Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Thyroid. 2013 Aug;23(8):997-1002. doi: 10.1089/thy.2012.0403. Epub 2013 Jul 17.
To describe the outcome of patients with poorly differentiated thyroid cancer (PDTC) presenting with gross extrathyroidal extension (ETE).
After obtaining Institutional Review Board approval, we performed a retrospective review of a consecutive series of thyroid cancer patients treated by primary surgical resection with or without adjuvant therapy at Memorial Sloan-Kettering Cancer Center from 1986 to 2009. Out of 91 PDTC patients, 27 (30%) had gross ETE (T4a), and they formed the basis of our study. Of 27 patients, 52% were women. The median age was 70 years (range 27-87 years). Ten patients (37%) presented with distant metastases; four to bone, three to lung, and three to both bone and lung. All patients had extended total thyroidectomy, except two who had subtotal thyroidectomy. Twenty patients (74%) had central compartment neck dissection and 11 also had lateral neck dissection. Four patients had pN0, six (30%) pN1a, and 10 (50%) pN1b neck disease. Twenty-one patients (77%) had adjuvant therapy: 15 (55%) radioactive iodine (RAI) only, three (11%) postoperative external beam radiation (EBRT) only, and three (11%) had both RAI and EBRT. Overall survival (OS), disease-specific survival (DSS), local recurrence-free survival (LRFS), and regional recurrence-free survival (RRFS) were calculated by the Kaplan Meier method.
The median follow-up time was 57 months (range 1-197 months). The 5 year OS and DSS were 47% and 49%, respectively. This poor outcome was due to distant metastatic disease; 10 patients had distant metastases at presentation and a further six developed distant metastases during follow-up. Locoregional control was good with 5-year LRFS and RRFS of 70% and 62%, respectively. Overall, eight patients (30%) had recurrences: two had distant alone, two regional, two regional and distant, one local and distant, and one had local, regional, and distant recurrence.
Aggressive surgery in patients with PDTC showing gross ETE resulted in satisfactory locoregional control. Due to the small proportion of patients who received EBRT (22%), it is not possible to analyze its benefit on locoregional control. Of significance is the observation that the majority of patients (60%) who presented with or subsequently developed distant metastases eventually died of distant disease. New systemic therapies to target distant metastatic disease are required for improvements in outcome.
描述伴有明显甲状腺外侵犯（T4a）的分化型甲状腺癌（PDTC）患者的预后。
本研究回顾性分析了纪念斯隆-凯特琳癌症中心 1986 年至 2009 年间接受以手术为主的初始治疗（包括辅助治疗）的连续甲状腺癌患者。91 例 PDTC 患者中，27 例（30%）存在明显甲状腺外侵犯（T4a），构成本研究的基础。27 例患者中，52%为女性，中位年龄 70 岁（范围 27-87 岁）。10 例（37%）患者存在远处转移；4 例转移至骨，3 例转移至肺，3 例同时转移至骨和肺。除 2 例患者接受甲状腺次全切除术外，其余 25 例患者均接受全甲状腺切除术。20 例（74%）患者行中央区颈部淋巴结清扫术，11 例患者行侧颈部淋巴结清扫术。4 例患者为 pN0，6 例（30%）为 pN1a，10 例（50%）为 pN1b 颈部淋巴结转移。21 例（77%）患者接受辅助治疗：15 例（55%）仅接受放射性碘治疗（RAI），3 例（11%）仅接受术后外照射治疗（EBRT），3 例（11%）同时接受 RAI 和 EBRT。采用 Kaplan-Meier 法计算总生存（OS）、疾病特异性生存（DSS）、局部无复发生存（LRFS）和区域无复发生存（RRFS）。
中位随访时间为 57 个月（范围 1-197 个月）。5 年 OS 和 DSS 分别为 47%和 49%。这种不良预后归因于远处转移；10 例患者在就诊时即存在远处转移，6 例患者在随访期间发生远处转移。局部区域控制良好，5 年 LRFS 和 RRFS 分别为 70%和 62%。总体而言，8 例患者（30%）出现复发：2 例为远处复发，2 例为区域复发，2 例为区域和远处复发，1 例为局部和远处复发，1 例为局部、区域和远处复发。
在伴有明显甲状腺外侵犯的 PDTC 患者中进行积极的手术治疗可获得满意的局部区域控制。由于接受 EBRT（22%）的患者比例较小，因此无法分析其对局部区域控制的获益。值得注意的是，大多数（60%）出现或随后发生远处转移的患者最终死于远处转移疾病。需要新的靶向远处转移疾病的系统治疗方法来改善预后。
