分化型甲状腺癌的长期预后：发展中国家的经验。
Long-term outcome of differentiated thyroid carcinoma: experience in a developing country.
机构信息
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India.
出版信息
World J Surg. 2010 Jan;34(1):40-7. doi: 10.1007/s00268-009-0293-y.
BACKGROUND
The presentation and outcome of differentiated thyroid carcinoma (DTC) in developing countries are different from the developed nations. We report the clinicopathologic profile and long-term outcome of DTC in an iodine-deficient area (IDA) in a developing country.
METHODS
This retrospective study included 302 patients with DTC operated between 1989 and 2002. These patients had been followed up for a minimum period of 5 years after surgery. Clinicopathological profile, intervention, and follow-up details were noted.
RESULTS
Mean age of the patients was 42 +/- 14 years. Mean follow-up period was 80 +/- 34 (24-196) months. Papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and poorly differentiated thyroid carcinoma (PDTC) was present in 62, 30, and 8% patients, respectively. Mean tumor size was 3.5 cm. Tumor multicentricity was noted in 40% of PTC, 22.2% of FTC, and 25% of PDTC patients. Lymphadenopathy was observed in 45, 10, and 67% patients with PTC, FTC, and PDTC, respectively. Extrathyroidal invasion and distant metastasis were observed in 36.8% (PTC 33%; FTC 36%; PDTC 71%) and 27% (PTC 17%; FTC 44%; PDTC 42%) of cases, respectively. Twenty percent of patients had synchronous metastases. Risk stratification ratio was 1:1.8 (high-risk vs. low-risk). Initial operative procedure was total thyroidectomy in 86.5% cases, and therapeutic lymph node dissection was performed in 37% cases. A total of 77.2% patients received adjuvant radioiodine therapy. Disease recurred in 26.6% of patients (thyroid bed recurrence 1.7%), and 21.2% patients died during follow-up. Overall survival (OS) rate at 10 years in both low-risk and high-risk groups of FTC (80 and 54%) was inferior to PTC (94 and 62%). Five-year OS for PDTC was 50%. Tumor multicentricity was a significant risk factor for OS in the low-risk group, whereas the presence of skeletal metastases and extrathyroidal invasion were significant factors for OS in the high-risk group.
CONCLUSIONS
Advance stage at presentation and proportionately high rates of FTC and PDTC contribute to poor outcome of DTC in developing countries. Despite dismal outcome, total thyroidectomy seems to prevent thyroid bed recurrence in surviving patients.
背景
发展中国家分化型甲状腺癌（DTC）的表现和结局与发达国家不同。我们报告了在碘缺乏地区（IDA）的一个发展中国家的 DTC 的临床病理特征和长期结果。
方法
本回顾性研究纳入了 1989 年至 2002 年间手术治疗的 302 例 DTC 患者。这些患者在手术后至少随访了 5 年。记录了临床病理特征、干预和随访细节。
结果
患者的平均年龄为 42±14 岁。平均随访时间为 80±34（24-196）个月。乳头状甲状腺癌（PTC）、滤泡状甲状腺癌（FTC）和未分化甲状腺癌（PDTC）分别占 62%、30%和 8%的患者。平均肿瘤大小为 3.5cm。40%的 PTC、22.2%的 FTC 和 25%的 PDTC 患者存在肿瘤多中心性。45%的 PTC、10%的 FTC 和 67%的 PDTC 患者出现淋巴结病。36.8%（PTC 33%；FTC 36%；PDTC 71%）和 27%（PTC 17%；FTC 44%；PDTC 42%）的患者分别存在甲状腺外侵犯和远处转移。20%的患者有同步转移。风险分层比为 1:1.8（高危 vs. 低危）。初始手术方式为全甲状腺切除术的占 86.5%，行治疗性淋巴结清扫术的占 37%。共有 77.2%的患者接受了辅助放射性碘治疗。26.6%的患者出现疾病复发（甲状腺床复发 1.7%），21.2%的患者在随访期间死亡。低危和高危 FTC 的 10 年总生存率（分别为 80%和 54%）均低于 PTC（分别为 94%和 62%）。PDTC 的 5 年总生存率为 50%。肿瘤多中心性是低危组 OS 的显著危险因素，而骨骼转移和甲状腺外侵犯的存在是高危组 OS 的显著因素。
结论
就诊时的晚期阶段以及 FTC 和 PDTC 的比例较高导致发展中国家 DTC 的结局较差。尽管预后不佳，但全甲状腺切除术似乎可以预防存活患者的甲状腺床复发。
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