Abboud Bassam, Tannoury Jenny
Department of General Surgery, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
J Med Liban. 2011 Oct-Dec;59(4):206-12.
Papillary carcinoma accounts for 85% of differentiated thyroid cancers. We witness a yearly increased incidence and this is may be, in part, due to the increasing use of neck ultrasonography. Certain histologic subtypes of papillary carcinoma have a worse prognosis related to vascular invasion, invasion into extrathyroidal tissues, extensive tumor necrosis and/or mitoses. Adequate surgery is the most important treatment variable influencing prognosis, while radioactive iodine treatment, TSH suppression, and external beam irradiation each play adjunctive roles in at least some patients. Numerous schemes have been developed in an effort to achieve more accurate risk factor stratification. Each of the schemes allows accurate identification of the majority (70-85%) of patients at low risk of mortality (T1-3, M0 patients), allowing the follow-up and management of these patients to be less intensive than the higher-risk minority (T4 and M1 patients), who may benefit from a more aggressive management strategy. Overall 5- and 20-year survival in the low-risk group was 100% and 99% respectively. However, the survival in the high-risk group dropped to almost 72% and 57% respectively.
乳头状癌占分化型甲状腺癌的85%。我们发现其发病率逐年上升，这可能部分归因于颈部超声检查的使用增加。乳头状癌的某些组织学亚型预后较差，与血管侵犯、甲状腺外组织侵犯、广泛的肿瘤坏死和/或核分裂有关。充分的手术是影响预后的最重要治疗变量，而放射性碘治疗、促甲状腺激素抑制和外照射在至少部分患者中各自发挥辅助作用。为了实现更准确的危险因素分层，已经制定了许多方案。每个方案都能准确识别出大多数（70-85%）死亡风险低的患者（T1-3、M0患者），使得这些患者的随访和管理强度低于高风险少数患者（T4和M1患者），后者可能受益于更积极的管理策略。低风险组的总体5年和20年生存率分别为100%和99%。然而，高风险组的生存率分别降至近72%和57%。
