Xue Shuai, Wang Peisong, Liu Jia, Chen Guang
Department of Thyroid Surgery, The First Hospital of Jilin University, 130061, Changchun, People's Republic of China.
World J Surg Oncol. 2017 Mar 16;15(1):62. doi: 10.1186/s12957-017-1130-7.
The extent of surgery in patients with unilateral multifocal papillary thyroid microcarcinoma (UMPTMC) remains to be controversial. Aimed to improve surgical management of UMPTMC, this study was performed to identify the recurrence of UMPTMC and analyze its predictive factors.
This study was approved by the Ethical Committee of The First Hospital of the Jilin University, and written informed consent was given by participants for their clinical records to be used in this study. We retrospectively analyzed a total of 97 consecutive patients who underwent initial surgery for the treatment of UMPTMC at The First Hospital of Jilin University, between October 2005 and October 2006.
Altogether, 97 patients of UMPTMC have been enrolled in our study, in which 57 cases were performed with hemithyroidectomy (HT) while other 40 cases with total thyroidectomy (TT). The sum diameter of all tumors >1 cm was more frequent in HT group than in TT group (40.35 vs 20%; p = 0.046). Positive central lymph nodes were found more frequently in the TT patients than in the HT patients (80 vs 59.65%; p = 0.046). Tumor recurrence was seen more frequently in the HT cases than in the TT cases (26 vs 5%; p = 0.007). The disease-free survival period was significantly shorter for the HT patients than for the TT patients (p = 0.0059 by the log-rank test). The disease-free survival rates at 5 and 10 years were 91.23 and 73.68%, respectively, in the HT group and 100 and 92.5%, respectively, in the TT group. Univariate analysis by Cox's proportional hazards method showed male gender, sum diameter of all tumors >1 cm, and central lymph node metastases (CLNM) to be risk factors for recurrence of HT patients. Male gender and sum diameter >1 cm were factors identified for multivariate analysis by Cox's proportional hazards method which yielded risk ratios of 3.037 [CI 1.026-8.988; p = 0.045] and 5.475 [CI 1.389-21.572; p = 0.015] in the HT group.
In summary, with an increased risk of recurrence, TT may be more reasonable as initial surgery in UMPTMC, especially with male gender and total tumor diameter greater than 1 cm.
单侧多灶性甲状腺微小乳头状癌（UMPTMC）患者的手术范围仍存在争议。为改善UMPTMC的手术治疗，本研究旨在确定UMPTMC的复发情况并分析其预测因素。
本研究经吉林大学第一医院伦理委员会批准，参与者签署书面知情同意书，同意将其临床记录用于本研究。我们回顾性分析了2005年10月至2006年10月期间在吉林大学第一医院接受UMPTMC初次手术的97例连续患者。
本研究共纳入97例UMPTMC患者，其中57例行甲状腺半切术（HT），40例行甲状腺全切术（TT）。HT组所有肿瘤直径总和>1 cm的情况比TT组更常见（40.35%对20%；p = 0.046）。TT组患者中央淋巴结阳性的情况比HT组更常见（80%对59.65%；p = 0.046）。HT组患者肿瘤复发的情况比TT组更常见（26%对5%；p = 0.007）。HT组患者的无病生存期明显短于TT组患者（对数秩检验p = 0.0059）。HT组5年和10年的无病生存率分别为91.23%和73.68%，TT组分别为100%和92.5%。Cox比例风险法单因素分析显示，男性、所有肿瘤直径总和>1 cm以及中央淋巴结转移（CLNM）是HT组患者复发的危险因素。Cox比例风险法多因素分析确定男性和直径总和>1 cm为因素，在HT组中风险比分别为3.037 [CI 1.026 - 8.988；p = 0.045]和5.475 [CI 1.389 - 21.572；p = 0.015]。
总之，由于复发风险增加，TT作为UMPTMC的初次手术可能更合理，尤其是对于男性且肿瘤总直径大于1 cm的患者。
