Ito Yasuhiro, Miyauchi Akira, Kihara Minoru, Fukushima Mitsuhiro, Higashiyama Takuya, Miya Akihiro
Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan.
World J Surg. 2018 Mar;42(3):615-622. doi: 10.1007/s00268-018-4479-z.
Papillary thyroid carcinoma (PTC) generally shows an excellent prognosis except in cases with aggressive backgrounds or clinicopathological features. Although the cause-specific survival (CSS) of PTC patients has been extensively investigated, the overall survival (OS) of these patients is unclear. We herein investigated both the OS and CSS of a large PTC patient series.
We enrolled 5897 PTC patients who underwent initial surgery between 1987 and 2005 (658 males and 5339 females; median age 51 years). Their median postoperative follow-up period was 177 months. Univariate and multivariate analyses for OS and CSS assessed the effects of gender, older age (≥55 years), distant metastasis at diagnosis (M1), significant extrathyroid extension, tumor size (cutoffs 2 and 4 cm), large node metastasis (N ≥ 3 cm), and extranodal tumor extension.
To date, 387 patients (7%) in this series have died from various causes, including 117 (2%) due to PTC. The 10-, 15-, and 20-year OS rates are 97, 95, and 90%, respectively. Older age and M1 were important prognostic factors for OS and CSS. Older age was a more significant factor than M1 for OS and vice versa for CSS. In the older patients, M1 was a prominent prognostic factor for both OS and CSS. In the young patients, M1 had less prognostic impact than in the older patients, and the prognostic values of M1 and N ≥ 3 cm for OS and CSS were identical and similar, respectively.
The most important prognostic value for OS was patient age, indicating that PTC is generally indolent. However, the control of distant metastasis in older patients remains a future challenge in order to further improve their OS and CSS. PTC of ≥3 cm in young patients should be carefully followed, even in the absence of metastases, and these patients should undergo aggressive therapies for recurrent lesions and metastases.
除了具有侵袭性背景或临床病理特征的病例外，甲状腺乳头状癌（PTC）通常预后良好。尽管已对PTC患者的病因特异性生存率（CSS）进行了广泛研究，但这些患者的总生存率（OS）尚不清楚。我们在此研究了一个大型PTC患者系列的OS和CSS。
我们纳入了1987年至2005年间接受初次手术的5897例PTC患者（男性658例，女性5339例；中位年龄51岁）。他们术后的中位随访期为177个月。对OS和CSS进行单因素和多因素分析，评估性别、老年（≥55岁）、诊断时远处转移（M1）、显著的甲状腺外扩展、肿瘤大小（临界值2和4 cm）、大淋巴结转移（N≥3 cm）和结外肿瘤扩展的影响。
迄今为止，该系列中有387例患者（7%）因各种原因死亡，其中117例（2%）死于PTC。10年、15年和20年的OS率分别为97%、95%和90%。老年和M1是OS和CSS的重要预后因素。对于OS，老年是比M1更显著的因素，而对于CSS则相反。在老年患者中，M1是OS和CSS的突出预后因素。在年轻患者中，M1的预后影响小于老年患者，并且M1和N≥3 cm对OS和CSS的预后价值分别相同和相似。
OS最重要的预后价值是患者年龄，这表明PTC通常生长缓慢。然而，为了进一步提高老年患者的OS和CSS，控制其远处转移仍然是未来的一项挑战。年轻患者中≥3 cm的PTC即使没有转移也应仔细随访，并且这些患者应接受针对复发灶和转移灶的积极治疗。
