Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Endocrine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Clin Endocrinol (Oxf). 2017 Nov;87(5):566-571. doi: 10.1111/cen.13378. Epub 2017 Jun 14.
The aim of this study was to report our incidence of clinically evident neck recurrence, salvage neck management and subsequent outcomes in patients with papillary thyroid cancer. This is important to know so that patients with thyroid cancer can be properly counselled about the implications of recurrent disease and subsequent outcome.
An institutional database of 3664 patients with thyroid cancer operated between 1986 and 2010 was reviewed. Patients with nonpapillary histology and gross residual disease and those with distant metastases at presentation or distant metastases prior to nodal recurrence were excluded from the study. Of these, 99 (3.0%) patients developed clinically evident nodal recurrence. Details of recurrence and subsequent therapy were recorded for each patient. Subsequent disease-specific survival (sDSS), distant recurrence-free survival (sDRFS) and nodal recurrence-free survival (sNRFS) were determined from the date of first nodal recurrence using the Kaplan-Meier method.
Of the 99 patients, 59% were female and 41% male. The median age was 41 years (range 5-91). The majority of patients had pT3/4 primary tumours (63%) and were pN+ (78%) at initial presentation. The median time to clinically evident nodal recurrence was 28 months (range: 3-264). Nodal recurrence occurred in the central neck in 15 (15%) patients, lateral neck in 74 (75%) patients and both in 10 (10%) patients. After salvage treatment, the 5-year sDSS was 97.4% from time of nodal recurrence. The 5-year sDRFS and sNRFS were 89.2% and 93.7%, respectively.
In our series, isolated clinically evident nodal recurrence occurred in 3.0% of patients. Such patients are successfully salvaged with surgery and adjuvant therapy with sDSS of 97.4% at 5 years.
本研究旨在报告我们在患有甲状腺乳头状癌的患者中临床明显颈部复发、挽救性颈部管理以及随后结果的发生率。了解这一点很重要，以便能够为患有甲状腺癌的患者提供适当的咨询，让他们了解疾病复发和随后结果的影响。
回顾了 1986 年至 2010 年间接受甲状腺癌手术的 3664 例患者的机构数据库。排除了非乳头状组织学和大体残留疾病以及在出现局部淋巴结转移或远处转移之前出现局部淋巴结转移的患者。其中，99 例（3.0%）患者出现临床明显的局部淋巴结复发。为每位患者记录了复发和随后治疗的详细信息。使用 Kaplan-Meier 方法，从首次局部淋巴结复发日期计算疾病特异性生存（sDSS）、远处无复发生存（sDRFS）和局部淋巴结无复发生存（sNRFS）。
99 例患者中，女性占 59%，男性占 41%。中位年龄为 41 岁（范围 5-91 岁）。大多数患者有 pT3/4 期原发肿瘤（63%），初次就诊时 pN+（78%）。临床明显局部淋巴结复发的中位时间为 28 个月（范围：3-264 个月）。15 例（15%）患者的中央颈部发生局部淋巴结转移，74 例（75%）患者的侧颈部发生局部淋巴结转移，10 例（10%）患者的中央和侧颈部均发生局部淋巴结转移。挽救性治疗后，局部淋巴结复发时的 5 年 sDSS 为 97.4%。5 年 sDRFS 和 sNRFS 分别为 89.2%和 93.7%。
在我们的系列中，3.0%的患者出现孤立的临床明显局部淋巴结复发。这些患者通过手术和辅助治疗成功挽救，5 年 sDSS 为 97.4%。
