复发性/持续性甲状腺乳头状癌患者行全面中央区清扫术的长期疗效。
Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma.
机构信息
Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
出版信息
Thyroid. 2011 Dec;21(12):1309-16. doi: 10.1089/thy.2011.0170.
BACKGROUND
Persistent or recurrent papillary thyroid carcinoma (PTC) occurs in some patients after initial thyroid surgery and often, radioactive iodine treatment. Here, we identify the efficacy, safety, and long-term outcome of our current surgical management paradigm for persistent/recurrent PTC in the central compartment in an interdisciplinary thyroid cancer clinical and research program at a tertiary thyroid cancer referral center.
METHODS
We retrospectively analyzed our standardized approach of comprehensive bilateral level VI/VII lymph node dissection (SND [VI, VII]) for cytologically confirmed PTC in the central compartment.
RESULTS
From 1994 to 2004, 210 patients, median age 42 (range 12-82) underwent SND (VI, VII). Most patients (106, 51%) had already undergone ≥2 surgical procedures for persistent or recurrent disease, and 31 (15%) had distant metastases at presentation. Postoperatively, 104 (71%) of the 146 patients who were thyroglobulin (Tg) positive had no evidence of disease. Anti-Tg antibodies were present in 38 patients (18%), 17 of whom (53%) did not have anti-Tg antibodies postoperatively. Fourteen patients (7%) were hypoparathyroid at presentation, and 2 more (1%) became permanently hypoparathyroid after surgery. Four patients (2%) experienced recurrent laryngeal nerve paralysis (RLNP) of a previously functioning nerve. Unanticipated RLNP was observed in only one nerve at risk. External beam radiation was given to 33 patients (17%). An additional 17 patients (8%) developed distant metastases during follow-up. At the last follow-up, 130 (66%) of the 196 patients had no detectable Tg; of these, 99 (76%) had no further evidence of disease. A median of 7.25 years after surgery, 167 (90%) of the 185 patients were without evidence of central disease, and 18 (10%) had developed central compartment recurrences within a median interval of 24.3 months. Of those with recurrence, 16 out of 18 patients (89%) underwent a subsequent surgical procedure, thus resulting in an overall 98% central compartment control rate. Kaplan-Meier disease-specific survival at 10 years was 98.9% for patients <45 years old and 77.9% for those ≥45 years old (log-rank p<0.00001). The only predictor of central compartment recurrence was malignancy in a thyroid remnant noted within the central compartment surgical specimen.
CONCLUSIONS
Bilateral comprehensive level VI/VII dissections are safe and effective for long-term control of recurrent/persistent PTC in the central lymphatic compartment.
背景
在初始甲状腺手术后和放射性碘治疗后，一些患者会出现持续性或复发性甲状腺乳头状癌（PTC）。在此，我们在一个三级甲状腺癌转诊中心的甲状腺癌临床和研究项目中，确定了我们目前针对中央隔室持续性/复发性 PTC 的综合双侧 VI/VII 水平淋巴结清扫术（SND [VI，VII]）的疗效、安全性和长期结果。
方法
我们回顾性分析了我们对中央隔室细胞学证实的 PTC 进行标准化双侧 VI/VII 水平淋巴结清扫术（SND [VI，VII]）的方法。
结果
1994 年至 2004 年，210 例患者，中位年龄 42 岁（范围 12-82 岁）接受了 SND（VI，VII）。大多数患者（106 例，51%）已经接受了≥2 次手术治疗持续性或复发性疾病，31 例（15%）在就诊时存在远处转移。术后，146 例甲状腺球蛋白（Tg）阳性的患者中有 104 例（71%）无疾病证据。38 例（18%）患者存在抗 Tg 抗体，其中 17 例（53%）术后不存在抗 Tg 抗体。14 例（7%）患者在就诊时甲状旁腺功能减退，2 例（1%）患者在手术后永久性甲状旁腺功能减退。4 例（2%）患者出现先前功能正常的喉返神经麻痹（RLNP）。仅在 1 个有风险的神经中观察到意外 RLNP。33 例（17%）患者接受了外照射。在随访期间，另外 17 例（8%）患者发生远处转移。最后一次随访时，196 例患者中有 130 例（66%）无法检测到 Tg；其中 99 例（76%）无进一步疾病证据。手术后中位数 7.25 年，185 例患者中有 167 例（90%）无中央疾病证据，18 例（10%）在中位数 24.3 个月内出现中央隔室复发。在有复发的患者中，18 例中有 16 例（89%）接受了进一步的手术治疗，因此总体中央隔室控制率为 98%。<45 岁患者的 10 年疾病特异性生存率为 98.9%，≥45 岁患者为 77.9%（对数秩检验 p<0.00001）。中央隔室手术标本中中央隔室残留甲状腺组织恶性肿瘤是中央隔室复发的唯一预测因素。
结论
双侧综合 VI/VII 清扫术是一种安全有效的方法，可长期控制中央淋巴结隔室复发性/持续性 PTC。
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