O'Neill C J, Vaughan L, Learoyd D L, Sidhu S B, Delbridge L W, Sywak M S
University of Sydney Endocrine Surgical Unit, St Leonards, NSW, Australia.
Eur J Surg Oncol. 2011 Feb;37(2):181-5. doi: 10.1016/j.ejso.2010.11.005. Epub 2010 Dec 8.
Follicular thyroid carcinoma (FTC) includes a spectrum of neoplasms with varying propensity for metastasis. The aim of this study is to describe outcomes for FTC following multimodality treatment, with particular reference to the degree of capsular and vascular invasion and to recommend a rational management approach based on these characteristics.
Patients with histologically confirmed FTC were identified from a prospectively maintained database. Details of intervention and long-term outcomes were obtained. Outcomes were compared between patients with minimally invasive follicular carcinoma (MI FTC) without vascular invasion (Group 1); angioinvasive MI FTC (Group 2); and those with widely invasive FTC (Group 3).
Between May 1983 and December 2008, 124 patients with FTC were identified. The overall disease-free survival rate was 85% at a median of 40 months follow-up. Disease-free survival was 97%, 81% and 46%, respectively, in Groups 1, 2 and 3, and significantly different between groups (p<0.001). Thirteen patients in this series developed distant metastases including 2 in Group 1 and 6 in Group 2. Only patients <45 years of age with MI FTC and no vascular invasion had 100% disease-free survival. After multivariate linear regression, age (p=0.03) and the presence of vascular invasion (p=0.03) were the most powerful predictors of distant metastasis.
Survival is improved in those with minimally invasive compared with widely invasive FTC. In patients <45 years with MI FTC without vascular invasion, hemithyroidectomy may be adequate treatment. All other patients with FTC should undergo total thyroidectomy and radioactive iodine ablation.
滤泡状甲状腺癌（FTC）包括一系列具有不同转移倾向的肿瘤。本研究的目的是描述FTC多模式治疗后的结果，特别提及包膜和血管侵犯程度，并根据这些特征推荐合理的管理方法。
从一个前瞻性维护的数据库中识别出组织学确诊为FTC的患者。获取干预细节和长期结果。对无血管侵犯的微小浸润性滤泡癌（MI FTC）患者（第1组）、血管侵犯性MI FTC患者（第2组）和广泛浸润性FTC患者（第3组）的结果进行比较。
1983年5月至2008年12月期间，共识别出124例FTC患者。中位随访40个月时，总体无病生存率为85%。第1组、第2组和第3组的无病生存率分别为97%、81%和46%，组间差异有统计学意义（p<0.001）。本系列中有13例患者发生远处转移，其中第1组2例，第2组6例。只有年龄<45岁的MI FTC且无血管侵犯的患者无病生存率为100%。多因素线性回归分析后，年龄（p=0.03）和血管侵犯的存在（p=0.03）是远处转移的最强预测因素。
与广泛浸润性FTC相比，微小浸润性FTC患者的生存率更高。对于年龄<45岁、MI FTC且无血管侵犯的患者，半甲状腺切除术可能是充分的治疗方法。所有其他FTC患者均应接受全甲状腺切除术和放射性碘消融治疗。
