术前超声特征与经典型甲状腺乳头状癌患者复发的相关性研究。
Association of Preoperative US Features and Recurrence in Patients with Classic Papillary Thyroid Carcinoma.
机构信息
From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea.
出版信息
Radiology. 2015 Nov;277(2):574-83. doi: 10.1148/radiol.2015142470. Epub 2015 May 8.
PURPOSE
To investigate whether ultrasonographic (US) features of thyroid nodules are associated with tumor recurrence in classic papillary thyroid carcinoma (PTC).
MATERIALS AND METHODS
This retrospective study was approved by the Institutional Review Board, and the need to obtain informed consent was waived. A total of 515 patients (mean age, 45.8 years ± 13.2 [standard deviation]; range, 17-80 years) who underwent total thyroidectomy and central lymph node dissection for classic PTC greater than 10 mm from January 2003 to February 2006 and who were followed up for 12 months or longer were included. Malignant-appearing PTCs were defined as those showing at least one suspicious US feature among marked hypoechogenicity, irregular or microlobulated margin, microcalcifications, and taller-than-wide shape. Benign-appearing PTCs were defined as those without any suspicious US features. Kaplan-Meier cumulative-event curves for recurrence were compared by using the log-rank test. The multivariate Cox proportional hazard regression analysis was used to estimate hazard ratios (HRs) of the malignant-appearing US features for recurrence in the preoperative, postoperative, and combined models.
RESULTS
Fifty-six (10.9%) of 515 patients had recurrence. Malignant-appearing PTCs had lower 5- and 10-year disease-free survival rates compared with benign-appearing PTCs (P = .01). In the preoperative model, malignant-appearing US features (HR, 3.523; 95% confidence interval [CI]: 1.263, 9.830) and larger nodule size (HR, 1.074; 95% CI: 1.051, 1.098) were independently associated with recurrence. In the combined model, male sex (HR, 1.990; 95% CI: 1.098, 3.610), malignant-appearing US features (HR, 2.828; 95% CI: 1.016. 7.870), larger nodule size (HR, 1.067; 95% CI: 1.043, 1.092), extrathyroidal extension (HR, 2.590; 95% CI: 1.160, 5.780), and lymph node metastasis (HR, 2.511; 95% CI: 1.163, 5.421) were independently associated with recurrence.
CONCLUSION
The presence of malignant-appearing US features was independently associated with recurrence in patients with classic PTC.
目的
探讨甲状腺结节的超声特征是否与经典型甲状腺乳头状癌（PTC）的肿瘤复发有关。
材料与方法
本回顾性研究经机构审查委员会批准，且豁免了获得知情同意的要求。共纳入 515 例 2003 年 1 月至 2006 年 2 月期间因大于 10mm 的经典 PTC 行甲状腺全切除术和中央淋巴结清扫术，且随访时间超过 12 个月的患者。恶性外观 PTC 定义为在明显低回声、不规则或微乳头状边缘、微钙化和高宽比中至少存在一种可疑的超声特征。良性外观 PTC 定义为无任何可疑超声特征。采用对数秩检验比较复发的累积事件曲线。采用多变量 Cox 比例风险回归分析估计术前、术后和联合模型中恶性外观超声特征对复发的风险比（HR）。
结果
515 例患者中有 56 例（10.9%）复发。恶性外观 PTC 的 5 年和 10 年无病生存率明显低于良性外观 PTC（P=0.01）。在术前模型中，恶性外观超声特征（HR，3.523；95%置信区间[CI]：1.263，9.830）和较大的结节大小（HR，1.074；95%CI：1.051，1.098）与复发独立相关。在联合模型中，男性（HR，1.990；95%CI：1.098，3.610）、恶性外观超声特征（HR，2.828；95%CI：1.016，7.870）、较大的结节大小（HR，1.067；95%CI：1.043，1.092）、甲状腺外侵犯（HR，2.590；95%CI：1.160，5.780）和淋巴结转移（HR，2.511；95%CI：1.163，5.421）与复发独立相关。
结论
在经典 PTC 患者中，恶性外观超声特征的存在与复发独立相关。
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