甲状腺乳头状癌的T1亚分类与复发风险相关吗？
Does the T1 subdivision correlate with the risk of recurrence of papillary thyroid cancer?
作者信息
Chereau Nathalie, Trésallet Christophe, Noullet Severine, Godiris-Petit Gaelle, Tissier Frédérique, Leenhardt Laurence, Menegaux Fabrice
机构信息
Departments of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
Departments of Pathology, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
出版信息
Langenbecks Arch Surg. 2016 Mar;401(2):223-30. doi: 10.1007/s00423-016-1399-y. Epub 2016 Mar 8.
BACKGROUND
Based on the AJCC seventh TNM classification, T1 intraglandular tumors are subdivided into T1a (≤10 mm) and T1b (11-20 mm), but the differences in prognosis remain controversial. The present study aimed to determine the clinicopathological features and outcomes of T1a and T1b patients.
METHODS
A retrospective study of 2518 T1 patients, including 1840 T1a (73 %) and 678 (27 %) T1b patients who underwent surgery for PTC from 1978 to 2014, was conducted. In patients with a preoperative or operative diagnosis of PTC, a total thyroidectomy (TT) with prophylactic (macroscopically N0) or therapeutic (evident N1) lymph node dissection (LND) was performed. Other patients had a TT or partial thyroidectomy without LND. The mean follow-up time was 8.9 ± 8.8 years (median, 6.5 years; range, 1-36.4 years).
RESULTS
A TT was performed in 2273 patients (90 %), including 1184 (52 %) with LND. Other patients (n = 245) had a single lobectomy with isthmectomy. Multifocality, bilaterality, number of tumors, sum of the largest size of all foci, vascular invasion, and (in patients with LND) LN metastases were significantly more frequent in T1b than in T1a patients. Of the 1184 patients with LND, 278 had LN metastases (N1, 23 %), including 136/680 T1a (20 %) and 142/504 (28 %) T1b patients (p = 0.002). These LN metastases were diagnosed after a prophylactic LND in 86/609 T1a (14 %) and 93/440 T1b (21 %) patients (p = 0.001). Recurrences were more frequent in T1b (n = 26, 3.8 %) than in T1a patients (n = 35, 1.9 %, p = 0.005). In the multivariate analysis, independent prognostic factors for recurrence in both groups were the number of tumors, the sum of the largest size of all foci and, in patients who had LND, LN metastases and extranodal extension. For N0-x patients, the recurrence rate was significantly higher in the T1b than in the T1a group (2.4 vs. 0.9 %, respectively, p = 0.005), although this rate was similar in N1 patients (16.2 % for T1a and 9.2 % for T1b patients, p = 0.1). The 5-year disease-free survival rates for T1a and T1b patients were 98.3 and 96.6 %, respectively (p = 0.01).
CONCLUSION
For PTC patients, T1b had poorer clinicopathological features and increased risk of recurrence than T1a.
背景
根据美国癌症联合委员会（AJCC）第七版TNM分类，T1期腺内肿瘤分为T1a（≤10 mm）和T1b（11 - 20 mm），但预后差异仍存在争议。本研究旨在确定T1a和T1b患者的临床病理特征及预后。
方法
对1978年至2014年接受甲状腺乳头状癌（PTC）手术的2518例T1期患者进行回顾性研究，其中包括1840例T1a患者（73%）和678例（27%）T1b患者。对于术前或术中诊断为PTC的患者，行全甲状腺切除术（TT）并进行预防性（宏观上N0）或治疗性（明显N1）淋巴结清扫（LND）。其他患者行TT或部分甲状腺切除术，未进行LND。平均随访时间为8.9±8.8年（中位数6.5年；范围1 - 36.4年）。
结果
2273例患者（90%）行TT，其中1184例（52%）进行了LND。其他患者（n = 245）行单叶切除加峡部切除。T1b患者的多灶性、双侧性、肿瘤数量、所有病灶最大径总和、血管侵犯以及（在进行LND的患者中）淋巴结转移明显比T1a患者更常见。在1184例进行LND的患者中，278例有淋巴结转移（N1，23%），包括136/680例T1a患者（20%）和142/504例（28%）T1b患者（p = 0.002）。这些淋巴结转移在86/609例T1a患者（14%）和93/440例T1b患者（21%）的预防性LND后被诊断出来（p = 0.001）。T1b患者的复发比T1a患者更频繁（n = 26，3.8% 比 n = 35，1.9%，p = 0.005）。在多因素分析中，两组复发的独立预后因素是肿瘤数量、所有病灶最大径总和，以及在进行LND的患者中，淋巴结转移和结外扩展。对于N0 - x患者，T1b组的复发率明显高于T1a组（分别为2.4%和0.9%，p = 0.005），尽管N1患者的复发率相似（T1a患者为16.2%，T1b患者为9.2%，p = 0.1）。T1a和T1b患者的5年无病生存率分别为98.3%和96.6%（p = 0.01）。
结论
对于PTC患者，T1b的临床病理特征比T1a差，复发风险增加。
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