Department of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.
Clin Nucl Med. 2013 May;38(5):332-8. doi: 10.1097/RLU.0b013e3182872ed2.
Differentiated thyroid microcarcinoma (DTM) has a good prognosis and survival, but recurrent disease may appear during follow-up. The aim of this study was to evaluate the influence of initial treatment including surgery and radioactive iodine (131I) on the survival and recurrence in patients with DTM.
Between January 1979 and December 2006, 130 patients with DTM were retrospectively evaluated, with a median follow-up of 10 years. Total/near-total thyroidectomy was performed in 121 (93.1%) of 130 patients, followed with 131I ablation in 71 (54.6%) of 130 patients.
The probability of disease-specific survival was 97.7% ± 1.3% after 5 and 10 years; the probability of disease-specific survival was 95.9% ± 2.2% after 15, 20, 25, and 28 years after the initial treatment and was significantly influenced by recurrence, clinical stage, and patients' age (P = 0.0001, P = 0.0005, and P = 0.02, respectively). Sex, histopathological type of the tumor, metastases at presentation, initial treatment, performance of radioactive therapy, and risk categories had no influence on survival (P = 0.8, P = 0.6, P = 0.1, P = 0.4, P = 0.5, and P = 0.1, respectively). The overall recurrence rate was 10.8%, (6.9% in lymph nodes, 1.5% in thyroid bed, and 2.3% at distant sites), with a median appearance time of 30 months. Recurrences were significantly influenced by regional metastases at presentation, radioiodine ablation, and initial treatment (P = 0.0002, P = 0.005, and P = 0.003, respectively); there was no relationship based on age, sex, histological type of the tumor, and tumor multifocality.
To perform more accurate surveillance for recurrence, total/near-total thyroidectomy followed by radioiodine ablation may be the optimal initial treatment for patients with DTM.
分化型甲状腺微小癌（DTM）预后及生存率良好，但在随访期间可能出现疾病复发。本研究旨在评估初始治疗（包括手术和放射性碘[131I]治疗）对 DTM 患者生存和复发的影响。
1979 年 1 月至 2006 年 12 月，回顾性分析了 130 例 DTM 患者，中位随访时间为 10 年。130 例患者中 121 例行甲状腺全/近全切除术（93.1%），71 例行 131I 消融术（54.6%）。
5 年和 10 年后疾病特异性生存率分别为 97.7%±1.3%；治疗后 15、20、25 和 28 年时疾病特异性生存率分别为 95.9%±2.2%，且明显受到复发、临床分期和患者年龄的影响（P=0.0001，P=0.0005，P=0.02）。性别、肿瘤组织病理学类型、首发时转移、初始治疗、放射性治疗和危险分层对生存率无影响（P=0.8，P=0.6，P=0.1，P=0.4，P=0.5，P=0.1）。总复发率为 10.8%（淋巴结 6.9%，甲状腺床 1.5%，远处转移 2.3%），中位复发时间为 30 个月。复发明显受局部转移、放射性碘消融和初始治疗的影响（P=0.0002，P=0.005，P=0.003）；年龄、性别、肿瘤组织病理学类型和肿瘤多灶性与复发无相关性。
对于 DTM 患者，行甲状腺全/近全切除术联合放射性碘消融术进行治疗，可能是更准确监测疾病复发的最佳初始治疗方案。
