Kalaitzidou Styliani, Papadakis Georgios, Sapera Aggeliki, Tampouratzi Dimitra, Drosou Aspasia, Triantafillou Eleni, Kotis Michalis, Aravantinou Aggeliki, Roumpidaki Zoi, Gkioxaris Vasileios, Karavasili Chrysa, Dracopoulou Anna, Kaltzidou Victoria, Veniou Irini, Karelas Ioannis, Stampouloglou Pavlos, Sarof Pavlos, Petridis Nicolaos, Papadouli Despina, Iordanidou Lydia, Trivizaki Erasmia, Manikis Panagiotis, Efstathiou Ilias, Tertipi Athanasia
Endocrinology Department, Metaxa Cancer Hospital, Piraeus, Greece.
J BUON. 2020 Jan-Feb;25(1):383-388.
Persistent/recurrent disease in the neck is frequent in patients with papillary thyroid cancer (PTC). The goal of this study was to evaluate the efficacy of the reoperation and radioiodine (RAI) treatment for persistent/recurrent disease after the initial treatment.
A total of 30 patients (13 M/17 F) with PTC were enrolled in this study. All had been submitted to total thyroidectomy for PTC and subsequently to reoperation for local persistent/recurrent disease. All had received RAI, before and/or after reoperation. The mean age at initial thyroidectomy and cancer diagnosis was 41.4±15.2 years. Initial T status was T1 in 22 cases (73.3%), T2 in 4 cases (13.3%) and T3 in 4 cases (13.3%). Initial N status was N0 in 2 cases (6.6%), N1 in 15 cases (50%) and Nx in 13 cases (43.3%).
Reoperation reduced the mean stimulated thyroglobulin (stimTg) serum concentration from 76.1±165.5 ng/mL to 20.1±28.8 ng/mL, p=0.002. The RAI treatment provided to 19 patients after reoperation reduced further the stimTg values from 28.6±32.4 ng/mL after reoperation, to 11.3±20.4 ng/mL, p=0.003. According to the dynamic risk stratification after the reoperation 7 patients (23.3%) had excellent response, 4 (13.3%) had biochemically incomplete response, 9 (30.0%) had indeterminate response and 10 (33.3%) had still structural incomplete response.
Surgery for local persistent/recurrent disease in papillary thyroid carcinoma reduces tumor burden, improves the biochemical and structural disease. Administration of therapeutic RAI after lymph node resections appears to further improve biochemical disease.
甲状腺乳头状癌（PTC）患者颈部持续性/复发性疾病很常见。本研究的目的是评估初次治疗后再次手术和放射性碘（RAI）治疗对持续性/复发性疾病的疗效。
本研究共纳入30例PTC患者（13例男性/17例女性）。所有患者均因PTC接受了甲状腺全切除术，随后因局部持续性/复发性疾病接受了再次手术。所有患者在再次手术前和/或后均接受了RAI治疗。初次甲状腺切除术和癌症诊断时的平均年龄为41.4±15.2岁。初始T分期为T1的有22例（73.3%），T2的有4例（13.3%），T3的有4例（13.3%）。初始N分期为N0的有2例（6.6%），N1的有15例（50%），Nx的有13例（43.3%）。
再次手术使刺激后甲状腺球蛋白（stimTg）血清平均浓度从76.1±165.5 ng/mL降至20.1±28.8 ng/mL，p = 0.002。19例患者在再次手术后接受了RAI治疗，使stimTg值从再次手术后的28.6±32.4 ng/mL进一步降至11.3±20.4 ng/mL，p = 0.003。根据再次手术后的动态风险分层，7例患者（23.3%）反应良好，4例（13.3%）生化反应不完全，9例（30.0%）反应不确定，10例（33.3%）仍有结构反应不完全。
甲状腺乳头状癌局部持续性/复发性疾病的手术可减轻肿瘤负荷，改善生化和结构疾病。淋巴结切除术后给予治疗性RAI似乎可进一步改善生化疾病。
