Vaisman F, Shaha A, Fish S, Michael Tuttle R
Endocrinology Service, Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USAEndocrinology Service, Universidade Federal do Rio de Janeiro and Instituto Nacional do Cancer, Rio de Janeiro, Brazil.
Clin Endocrinol (Oxf). 2011 Jul;75(1):112-9. doi: 10.1111/j.1365-2265.2011.04002.x.
To describe the risk of structural disease recurrence in a cohort of patients with differentiated thyroid cancer selected for treatment with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation (RRA).
Retrospective review.
A total of 289 patients were selected for either thyroid lobectomy (n = 72) or total thyroidectomy (n = 217) without RRA and followed with modern disease detection tools in a tertiary referral centre. Most patients had papillary thyroid cancer (89%) without clinically evident lymph node metastases (91%). However, 55% (156/289) of patients had primary tumours that were >1 cm and 10% (28/289) had minor extrathyroidal extension.
The primary endpoint was detection of recurrent/persistent structural disease.
After a 5-year median follow-up, structural disease recurrence was detected in 2·3% (5/217) of patients treated with total thyroidectomy without RRA, and in 4·2% (3/72) of patients treated with thyroid lobectomy. Size of the primary tumour, the presence of cervical lymph node metastases and American Thyroid Association risk category were all statistically significant predictors of recurrence. Changes in serum thyroglobulin were not helpful in identifying the presence of persistent/recurrent structural disease. Importantly, 88% (7/8) of the patients that had recurrent disease were rendered clinically disease free with additional therapies.
Initial risk stratification is able to identify a cohort of patients with differentiated thyroid cancer with a very low risk of structural disease recurrence following treatment with either thyroid lobectomy or total thyroidectomy without RRA. Our data strongly support a selective approach to the initial management of thyroid cancer.
描述一组接受甲状腺叶切除术或全甲状腺切除术且未进行放射性碘残留消融（RRA）治疗的分化型甲状腺癌患者中结构疾病复发的风险。
回顾性研究。
共有289例患者被选择接受甲状腺叶切除术（n = 72）或全甲状腺切除术（n = 217）且未进行RRA，并在一家三级转诊中心采用现代疾病检测工具进行随访。大多数患者患有乳头状甲状腺癌（89%），无临床明显的淋巴结转移（91%）。然而，55%（156/289）的患者原发肿瘤直径>1 cm，10%（28/289）的患者有轻微的甲状腺外侵犯。
主要终点是检测复发性/持续性结构疾病。
中位随访5年后，在未进行RRA的全甲状腺切除术治疗的患者中，2.3%（5/217）检测到结构疾病复发，在接受甲状腺叶切除术治疗的患者中，4.2%（3/72）检测到复发。原发肿瘤大小、颈部淋巴结转移情况以及美国甲状腺协会风险分类均为复发的统计学显著预测因素。血清甲状腺球蛋白的变化对识别持续性/复发性结构疾病并无帮助。重要的是，88%（7/8）的复发患者通过额外治疗实现了临床无病状态。
初始风险分层能够识别出一组分化型甲状腺癌患者，他们在接受甲状腺叶切除术或全甲状腺切除术且未进行RRA治疗后，结构疾病复发风险极低。我们的数据有力地支持了对甲状腺癌初始管理采取选择性方法。
