甲状腺髓样癌的外科治疗及预后分析

[Surgical treatment and prognosis analysis on medullary thyroid carcinoma].

作者信息

Zhang Zai-xing, Li Zheng-jiang, Tang Ping-zhang, Xu Zhen-gang, Zhang Zong-min, An Chang-ming

机构信息

Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Mar;46(3):209-13.

PMID:21575412

Abstract

OBJECTIVE

To study the clinical characteristics, the surgical treatments and the prognostic factors of medullary thyroid carcinoma.

METHODS

Eighty-two cases of medullary thyroid carcinoma undergoing surgeries between January 1999 and December 2004 were reviewed. There were 39 males and 43 females. Age ranged from 16 to 77 years old, with a median of 46 years old. The calcitonin, chromogranin A and neuron-specific enolase were analysed by immunohistochemistry in samples, and calcitonin was detected in 24 cases. Of them, 28 cases underwent lobectomy with isthmectomy, 24 for remained lobe dissection, 16 for total thyroidectomy, and 14 only for neck and upper mediastinal lymph node dissection. Of the 82 cases, 68 cases underwent trachea esophageal ditch dissection, 53 for unilateral neck dissection, 11 for bilateral neck dissection, 13 for upper mediastinal lymph node dissection through trans-cervical approach, and 5 for mediastinal lymph node dissection through inverted T-shaped incision.

RESULTS

Immunohistochemical examination revealed that the expression rates of calcitonin, chromogranin A and neuron-specific enolase were 95.8%, 88.9% and 80.0% respectively. Total metastasis rate of neck lymph nodes was 68.8%, and the rates in level II, III, IV, V and VI were 27.3%, 47.7%, 59.1%, 11.4% and 52.3% respectively. The overall five-year survival rate was 87.8%. The recurrent rate of contralateral lobes was 5.8% and local recurrent rate was 7.3% respectively. Univariate analysis showed that gender, age and TNM stage were significant prognostic factors. Multivariate analysis revealed that distant metastasis was an independent prognostic factor.

CONCLUSIONS

Standard radical surgery of the primary and metastatic lesion is key to the treatment of medullary thyroid carcinoma. Lobectomy with isthmectomy should be applied to sporadic medullary thyroid carcinoma, with regular postoperative follow-up, and total thyroidectomy to familial or bilateral medullary thyroid carcinoma. Therefore, detecting the calcitonin is very important for medullary thyroid carcinoma patients' prognosis.

摘要

目的

研究甲状腺髓样癌的临床特征、手术治疗方法及预后因素。

方法

回顾性分析1999年1月至2004年12月期间接受手术治疗的82例甲状腺髓样癌患者。其中男性39例，女性43例。年龄范围为16至77岁，中位年龄为46岁。对样本进行免疫组织化学分析降钙素、嗜铬粒蛋白A和神经元特异性烯醇化酶，24例检测到降钙素。其中，28例行甲状腺叶切除加峡部切除，24例行残留叶切除术，16例行甲状腺全切除术，14例仅行颈部及上纵隔淋巴结清扫术。82例患者中，68例行气管食管沟清扫术，53例行单侧颈部清扫术，11例行双侧颈部清扫术，13例行经颈部入路上纵隔淋巴结清扫术，5例行经倒“T”形切口纵隔淋巴结清扫术。

结果

免疫组织化学检查显示，降钙素、嗜铬粒蛋白A和神经元特异性烯醇化酶的表达率分别为95.8%、88.9%和80.0%。颈部淋巴结总转移率为68.8%，Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区转移率分别为27.3%、47.7%、59.1%、11.4%和52.3%。总体五年生存率为87.8%。对侧叶复发率和局部复发率分别为5.8%和7.3%。单因素分析显示，性别、年龄和TNM分期是显著的预后因素。多因素分析显示，远处转移是独立的预后因素。