Sugitani Iwao, Fujimoto Yoshihide, Yamamoto Noriko
Division of Head and Neck, Cancer Institute Hospital, Tokyo, Japan.
Surgery. 2008 Jan;143(1):35-42. doi: 10.1016/j.surg.2007.06.011. Epub 2007 Dec 3.
The presence of distant metastases is the most important predictive factor of poor outcomes in patients with papillary thyroid carcinoma (PTC). Some patients have very slow-growing distant metastases with relatively favorable outcomes, so predicting prognosis is not easy. Furthermore, many patients with distant metastases show locally advanced disease, and no consensus is available for operative control of cervical tumor in this situation.
Among 1023 patients with PTC who underwent primary thyroidectomy from 1976 to 2002, 42 patients displayed distant metastases at initial presentation and 44 patients developed distant metastases during follow-up. We reviewed the records retrospectively of these 86 patients. Mean duration of follow-up after detection of distant metastases was 7 years. Our treatment approach for patients with locally advanced neoplasms was radical resection including extensive neck dissection and extended resection of the involved organs, even when distant metastases were present.
Disease-specific survival of the 86 patients with distant metastases at 5 and 10 years was 65% and 45%, respectively. Using multivariate analysis, older age at time of distant metastases detection, distant metastases involving sites other than the lung, distant metastases diameter > or = 2 cm, presence of large nodal metastases (> or = 3 cm), and a primary neoplasm with poorly differentiated components were all predictive of worse prognosis. Our aggressive approach allowed curative resection in all but 1 patient, and only 5 patients (6%) succumbed to local disease. Patients with cervical recurrences displayed worse prognosis than those without.
Although the currently employed modalities of therapy for distant metastases do not have definitive impact on survival, some PTC patients with distant metastases, including younger patients with well-differentiated, small lung metastases appear to have relatively favorable outcomes. Local operative control of PTC is important even in patients with distant metastases, particularly when the distant metastases appear to be slow-growing.
远处转移的存在是甲状腺乳头状癌（PTC）患者预后不良的最重要预测因素。一些患者的远处转移生长非常缓慢，预后相对较好，因此预测预后并不容易。此外，许多有远处转移的患者表现为局部晚期疾病，在这种情况下，对于颈部肿瘤的手术控制尚无共识。
在1976年至2002年接受初次甲状腺切除术的1023例PTC患者中，42例在初次就诊时即出现远处转移，44例在随访期间出现远处转移。我们回顾性分析了这86例患者的记录。远处转移发现后的平均随访时间为7年。对于局部晚期肿瘤患者，我们的治疗方法是根治性切除，包括广泛的颈部清扫和受累器官的扩大切除，即使存在远处转移。
这86例有远处转移的患者5年和10年的疾病特异性生存率分别为65%和45%。多因素分析显示，远处转移发现时年龄较大、远处转移累及肺以外部位、远处转移直径≥2 cm、存在大的淋巴结转移（≥3 cm）以及原发性肿瘤伴有低分化成分均提示预后较差。我们积极的治疗方法使除1例患者外的所有患者均得以根治性切除，仅有5例患者（6%）死于局部疾病。有颈部复发的患者预后比无颈部复发的患者差。
尽管目前用于治疗远处转移的方法对生存率没有决定性影响，但一些有远处转移的PTC患者，包括年轻的、分化良好的小肺转移患者，似乎有相对较好的预后。即使对于有远处转移的患者，PTC的局部手术控制也很重要，特别是当远处转移生长似乎缓慢时。
