Verburg Frederik A, de Keizer Bart, Lam Marnix G E H, de Klerk J M H, Lips Cornelis J M, Borel-Rinkes Inne H M, van Isselt Johannes W
Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
World J Surg. 2007 Dec;31(12):2309-14. doi: 10.1007/s00268-007-9257-2.
The aim of this study was to assess the efficacy of treatment of patients with papillary thyroid carcinoma (PTC) and lymph node metastases at the time of diagnosis and its influence on the course of the disease.
It is a retrospective review of all 51 patients with PTC and histologically proven lymph node metastases treated with I-131 ablation in our center between January 1990 and January 2003. Patients were considered disease-free if during follow-up thyroglobulin levels were undetectable and scintigraphy with 370 MBq (131)I was negative during thyroid-stimulating hormone stimulation. Staging of patients was in accordance with the 5th edition of the TNM system.
After a median follow-up of 84 months, 33 (65%) patients were never free of detectable disease; and 3 of these patients had died of the PTC. In total, 22 patients still showed persistent activity in the neck outside the thyroid bed, which was suspect to be cervical lymph node metastasis on postablation scintigraphy; it was not related to the initial clinical presentation (lymph node metastasis or a thyroid nodule without suspicion of metastatic disease) or to the extent of surgery. Altogether, 34 patients required additional treatment. Patients presenting with clinically overt lymph node metastasis showed a significantly (p = 0.022) lower rate of becoming disease-free than those in whom microscopic lymph node involvement was unexpectedly found upon pathologic examination. There was no significant association of the eventual outcome with the extent of surgical treatment, TNM staging, or age.
Patients with lymph node metastasis are considerably less likely to become disease-free. If the initial treatment does not result in a disease-free status, chances are low that additional treatment will succeed in achieving it.
本研究旨在评估甲状腺乳头状癌（PTC）患者在诊断时伴有淋巴结转移的治疗效果及其对疾病进程的影响。
回顾性分析1990年1月至2003年1月在本中心接受I-131消融治疗的51例经组织学证实为PTC且伴有淋巴结转移的患者。如果在随访期间甲状腺球蛋白水平检测不到，且在促甲状腺激素刺激下用370MBq（131）I进行的闪烁扫描为阴性，则认为患者无疾病。患者分期按照TNM系统第5版进行。
中位随访84个月后，33例（65%）患者从未达到无疾病状态；其中3例患者死于PTC。总共有22例患者在甲状腺床外的颈部仍显示持续活性，在消融后闪烁扫描中怀疑为颈部淋巴结转移；这与初始临床表现（淋巴结转移或无转移疾病怀疑的甲状腺结节）或手术范围无关。共有34例患者需要额外治疗。临床明显有淋巴结转移的患者达到无疾病状态的比例显著低于（p = 0.022）病理检查意外发现微小淋巴结受累的患者。最终结局与手术治疗范围、TNM分期或年龄无显著关联。
伴有淋巴结转移的患者达到无疾病状态的可能性大大降低。如果初始治疗未导致无疾病状态，额外治疗成功实现这一状态的机会很低。
