Yao Yao, Cheng Shuai, Xu Xinyu, Chen Xinyuan, Chen Wei, Qian Yichun, Zhang Yuan
Department of Head and Neck Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
Department of Head and Neck Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.
Ann Transl Med. 2020 Aug;8(15):928. doi: 10.21037/atm-18-1301.
Locally advanced differentiated thyroid cancer (DTC) is rare. The optimal treatment remains controversial. This study was to investigate the natural history and prognostic factors of patients with locally advanced DTC and assess the effects of radioiodine therapy for locally advanced DTC.
A retrospective study was performed in 259 patients with locally advanced DTC. The clinicopathological features, prognostic factors and the effects of radioiodine therapy were evaluated using univariate and multivariate statistical analysis.
Among the clinicopathological characteristics of locally advanced DTC, the patient's age (unfavourable >55 years), extent of primary tumour (more widely extrathyroidal extension showed a worse prognosis than others), tumor size, histopathological classifications and distant metastases were the significant prognostic factors. With regard to the effects of RAI on local invasive DTC, neither T3b nor T4 patients without distant metastases could benefit from performance of I therapy for over survival and locoregional relapse-free survival.
In patients with locally advanced DTC, the independent prognostic factors were age, extent of extrathyroidal invasion, tumor size, histopathological classifications and distant metastases. Adjuvant postoperative RAI did not affect overall survival and locoregional control in patients with locally advanced DTC who had no distant metastasis disease. Given the results, we suggested radioiodine would not be applied for metastasis-free patients with locally advanced DTC postoperatively.
局部晚期分化型甲状腺癌（DTC）较为罕见。最佳治疗方案仍存在争议。本研究旨在探讨局部晚期DTC患者的自然病程和预后因素，并评估放射性碘治疗对局部晚期DTC的疗效。
对259例局部晚期DTC患者进行回顾性研究。采用单因素和多因素统计分析评估临床病理特征、预后因素及放射性碘治疗的效果。
在局部晚期DTC的临床病理特征中，患者年龄（＞55岁预后不良）、原发肿瘤范围（甲状腺外浸润范围越广，预后越差）、肿瘤大小、组织病理学分类及远处转移是重要的预后因素。关于放射性碘（RAI）对局部浸润性DTC的疗效，无远处转移的T3b或T4患者均不能从碘治疗中获得生存及局部区域无复发生存的益处。
在局部晚期DTC患者中，独立的预后因素为年龄、甲状腺外浸润范围、肿瘤大小、组织病理学分类及远处转移。术后辅助性RAI对无远处转移疾病的局部晚期DTC患者的总生存及局部区域控制无影响。基于这些结果，我们建议术后对无转移的局部晚期DTC患者不应用放射性碘治疗。
