Lamartina Livia, Borget Isabelle, Mirghani Haitham, Al Ghuzlan Abir, Berdelou Amandine, Bidault François, Deandreis Désirée, Baudin Eric, Travagli Jean-Paul, Schlumberger Martin, Hartl Dana M, Leboulleux Sophie
Department of Nuclear Medicine and Endocrine Oncology and.
Department of Biostatistics and Epidemiology.
J Clin Endocrinol Metab. 2017 Mar 1;102(3):1020-1031. doi: 10.1210/jc.2016-3284.
Persistent/recurrent disease in the neck is frequent in patients with differentiated thyroid cancer (DTC).
Assess efficacy, safety, and prognostic factors of first neck reoperation in DTC.
Retrospective study of consecutive patients undergoing neck reoperation for recurrent/persistent DTC in a referral cancer center. Response after reoperation was defined according to the 2015 American Thyroid Association guidelines.
One hundred sixty-one DTC patients were enrolled (64% females, median age 35 years, 96% papillary DTC). Initial stage was pT3 in 43% and pT4 in 10%, pN1 in 74%. Aggressive histology was present in 25% of the patients, in both primary and persistent/recurrent tumor. Four patients had no malignancy in the reoperative specimen, and 1 patient died due to postoperative hematoma and was excluded from further analysis. Following reoperation, 15 patients (10%) had persistent structural disease, 16 (10%) had biochemical incomplete response, 26 (17%) had indeterminate response, and 99 (63%) had complete response (CR), among whom 24 relapsed later. After a median follow-up of 5 years, only 83 patients (53%) had CR without the need for further treatments. The rate of permanent complications was: hypoparathyroidism 2%, laryngeal nerve palsy 0.6%, other 6%. Age ≥45 years, aggressive histology, and lymph node ratio ≥0.6 at initial surgery were independent risk factors for incomplete response after reoperation. Male sex, aggressive histology, and ≥10 metastases at reoperation were independent risk factors of secondary relapse following CR achieved with reoperation.
A careful risk-benefit analysis should guide surgical decision, particularly in patients with risk factors for incomplete response.
分化型甲状腺癌（DTC）患者颈部持续性/复发性疾病很常见。
评估DTC首次颈部再次手术的疗效、安全性和预后因素。
对一家转诊癌症中心连续接受复发性/持续性DTC颈部再次手术的患者进行回顾性研究。再次手术后的反应根据2015年美国甲状腺协会指南进行定义。
纳入161例DTC患者（64%为女性，中位年龄35岁，96%为乳头状DTC）。初始分期为pT3的占43%，pT4的占10%，pN1的占74%。25%的患者在原发性和持续性/复发性肿瘤中均存在侵袭性组织学特征。4例患者再次手术标本中无恶性肿瘤，1例患者因术后血肿死亡，被排除在进一步分析之外。再次手术后，15例患者（10%）有持续性结构疾病，16例（10%）有生化不完全反应，26例（17%）有不确定反应，99例（63%）有完全反应（CR），其中24例后来复发。中位随访5年后，只有83例患者（53%）有CR且无需进一步治疗。永久性并发症发生率为：甲状旁腺功能减退2%，喉返神经麻痹0.6%，其他6%。年龄≥45岁、侵袭性组织学特征以及初次手术时淋巴结比率≥0.6是再次手术后不完全反应的独立危险因素。男性、侵袭性组织学特征以及再次手术时有≥10处转移是再次手术获得CR后二次复发的独立危险因素。
应进行仔细的风险效益分析以指导手术决策，尤其是对于有不完全反应危险因素的患者。
