Kobayashi Kenya, Takenouchi Shigeo, Mitani Hiroki, Yoshida Tuyoshi
Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan; Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan.
Auris Nasus Larynx. 2014 Dec;41(6):548-51. doi: 10.1016/j.anl.2014.05.012. Epub 2014 Jun 26.
Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma.
We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk.
The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p<0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (≥4cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis.
Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence.
基于风险的治疗是甲状腺乳头状癌的最佳管理策略；然而，甲状腺切除术和颈部清扫术的最佳范围仍存在争议。本研究旨在阐明甲状腺乳头状癌患者保守手术后的复发模式。
我们回顾性分析了93例行保守手术治疗的甲状腺乳头状癌患者。我们分析了根据风险分层的患者的复发率、复发模式、复发危险因素、挽救性治疗和无病生存期（DFS）。
低风险组的复发率显著低于高风险组（14%对34%；p<0.01）。两组的复发模式也有所不同，低风险组同侧颈部复发更为常见（9%），而高风险组对侧颈部复发更为常见（18%）。有对侧甲状腺叶转移和/或对侧甲状腺叶直接侵犯的患者，其对侧颈部转移率显著高于无这两种特征的患者。所有患者的总体5年DFS为81%。在单因素分析中，T和N分期较晚、原发肿瘤较大（≥4cm）、甲状腺外侵犯和高风险组与较差的5年DFS显著相关。
保守手术可能是低风险甲状腺乳头状癌患者的良好治疗选择。不同风险组的肿瘤复发模式不同，对侧甲状腺叶病变和对侧叶直接侵犯是对侧颈部复发的危险因素。
