[多灶性甲状腺乳头状癌：168例临床分析]

Lin Yi-Kai, Sheng Jian-Ming, Zhao Wen-He, Wang Wei-Bin, Yu Xiong-Fei, Teng Li-Song, Ma Zhi-Min

Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou 310003, China.

Zhonghua Wai Ke Za Zhi. 2009 Mar 15;47(6):450-3.

OBJECTIVE

To investigate the clinical features and treatment of multifocal papillary thyroid carcinoma (PTC).

METHODS

A retrospective survey was carried out in 648 patients with PTC who underwent surgery from January 1997 to December 2006. One hundred and sixty-eight cases of the patients presented with multiple tumor masses (> or = 2). The risk factors, including sex of the patients, age at diagnosis, family history of thyroid tumor, multiplicity and bilaterality of tumor, extra-thyroidal extension, lymph node involvement and other were analyzed between solitary PTC and multifocal PTC group.

RESULTS

The mean age of the patients was 42 years (range, 14 - 78 years), included 49 male and 119 female. Tumor foci were found in both thyroid lobes in 117 cases (69.6%). Patients with multifocal PTC were characterized by a higher ratio of male (P = 0.004), family history of thyroid tumor (P = 0.031), neck lymph node metastasis (P = 0.008) and extra-thyroidal extension (P = 0.001). However, solitary PTC tended to be with a higher rate of benign goiters in pathologic examination. In multifocal PTC group, male, neck lymphadenectasis, > or = 3 tumor masses or bilaterality of tumor tended to presented with larger tumor, more neck lymph node metastasis and extra-thyroidal extension; And a less malignant tumor in the cases detected with benign goiters in histological examination. By the end of 2007, 164 cases (97.6%) completed follow-up with a mean period of 46.1 months (range, 2 - 127 months), 5 died in the meantime. One patient has been followed-up for 16 months for suspect of lung metastases by chest X-ray. Recurrence occurred in 8 patients and were re-resected, 2 in remnant thyroid and 6 in neck lymph nodes. The overall 1-, 2-, 5-, and 10-year survival rate was 98.2%, 97.4%, 96.5% and 96.5%, respectively. American Joint Committee on Cancer (AJCC) stage was associated with prognosis significantly (chi(2) = 168.832, P = 0.000).

CONCLUSIONS

Multifocus is one of the clinical features of PTC and is more malignant than solitary PTC. Total thyroidectomy with central compartment neck dissection could be standard treatment. Lateral nodal dissection is not necessary except for the cases with lymph node metastasis. AJCC stage is still the best prognostic factor.

目的

探讨多灶性甲状腺乳头状癌（PTC）的临床特征及治疗方法。

方法

对1997年1月至2006年12月期间接受手术治疗的648例PTC患者进行回顾性研究。其中168例患者表现为多个肿瘤病灶（≥2个）。分析了单发PTC组和多灶性PTC组之间的危险因素，包括患者性别、诊断时年龄、甲状腺肿瘤家族史、肿瘤的多灶性和双侧性、甲状腺外侵犯、淋巴结转移等。

结果

患者平均年龄42岁（范围14 - 78岁），其中男性49例，女性119例。117例（69.6%）患者双侧甲状腺叶均发现肿瘤病灶。多灶性PTC患者的特点是男性比例较高（P = 0.004）、有甲状腺肿瘤家族史（P = 0.031）、颈部淋巴结转移（P = 0.008）和甲状腺外侵犯（P = 0.001）。然而，单发PTC在病理检查中良性甲状腺肿的发生率往往较高。在多灶性PTC组中，男性、颈部淋巴结清扫、≥3个肿瘤病灶或肿瘤双侧性往往表现为肿瘤较大、颈部淋巴结转移较多和甲状腺外侵犯；而组织学检查中伴有良性甲状腺肿的病例肿瘤恶性程度较低。截至2007年底，164例（97.6%）患者完成随访，平均随访时间46.1个月（范围2 - 127个月），期间5例死亡。1例患者因胸部X线怀疑肺转移，已随访16个月。8例患者复发并再次手术切除，2例在残留甲状腺复发，6例在颈部淋巴结复发。总体1年、2年、5年和10年生存率分别为98.2%、97.4%、96.5%和96.5%。美国癌症联合委员会（AJCC）分期与预后显著相关（χ² = 168.832，P = 0.000）。