Zheng Wei, Wang Xuan, Rui Zhongying, Wang Yi, Meng Zhaowei, Wang Renfei
Departments of Nuclear Medicine.
Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
Nucl Med Commun. 2019 May;40(5):477-483. doi: 10.1097/MNM.0000000000000991.
The aim of this study was to identify clinical features and therapeutic outcomes of patients with papillary thyroid cancer (PTC) according to tumor diameter and evaluate the correlation of neck lymph node (LN) involvement of papillary thyroid microcarcinoma (PTMC) according to patients' age.
We divided 467 patients into two groups according to tumor diameter: PTMC group (≤1 cm) and non-PTMC group (>1 cm). The clinical data were analyzed retrospectively. Thereafter, we divided the PTMC patients into three subgroups according to age: young subgroup (<45 years), middle subgroup (45-54 years), and old subgroup (≥55 years). A further study about clinical features, especially the neck LN involvement in three subgroups, was analyzed.
All patients received radioiodine ablation at least once. There were more patients with a single cancer lesion and cancer in the unilateral lobe, less number of neck LN involvement, fewer patients with neck lymph node metastasis (LNM), and more patients with Hashimoto's thyroiditis in PTMC group than in non-PTMC group. At the further evaluation, 58.03% patients maintained clinical remission, which was more in the PTMC group than in non-PTMC group. There was no significant difference in recurrence, but the disease-free survival rate of patients in the PTMC group was higher than in the non-PTMC group. In the PTMC group, the radioactive iodine curative ratio in younger patients is lower than that in the other two subgroups. Both the LNM and central LNM (CLNM) rates were significantly higher in young patients compared with older patients. In addition, the LNM-positive group had more male patients, larger tumor size, and higher thyroglobulin antibody level. Both LNM and the CLNM rates were significantly higher in the young subgroup than in the older subgroup. Young and middle age and extrathyroid extension were independent risk factors for neck LNM. Unlike LNM, young age, extrathyroid extension, and male sex were independent risk factors for CLNM.
Some PTMCs were less aggressive and the therapeutic outcomes of them were better than non-PTMC. Moreover, PTMCs in young patients were more aggressive, especially in LNM. Hence, clinicians should consider an individualized treatment according to tumor characteristics and age to achieve better therapeutic efficacy.
本研究旨在根据肿瘤直径确定甲状腺乳头状癌（PTC）患者的临床特征和治疗结果，并根据患者年龄评估甲状腺微小乳头状癌（PTMC）颈部淋巴结（LN）受累情况的相关性。
我们根据肿瘤直径将467例患者分为两组：PTMC组（≤1 cm）和非PTMC组（>1 cm）。对临床资料进行回顾性分析。此后，我们根据年龄将PTMC患者分为三个亚组：年轻亚组（<45岁）、中年亚组（45 - 54岁）和老年亚组（≥55岁）。对三个亚组的临床特征，尤其是颈部LN受累情况进行了进一步研究。
所有患者均至少接受过一次放射性碘消融治疗。与非PTMC组相比，PTMC组中单一癌灶及单侧叶癌患者更多，颈部LN受累数量更少，颈部淋巴结转移（LNM）患者更少，桥本甲状腺炎患者更多。在进一步评估中，58.03%的患者维持临床缓解，PTMC组高于非PTMC组。复发方面无显著差异，但PTMC组患者的无病生存率高于非PTMC组。在PTMC组中，年轻患者的放射性碘治愈率低于其他两个亚组。年轻患者的LNM和中央LNM（CLNM）率均显著高于老年患者。此外，LNM阳性组男性患者更多、肿瘤尺寸更大、甲状腺球蛋白抗体水平更高。年轻亚组的LNM和CLNM率均显著高于老年亚组。年轻和中年以及甲状腺外侵犯是颈部LNM的独立危险因素。与LNM不同，年轻、甲状腺外侵犯和男性是CLNM的独立危险因素。
部分PTMC侵袭性较低，其治疗结果优于非PTMC。此外，年轻患者的PTMC侵袭性更强，尤其是在LNM方面。因此，临床医生应根据肿瘤特征和年龄考虑个体化治疗，以获得更好的治疗效果。
