Toniato Antonio, Boschin Isabella, Casara Dario, Mazzarotto Renzo, Rubello Domenico, Pelizzo Mariarosa
Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
Ann Surg Oncol. 2008 May;15(5):1518-22. doi: 10.1245/s10434-008-9859-4. Epub 2008 Mar 7.
The prognosis of patients with papillary thyroid carcinoma (PTC) is usually favorable; however, a subset of patients can develop local recurrence or distant metastases. The aim of this study was to evaluate the prognostic factors influencing the recurrence and the survival rate in 950 PTC patients.
From 1990 to 2005, 950 consecutive patients affected by PTC were operated on at our Department. We analyzed the prognostic role of the following parameters: gender, age at initial treatment, extent of thyroid surgery, node dissection, tumor size, node metastases, distant metastases, stage, and 131-I therapy.
Seventy-nine patients (8.3%) developed locoregional or distant metastases after an average follow-up of 7.8 years (range 2-17 years); in particular local recurrence was observed in 25 cases and distant metastases in 54 cases. The global 10- and 15-year survival rates were 91.38% and 88.69%, respectively. At univariate analysis, all variables were significantly correlated with recurrence (P = .001) except gender (P = .3); moreover, gender (P = .2), node dissection (P = .5), and node metastases (P = .06) were not significant on 10- and 15-year survival. At multivariate analysis the age at first treatment, T4, M+, stage IV, the extent of thyroid surgery, and the 131-I therapy resulted to be significant and independent prognostic factors (P < .001).
Our data, in disagreement with other staging systems, suggest that gender does not play a significant role both in recurrence and survival. Moreover, the 131-I therapy was a statistically significant prognostic factor at univariate and multivariate analyses.
甲状腺乳头状癌（PTC）患者的预后通常良好；然而，一部分患者会出现局部复发或远处转移。本研究的目的是评估影响950例PTC患者复发和生存率的预后因素。
1990年至2005年，我科对950例连续的PTC患者进行了手术。我们分析了以下参数的预后作用：性别、初始治疗时的年龄、甲状腺手术范围、淋巴结清扫、肿瘤大小、淋巴结转移、远处转移、分期和¹³¹-I治疗。
平均随访7.8年（范围2 - 17年）后，79例患者（8.3%）出现局部或远处转移；特别是25例出现局部复发，54例出现远处转移。10年和15年的总生存率分别为91.38%和88.69%。单因素分析时，除性别外（P = 0.3），所有变量均与复发显著相关（P = 0.001）；此外，性别（P = 0.2）、淋巴结清扫（P = 0.5）和淋巴结转移（P = 0.06）在10年和15年生存率方面无显著意义。多因素分析时，首次治疗时的年龄、T4、M⁺、IV期、甲状腺手术范围和¹³¹-I治疗是显著且独立的预后因素（P < 0.001）。
我们的数据与其他分期系统不同，表明性别在复发和生存方面均无显著作用。此外，在单因素和多因素分析中，¹³¹-I治疗都是具有统计学意义的预后因素。
