29 例局部晚期滤泡或 Hurthle 细胞甲状腺癌患者的新辅助化疗：一项 2 期研究。

Neoadjuvant chemotherapy in 29 patients with locally advanced follicular or Hürthle cell thyroid carcinoma: a phase 2 study.

机构信息

Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia.

出版信息

Thyroid. 2012 Feb;22(2):131-7. doi: 10.1089/thy.2011.0243. Epub 2011 Dec 16.

DOI:10.1089/thy.2011.0243

PMID:22175241

Abstract

BACKGROUND

It is believed that chemotherapy (ChT) is ineffective in follicular thyroid carcinoma (FTC) and Hürthle cell thyroid carcinoma (HCTC). The aim of our retrospective study was to find out whether neodjuvant ChT before thyroid surgery had any effect on the size of primary tumor in patients with FTC or HCTC.

METHODS

The study included 29 patients (20 women, 9 men; mean age: 60.8 years) with FTC or HCTC who had T3 or T4 tumor and were treated with neoadjuvant ChT from 1979 to 2004. A mean tumor diameter was 9.3 cm. Extrathyroid growth of tumor was present in 15 patients. Regional and distant metastases were detected in 6 and 12 patients, respectively. With respect to the site of metastatic spread, the lung was involved in eight patients and the skeleton in five. ChT consisted of vinblastine in 19 cases, vinblastine with adriamycin in 5 cases, or other ChT regimens in 5 cases.

RESULTS

Altogether, 67 cycles of ChT were given and tumor size decreased by >50% in 13 patients (=45%). ChT was effective in patients with FTC and HCTC in 47% and 43%, respectively. In the patients with and without distant metastases, the primary tumor size decreased by >50% in 17% and 65% (p=0.02), respectively. R0, R1, and R2 resection was performed in 15, 10, and 4 cases, respectively. Histopathology revealed that ChT (i.e., wide areas of tumor necrosis) was effective in seven patients (24%). The 5- and 10-year cause-specific survivals of the patients were 77% and 47%, while the 5- and 10-year disease-free intervals were 57% and 46%, respectively. Six patients are alive (median survival: 162 months), four of them have no evidence of disease, six patients died of other causes (median survival: 101 months), while 17 patients died of FTC or HCTC (median survival: 72 months). Among them, 16 died of distant metastases, while only one succumbed to locoregional recurrence and distant metastases.

CONCLUSIONS

ChT before surgical procedure may be effective in order to decrease the tumor size in FTC or HCTC in 45% of patients.

摘要

背景

据信，化疗（ChT）在滤泡状甲状腺癌（FTC）和 Hurthle 细胞甲状腺癌（HCTC）中无效。我们回顾性研究的目的是确定甲状腺手术前的新辅助 ChT 是否会影响 FTC 或 HCTC 患者的原发性肿瘤大小。

方法

该研究纳入了 1979 年至 2004 年间接受新辅助 ChT 治疗的 29 例 FTC 或 HCTC 患者（20 名女性，9 名男性；平均年龄：60.8 岁），这些患者 T3 或 T4 肿瘤且肿瘤有外甲状腺生长。平均肿瘤直径为 9.3cm。15 例患者有肿瘤外侵。6 例患者有局部和远处转移，12 例患者有远处转移。就转移性扩散部位而言，8 例患者累及肺部，5 例患者累及骨骼。ChT 包括长春碱 19 例，长春碱联合多柔比星 5 例，或其他 ChT 方案 5 例。

结果

共给予 67 个周期的 ChT，13 例（45%）患者肿瘤大小减少>50%。FTC 和 HCTC 患者的 ChT 有效率分别为 47%和 43%。在有和无远处转移的患者中，原发性肿瘤大小减少>50%的比例分别为 17%和 65%（p=0.02）。R0、R1 和 R2 切除分别在 15、10 和 4 例患者中进行。组织病理学显示，ChT（即广泛的肿瘤坏死）在 7 例患者中有效（24%）。患者的 5 年和 10 年特异性生存率分别为 77%和 47%，而 5 年和 10 年无病间隔分别为 57%和 46%。6 例患者存活（中位生存期：162 个月），其中 4 例无疾病证据，6 例死于其他原因（中位生存期：101 个月），17 例死于 FTC 或 HCTC（中位生存期：72 个月）。其中，16 例死于远处转移，而仅有 1 例死于局部复发和远处转移。