Division of Head and Neck, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan.
World J Surg. 2012 Jun;36(6):1231-40. doi: 10.1007/s00268-012-1518-z.
Extrathyroidal invasion is one of the most significant risk factors for patients with papillary thyroid carcinoma (PTC). The purpose of this study was to evaluate a novel definition of extrathyroidal invasion for patients with PTC as a method for predicting a patient's prognosis.
The prospective study was conducted for consecutive 930 patients with primary PTC who received surgery during 1993-2009. We defined only patients who had preoperative recurrent laryngeal nerve palsy or patients in whom the tumor had invaded to the mucosa of the trachea and/or esophagus as Ex3. Patients with minimal invasion were classified as Ex1, and patients with massive invasion, when we could shave off the tumors, were classified as Ex2. Patients without extrathyroidal invasion were classified as Ex0.
Patients classified Ex3 showed significantly shorter disease-free survival (p = 0.03) and disease-specific survival (p = 0.007) than patients classified Ex2. The time to recurrence at resection sites was shorter in patients classified Ex3 than in patients classified Ex2 (p = 0.02). The time to death due to distant metastasis of patients classified Ex3 was significantly shorter than that of patients classified Ex2 (p = 0.02). Within the patients classified Ex3, disease-specific survival of patients with invasion to other nearby structures was shorter than that of patients with invasion to only recurrent laryngeal nerve (p = 0.008).
The degree and site of invasion is an important prognostic factor for PTC. Our novel classification of extrathyroidal invasion is valuable in predicting the prognosis of PTC.
甲状腺外侵犯是影响甲状腺乳头状癌（PTC）患者的最重要的危险因素之一。本研究旨在评估一种新的 PTC 甲状腺外侵犯定义，作为预测患者预后的一种方法。
前瞻性研究纳入了 1993 年至 2009 年间接受手术治疗的连续 930 例原发性 PTC 患者。我们仅将术前有喉返神经麻痹或肿瘤侵犯气管和/或食管黏膜的患者定义为 Ex3。微小侵犯患者被归类为 Ex1，广泛侵犯但可以刮除肿瘤的患者被归类为 Ex2。无甲状腺外侵犯的患者被归类为 Ex0。
Ex3 组患者的无病生存率（p=0.03）和疾病特异性生存率（p=0.007）明显低于 Ex2 组。Ex3 组患者的复发时间明显短于 Ex2 组（p=0.02）。Ex3 组患者因远处转移而死亡的时间明显短于 Ex2 组（p=0.02）。在 Ex3 组患者中，除喉返神经侵犯外，侵犯其他邻近结构的患者疾病特异性生存率明显短于仅侵犯喉返神经的患者（p=0.008）。
侵犯程度和部位是 PTC 的重要预后因素。我们提出的新的甲状腺外侵犯分类对预测 PTC 的预后具有重要价值。
