Mercante Giuseppe, Frasoldati Andrea, Pedroni Corrado, Formisano Debora, Renna Luigi, Piana Simonetta, Gardini Giorgio, Valcavi Roberto, Barbieri Verter
Department of Otolaryngology, Thyroid Disease Center-Arcispedale Santa Maria Nuova of Reggio Emilia, Reggio Emilia, Italy.
Thyroid. 2009 Jul;19(7):707-16. doi: 10.1089/thy.2008.0270.
The management of thyroid papillary microcarcinoma (PMC) is controversial. Total thyroidectomy, thyroid lobectomy/isthmectomy, and even no treatment have been proposed. We investigated the clinical course and prognostic factors for disease recurrence and distant metastasis in 445 patients with PMC.
Data from 445 patients diagnosed with PMC in the period from 1978 to 2003 were reviewed and analyzed. Total thyroidectomy was performed in 404 patients and loboisthmusectomy in 41. Neck dissection took place in 226 patients (49.7%), with 166 of only the central compartment and 60 of both the central and lateral compartments. Radioiodine ((131)I) ablation treatment was given to 389 patients.
Median tumor size was 7 mm (range 1-10 mm). PMC was multifocal in 156 cases (35%) and bilateral in 60 cases (13.5%). Extrathyroidal tumor extension (pT3) and neck lymph node metastasis (pN1) were present in 133 (30%) and 182 (40.9%) patients, respectively. Capsular invasion without extrathyroidal tumor extension was observed in 39 (8.7%) patients. Mean follow-up was 5.3 (range 1-26) years. Seventeen (3.8%) patients had recurrence or persistence of disease: neck recurrence (NR) in 12 (2.7%), distant metastasis (DM) in four (0.9%), NR + DM in one (0.2%). One patient (0.2%) died of the disease. Capsular invasion, extrathyroidal tumor extension (pT3), and neck lymph node metastasis at presentation (pN1) were the only independent risk factors for NR and/or DM occurrence (p < 0.05). Patients not showing these features, who were treated with loboisthmusectomy only, never experienced disease recurrence.
Total thyroidectomy seems advisable in PMC with extrathyroidal extension and neck lymph node metastasis at presentation. Capsular invasion without extrathyroidal extension may suggest aggressive tumor behavior and require radical treatment.
甲状腺微小乳头状癌（PMC）的治疗存在争议。有人提出应行甲状腺全切术、甲状腺叶切除术/峡部切除术，甚至不进行治疗。我们研究了445例PMC患者的临床病程以及疾病复发和远处转移的预后因素。
回顾并分析了1978年至2003年期间诊断为PMC的445例患者的数据。404例行甲状腺全切术，41例行甲状腺叶峡部切除术。226例患者（49.7%）进行了颈部清扫术，其中仅清扫中央区166例，同时清扫中央区和侧区60例。389例患者接受了放射性碘（¹³¹I）消融治疗。
肿瘤中位大小为7mm（范围1 - 10mm）。PMC多灶性病变156例（35%），双侧病变60例（13.5%）。分别有133例（30%）和182例（40.9%）患者存在甲状腺外肿瘤侵犯（pT3）和颈部淋巴结转移（pN1）。39例（8.7%）患者存在包膜侵犯但无甲状腺外肿瘤侵犯。平均随访时间为5.3年（范围1 - 26年）。17例（3.8%）患者出现疾病复发或持续存在：颈部复发（NR）12例（2.7%），远处转移（DM）4例（0.9%），颈部复发 + 远处转移1例（0.2%）。1例患者（0.2%）死于该疾病。包膜侵犯、甲状腺外肿瘤侵犯（pT3）以及初次就诊时颈部淋巴结转移（pN1）是NR和/或DM发生的唯一独立危险因素（p < 0.05）。未表现出这些特征且仅接受甲状腺叶峡部切除术治疗的患者从未出现疾病复发。
对于初次就诊时存在甲状腺外侵犯和颈部淋巴结转移的PMC患者，甲状腺全切术似乎是可取的。存在包膜侵犯但无甲状腺外侵犯可能提示肿瘤行为具有侵袭性，需要进行根治性治疗。
