Lei Shangtong, Wang Da, Ge Junna, Liu Hao, Zhao Donghui, Li Guoxin, Ding Zihai
Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
World J Surg Oncol. 2015 Mar 21;13:115. doi: 10.1186/s12957-015-0519-4.
Whether familial papillary thyroid cancer (FPTC) is more aggressive than sporadic counterpart remains elusive, and the optimal clinical approach for FPTC is yet to be established. In this study, we investigated familial occurrence of PTC in China and reviewed our experience of its surgical treatment.
The clinical records of 248 consecutive patients with an established diagnosis of PTC who were admitted to Nanfang Hospital for thyroidectomy between January 2011 and June 2013 were analyzed in this study. Patients included 66 males and 182 females, aged 11 to 76 years.
Twenty-two patients (8.9%) with a positive family history were confirmed. Patients with FPTC had a predilection for female subjects and tended to be younger than other patients, but the difference was not significant (P = 0.0514 and P = 0.168). They were more likely to present large tumors (P = 0.0024), multifocality (familial vs. sporadic: 54.50% vs. 26.50%; P < 0.006), local invasion (81.8% vs. 23.9%; P < 0.001), and malignant lymph nodes (63.6% vs. 33.6%; P = 0.005). Univariate and multivariate analyses identified that a positive family history was an independent risk factor for local invasion (OR: 5.683; 95% CI: 2.056 to 15.707; P = 0.001), malignant lymph nodes (OR: 3.005; 95% CI: 1.046 to 8.630; P = 0.041) in FPTC patients. Kaplan-Meier survival curves revealed that an aggressive surgical strategy was associated with a better relapse-free survival than conventional one (P = 0.032).
FPTC is more likely to possess aggressive features than sporadic counterparts. Thus, screening of at-risk families is essential to aid in earlier recognition. An aggressive surgical strategy appeared to be the more effective therapy. However, sufficient detailed interrogation and long-term follow-up of the patients and their family are necessary for providing individualized recommendations for clinical management.
家族性甲状腺乳头状癌（FPTC）是否比散发性甲状腺乳头状癌更具侵袭性仍不明确，且FPTC的最佳临床治疗方法尚未确立。在本研究中，我们调查了中国PTC的家族发病情况，并回顾了我们对其手术治疗的经验。
本研究分析了2011年1月至2013年6月期间连续入住南方医院接受甲状腺切除术且确诊为PTC的248例患者的临床记录。患者包括66名男性和182名女性，年龄在11至76岁之间。
确诊有22例（8.9%）患者有家族史阳性。FPTC患者以女性居多，且往往比其他患者更年轻，但差异不显著（P = 0.0514和P = 0.168）。他们更易出现大肿瘤（P = 0.0024）、多灶性（家族性与散发性：54.50%对26.50%；P < 0.006）、局部侵犯（81.8%对23.9%；P < 0.001）以及恶性淋巴结（63.6%对33.6%；P = 0.005）。单因素和多因素分析确定家族史阳性是FPTC患者局部侵犯（OR：5.683；95%CI：2.056至15.707；P = 0.001）、恶性淋巴结（OR：3.005；95%CI：1.046至8.630；P = 0.041）的独立危险因素。Kaplan-Meier生存曲线显示，积极的手术策略与比传统策略更好的无复发生存率相关（P = 0.032）。
FPTC比散发性甲状腺乳头状癌更可能具有侵袭性特征。因此，对高危家族进行筛查对于早期识别至关重要。积极的手术策略似乎是更有效的治疗方法。然而，对患者及其家族进行充分详细的询问和长期随访对于提供个体化的临床管理建议是必要的。
