Sarda A K, Kapur M M
Department of Surgery, All India Institute of Medical Sciences, New Delhi.
Acta Oncol. 1990;29(7):863-7. doi: 10.3109/02841869009096380.
A retrospective analysis of 206 cases of thyroid carcinoma treated at a single surgical service in a region with endemic goitre is presented. In contrast to the marked female preponderance in surgically treated benign thyroid disorders, the frequency of thyroid carcinoma was almost equal in the two sexes (males/females = 100/106). The duration of symptoms was, as a rule, short and there was a predominance of advanced lesions (T3N3M1) even among the well-differentiated tumours. Papillary carcinoma was the most common histologic type (45%) but its proportion was considerably lower than usually reported from non-endemic regions. The average TSH level was significantly elevated in the carcinoma group and associated adenomatous changes were found in 40/100 cases which might suggest an etiologic role of increased TSH stimulation. Since most thyroid carcinomas had a very malignant clinical behaviour, surgical treatment aimed at near-total thyroidectomy which was performed in 62% of the cases. During a follow-up of up to eleven years recurrence in the remaining contralateral lobe occurred in 23% of patients with hemithyroidectomy and loco-regional recurrence was seen in 29% of patients with near-total thyroidectomy. Mortality was high in all histologic types, further underlining the aggressive biologic behaviour of thyroid cancers in an endemic area.
本文对某地方性甲状腺肿流行地区单一外科治疗的206例甲状腺癌病例进行了回顾性分析。与外科治疗的良性甲状腺疾病中女性明显占优势不同，甲状腺癌在两性中的发病率几乎相等（男性/女性 = 100/106）。通常症状持续时间较短，即使在高分化肿瘤中，晚期病变（T3N3M1）也占主导。乳头状癌是最常见的组织学类型（45%），但其比例明显低于非流行地区通常报道的比例。癌组平均促甲状腺激素（TSH）水平显著升高，100例中有40例发现相关腺瘤样改变，这可能提示TSH刺激增加的病因学作用。由于大多数甲状腺癌具有非常恶性的临床行为，手术治疗目标是近全甲状腺切除术，62%的病例实施了该手术。在长达11年的随访中，行半甲状腺切除术的患者对侧剩余叶复发率为23%，行近全甲状腺切除术的患者局部区域复发率为29%。所有组织学类型的死亡率都很高，这进一步凸显了流行地区甲状腺癌的侵袭性生物学行为。
