Shi C L, Guo Y, Lyu Y C, Nanding Z A B Y S, Gao W C, Shi T F, Qin H D, Liu S Y
The Fourth Department of General Surgery, the Second Hospital Affiliated to Harbin Medical University, Harbin 150086, China.
Department of Breast and Thyroid Surgery, Heze Municipal Hospital, Heze 274000, Shandong Province, China.
Zhonghua Zhong Liu Za Zhi. 2017 May 23;39(5):361-366. doi: 10.3760/cma.j.issn.0253-3766.2017.05.008.
To investigate the difference of prognostic factors and recurrence rates between papillary thyroid microcarcinoma (PTMC) and lager papillary thyroid carcinoma (PTC) and analyze the clinical pathological characteristics of PTMC suitable for surgery. A retrospective analysis on the clinicopathological features, expression level of of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E gene mutation and pigment epithelium-derived factor (PEDF), and postoperative follow-up results of the 251 PTC patients who underwent surgical treatment from October 2011 to October 2013, including 169 cases with PTMC and 82 with lager PTC (Tumor diameter>1 cm). The BRAF V600E mutation rates of PTMC and lager PTC patients are 65.1%(110/169)and 78.0% (64/82) respectively, and the difference is statistically significant (<0.05). The prevalence of extrathyroidal invasion (7.1%) and lymph nodes metastasis (27.2%) of the patients with PTMC were significantly lower than those of the patients with larger PTC (15.9% and 46.3%, respectively)(<0.01). The follow-up durations for PTMC and lager PTC were (45.6±3.6) months and (45.0±3.4) months, respectively (>0.05). There was no statistic significance for the difference in age, gender, coexistent hashimoto's thyroiditis, PEDF expression, and recurrence rate between the patients with PTMC and with larger PTC (>0.05). The recurrence rate of the patients who have the high risk factors of PTMC was 1.6%(2/122)and that of larger PTC was 4.9% (4/82). Extrathyroid invasion, lymph node metastases and BRAF V600E gene mutation are the high risk factors of recurrent PTMC. The same treatment strategy should be considered for PTMC with coexistent high risk factors as that for larger PTC. For PTMC with BRAF V600E gene mutation, earlier surgical treatment is suggested. PTMC patients with BRAF V600E gene mutation and high cell subtype are suggested to undergo total thyroidectomy for the first operation in order to reduce the potential risk of recurrence.
探讨甲状腺微小乳头状癌(PTMC)与较大甲状腺乳头状癌(PTC)预后因素及复发率的差异,并分析适合手术治疗的PTMC的临床病理特征。回顾性分析2011年10月至2013年10月接受手术治疗的251例PTC患者的临床病理特征、v-raf鼠肉瘤病毒癌基因同源物B1(BRAF)V600E基因突变和色素上皮衍生因子(PEDF)的表达水平以及术后随访结果,其中包括169例PTMC患者和82例较大PTC患者(肿瘤直径>1 cm)。PTMC患者和较大PTC患者的BRAF V600E突变率分别为65.1%(110/169)和78.0%(64/82),差异具有统计学意义(<0.05)。PTMC患者的甲状腺外侵犯(7.1%)和淋巴结转移(27.2%)发生率显著低于较大PTC患者(分别为15.9%和46.3%)(<0.01)。PTMC和较大PTC的随访时间分别为(45.6±3.6)个月和(45.0±3.4)个月(>0.05)。PTMC患者与较大PTC患者在年龄、性别、合并桥本甲状腺炎、PEDF表达及复发率方面的差异无统计学意义(>0.05)。具有PTMC高危因素患者的复发率为1.6%(2/122),较大PTC患者的复发率为4.9%(4/82)。甲状腺外侵犯、淋巴结转移和BRAF V600E基因突变是PTMC复发的高危因素。对于存在高危因素的PTMC,应考虑与较大PTC相同的治疗策略。对于BRAF V600E基因突变的PTMC,建议早期手术治疗。对于BRAF V600E基因突变且细胞亚型较高的PTMC患者,建议首次手术行全甲状腺切除术,以降低潜在的复发风险。