1 Department of Surgery, Walter Reed National Military Medical Center , Bethesda, Maryland.
Thyroid. 2014 Feb;24(2):241-4. doi: 10.1089/thy.2012.0567. Epub 2013 Sep 3.
The clinical importance of extrathyroidal extension (ETE) on outcome of papillary thyroid cancer (PTC), particularly with respect to disease extending to the surgical margin is not well established. This study assessed the importance of surgical margin and extrathyroidal invasion relative to local control of disease and oncologic outcome.
A retrospective analysis of a prospective institutional endocrine database was conducted on 276 patients with PTC treated between 1955 and 2004 to determine the impact of margin-negative resection (n=199, 72%), disease up to within 1 mm of surgical margin (n=19, 7%), microscopic (n=39, 14%), and gross (n=19, 7%) ETE. Data were compared with Fisher's exact test or analysis of variance (ANOVA).
Median follow-up was 3.1-6.8 years per study group (disease-free survival, range 1-37 years). The proportion of those with age >45 years, prior radiation exposure, distant metastasis at presentation, and those undergoing total thyroidectomy was not significantly different between groups. Tumor size and multifocality correlated with extent of local disease, which in turn was significantly associated with regional nodal disease at time of primary operation as well as prevalence of persistence of disease after multimodality therapy. Extent of local disease correlated significantly with subsequent clinical recurrence after a disease-free period (p=0.006); however, recurrence rates were not significantly different between negative and close (≤1 mm) margin resection.
Oncological outcome correlates with the extent of extrathyroidal invasion. Outcome is worse in patients with gross extrathyroidal disease extension than in those with microscopic local invasion apparent on histopathological assessment. However, the risk of clinical recurrence appears similar between patients undergoing margin-negative and "close margin" resection.
甲状腺外侵犯（ETE）对甲状腺乳头状癌（PTC）患者预后的临床重要性尚不清楚，尤其是对于侵犯手术切缘的患者。本研究评估了手术切缘和甲状腺外侵犯相对于疾病局部控制和肿瘤学结局的重要性。
对 1955 年至 2004 年间治疗的 276 例 PTC 患者的前瞻性机构内分泌数据库进行回顾性分析，以确定无边缘阴性切除（n=199，72%）、肿瘤侵犯至手术切缘 1mm 以内（n=19，7%）、显微镜下（n=39，14%）和大体（n=19，7%）甲状腺外侵犯的患者比例对疾病局部控制和肿瘤学结局的影响。数据采用 Fisher 确切检验或方差分析（ANOVA）进行比较。
各组的中位随访时间为 3.1-6.8 年（无病生存时间 1-37 年）。各组间年龄>45 岁、既往放疗、初诊时远处转移及行全甲状腺切除术的比例无显著差异。肿瘤大小和多灶性与局部疾病的范围相关，而局部疾病的范围又与原发手术时的区域淋巴结疾病以及多模式治疗后疾病持续存在的发生率显著相关。局部疾病的范围与无病间期后的临床复发显著相关（p=0.006）；然而，阴性和接近（≤1mm）切缘的患者复发率无显著差异。
肿瘤学结局与甲状腺外侵犯的范围相关。大体甲状腺外疾病侵犯的患者比组织学评估有微小局部侵犯的患者预后差。然而，在边缘阴性和“接近边缘”切除的患者中，临床复发的风险似乎相似。
