根据甲状腺切除术的范围，1 至 4 厘米分化型甲状腺癌患者的肿瘤学结果。

Oncologic outcomes in patients with 1-cm to 4-cm differentiated thyroid carcinoma according to extent of thyroidectomy.

机构信息

Department of Surgery, Pusan National University College of Medicine, Busan, Korea.

Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Head Neck. 2019 Jan;41(1):56-63. doi: 10.1002/hed.25356. Epub 2018 Dec 10.

DOI:10.1002/hed.25356

PMID:30536465

Abstract

BACKGROUND

Recent guidelines advocate unilateral thyroidectomy for low-risk 1-cm to 4-cm differentiated thyroid cancer (DTC). This study was designed to examine the association between the extent of thyroidectomy and oncologic outcomes in patients with 1-cm to 4-cm DTC.

MATERIALS AND METHODS

From April 1978 to December 2011, 16 057 patients with DTC underwent thyroidectomy at Yonsei University Hospital. Among them, 5266 (32.8%) patients were classified as having 1-cm to 4-cm DTC and were enrolled in this study. Clinicopathologic features and prognostic results (disease-free survival [DFS] and disease-specific survival [DSS] rates) were analyzed by retrospective medical record review. The mean follow-up duration was 57.3 ± 58.1 months.

RESULTS

Of tumor subtypes in the study group, papillary thyroid carcinoma was the most common (97.5%) and follicular thyroid carcinoma occurred at a rate of 2.5%. In this study, the mean tumor size was 1.84 ± 0.74 cm. Patients had extrathyroidal extension (69.3%), multiplicity (35.1%), bilaterality (26.4%), central lymph node metastasis (53.0%), and lateral neck node metastases (19.9%). Of the 5266 patients, 4292 (81.5%) underwent total thyroidectomy and 974 (18.5%) had lobectomies. Recurrence rates in the total thyroidectomy and lobectomy groups were 5.7% and 9.4%, respectively. The lobectomy group had lower DFS (P = .007) and higher DSS (P = .034) than the total thyroidectomy group. A multivariate analysis for DFS revealed that tumor size, N classification, and extent of thyroidectomy were independent risk factors. On multivariate analysis, independent risk factors for DSS were age, sex, tumor size, and M classifications.

CONCLUSION

Although extent of thyroidectomy does not affect DSS, total thyroidectomy is beneficial for reducing recurrence in patients with 1-cm to 4-cm DTC. However, if such tumors have such low-risk features as being unifocal, intrathyroidal, and lymph node metastasis-negative, extent of thyroidectomy does not affect oncologic outcome and lobectomy may be sufficient.

摘要

背景

最近的指南主张对低危 1 至 4 厘米分化型甲状腺癌（DTC）患者行单侧甲状腺切除术。本研究旨在探讨 1 至 4 厘米 DTC 患者甲状腺切除术范围与肿瘤学结局之间的关系。

材料与方法

1978 年 4 月至 2011 年 12 月，16057 例 DTC 患者在延世大学医院接受甲状腺切除术。其中，5266 例（32.8%）患者被分类为患有 1 至 4 厘米 DTC，并被纳入本研究。通过回顾性病历审查分析临床病理特征和预后结果（无病生存率[DFS]和疾病特异性生存率[DSS]）。平均随访时间为 57.3 ± 58.1 个月。

结果

在研究组的肿瘤亚型中，乳头状甲状腺癌最为常见（97.5%），滤泡状甲状腺癌发生率为 2.5%。在本研究中，肿瘤平均大小为 1.84 ± 0.74 厘米。患者存在甲状腺外侵犯（69.3%）、多发病灶（35.1%）、双侧病变（26.4%）、中央淋巴结转移（53.0%）和侧颈部淋巴结转移（19.9%）。在 5266 例患者中，4292 例（81.5%）行甲状腺全切除术，974 例（18.5%）行甲状腺叶切除术。甲状腺全切除术组和甲状腺叶切除术组的复发率分别为 5.7%和 9.4%。甲状腺叶切除术组的 DFS 较低（P =.007），DSS 较高（P =.034）。DFS 的多变量分析显示，肿瘤大小、N 分类和甲状腺切除术范围是独立的危险因素。多变量分析显示，DSS 的独立危险因素为年龄、性别、肿瘤大小和 M 分类。