and radiation therapy (p=0.2172) were not associated with prolonged survival.
Patients with insular thyroid carcinoma have unfavorable outcomes. Postoperative radioiodine therapy or radiotherapy seemed not to be strongly associated with prolonged survival.
甲状腺岛叶癌是一种具有侵袭性且致死率高的独特临床病理实体。但因其罕见，尚无单一机构对其临床病理特征及放射性碘治疗效果有足够经验。文献综述及汇总分析可能有助于患者管理。
1991年1月至2005年12月，台北荣民总医院诊断出9例甲状腺岛叶癌患者。收集临床病理数据进行分析。在Medline中检索关于甲状腺岛叶癌的英文文献。纳入有详细治疗及随访描述的患者。分析临床病理特征、淋巴结及远处转移率和预后因素。
从23篇有详细治疗及随访描述的文章中收集的486例患者中的73例与我们的9例患者合并进行分析，本文共82例患者。患者平均随访时间为84.5个月。男性26例（31.7%），女性56例（68.3%）。淋巴结转移率为49%，远处转移率为57.5%。疾病特异性死亡率为37.8%。甲状腺岛叶癌的5年和10年生存率分别为72.2%和52%。年龄大于45岁的患者（p = 0.0004）和远处转移（p < 0.0001）是不良预后因素。使用放射性碘治疗（p = 0.9789）和放射治疗（p = 0.2172）与延长生存期无关。
甲状腺岛叶癌患者预后不良。术后放射性碘治疗或放射治疗似乎与延长生存期无密切关联。
