Huang Guomin, Tian Xiaofeng, Li Yuhui, Ji Fujian
Department of General Surgery, The China Japan Friendship Hospital of Jilin University Changchun 130012, China.
Int J Clin Exp Med. 2014 Dec 15;7(12):5802-7. eCollection 2014.
To investigate clinical characteristics and surgical treatment of multifocal papillary thyroid carcinoma.
A total of 648 patients diagnosed with papillary thyroid carcinoma were enrolled, 168 with multifocal papillary thyroid carcinoma. Clinicopathological factors including gender, age at diagnosis, family history of thyroid tumor, multiplicity and bilaterality of tumor, extra-thyroidal extension, lymph node involvement and other factors were statistically compared.
The incidence of multifocal papillary thyroid carcinoma was 25.9% and 117 presented with bilateral thyroid gland lesions. In multifocal group, patients had a higher ratio of male subjects, family history of thyroidal tumor, neck lymph node metastasis and extra-thyroidal extension by B-ultrasound. Solitary papillary thyroid carcinoma tended to be with a higher rate of benign goiters. In multifocal group, males with neck lymphadenectasis, ≥ 3 tumor masses or bilaterality of tumors tended to present with larger tumors, a higher incidence of neck lymph node metastasis and extra-thyroidal extension. 164 cases completed the follow-up, 5 died, 1 suspected with lung metastasis and still survived, 6 underwent repeated surgery due to lymph node recurrence at 3-41 months postoperatively and 2 surgically treated with recurrent gland tumor. Overall 1-, 2-, 5-, and 10-year survival rate was 98.2%, 97.4%, 96.5% and 96.5%, respectively.
Multifocal papillary thyroid carcinoma is more malignant and highly differentiated than solitary lesions. Total thyroidectomy combined with neck dissection of central compartment could be utilized as standard treatment. Lateral nodular dissection should be considered for the patients with lymph node metastasis.
探讨多灶性甲状腺乳头状癌的临床特征及手术治疗方法。
共纳入648例确诊为甲状腺乳头状癌的患者，其中168例为多灶性甲状腺乳头状癌。对性别、确诊年龄、甲状腺肿瘤家族史、肿瘤的多灶性和双侧性、甲状腺外侵犯、淋巴结受累等临床病理因素进行统计学比较。
多灶性甲状腺乳头状癌的发生率为25.9%，117例表现为双侧甲状腺病变。多灶性组中，男性患者、有甲状腺肿瘤家族史、颈部淋巴结转移以及超声提示甲状腺外侵犯的比例更高。单发性甲状腺乳头状癌合并良性甲状腺肿的比例较高。在多灶性组中，行颈部淋巴结清扫术的男性患者、肿瘤灶≥3个或肿瘤为双侧性者，其肿瘤往往更大，颈部淋巴结转移和甲状腺外侵犯的发生率更高。164例患者完成随访，5例死亡，1例疑似肺转移但仍存活，6例术后3 - 41个月因淋巴结复发接受再次手术，2例因复发性腺肿瘤接受手术治疗。总体1年、2年、5年和10年生存率分别为98.2%、97.4%、96.5%和96.5%。
多灶性甲状腺乳头状癌比单发病灶更具侵袭性且分化程度高。全甲状腺切除术联合中央区颈部淋巴结清扫术可作为标准治疗方法。对于有淋巴结转移的患者应考虑行侧方淋巴结清扫术。
