Dipartimento di Medicina Interna e Specialità Medica, Università di Roma Sapienza, V.le del Policlinico, 155, 00161 Rome, Italy.
J Clin Endocrinol Metab. 2013 Feb;98(2):636-42. doi: 10.1210/jc.2012-3401. Epub 2013 Jan 4.
The current use of life-long follow-up in patients with papillary thyroid cancer (PTC) is based largely on the study of individuals diagnosed and treated in the latter half of the 20th century when recurrence rates were approximately 20% and relapses detected up to 20-30 years after surgery. Since then, however, diagnosis, treatment, and postoperative monitoring of PTC patients have evolved significantly.
The objective of the study was to identify times to PTC recurrence and rates by which these relapses occurred in a more recent patient cohort.
We retrospectively analyzed follow-up data for 1020 PTC patients consecutively diagnosed in 1990-2008 in 8 Italian hospital centers for thyroid disease. Patients underwent thyroidectomy, with or without radioiodine ablation of residual thyroid tissue and were followed up with periodic serum thyroglobulin assays and neck sonography.
At the initial posttreatment (≤ 12 months) examination, 948 patients had no structural/functional evidence of disease. During follow-up (5.1-20.4 years; median 10.4 years), recurrence (cervical lymph nodes, thyroid bed) was diagnosed in 13 (1.4%) of these patients. All relapses occurred 8 or fewer years after treatment (10 within the first 5 years, 6 within the first 3 years). Recurrence was unrelated to the use/omission of postoperative radioiodine ablation.
In PTC patients whose initial treatment produces disease remission (no structural evidence of disease), recurrent disease is rare, and it usually occurs during the early postoperative period. The picture of recurrence timing during the follow-up provides a foundation for the design of more cost-effective surveillance protocols for PTC patients.
目前对甲状腺乳头状癌（PTC）患者进行终身随访主要基于 20 世纪后半叶确诊和治疗的患者的研究，当时复发率约为 20%，手术后 20-30 年内可检测到复发。然而，自那时以来，PTC 患者的诊断、治疗和术后监测已经发生了显著变化。
本研究的目的是确定在最近的患者队列中 PTC 复发的时间和复发率。
我们回顾性分析了 1990-2008 年间在意大利 8 家甲状腺疾病中心连续确诊的 1020 例 PTC 患者的随访数据。患者接受甲状腺切除术，伴或不伴残留甲状腺组织的放射性碘消融，并定期进行血清甲状腺球蛋白测定和颈部超声检查。
在初始治疗后（≤12 个月）检查时，948 例患者无结构/功能疾病证据。在随访期间（5.1-20.4 年；中位 10.4 年），其中 13 例（1.4%）患者诊断出复发（颈部淋巴结、甲状腺床）。所有复发均发生在治疗后 8 年以内（10 例发生在第 5 年内，6 例发生在第 3 年内）。复发与术后放射性碘消融的使用/省略无关。
在初始治疗产生疾病缓解（无结构疾病证据）的 PTC 患者中，复发病例很少见，且通常发生在术后早期。随访期间复发时间的情况为设计更具成本效益的 PTC 患者监测方案提供了基础。
