Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, China.
Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
Front Endocrinol (Lausanne). 2020 Oct 8;11:553577. doi: 10.3389/fendo.2020.553577. eCollection 2020.
The aim of this study was to investigate risk factors of occult carcinoma in clinically solitary papillary thyroid carcinoma (PTC) patients, and to put emphasis on the predictive value of risk-scoring model to determine the optimal scope of surgery.
A total of 573 clinically solitary PTC patients who underwent total thyroidectomy (TT) from two hospitals were retrospectively analyzed. Clinicopathological features were collected, univariate and multivariate analyses were performed to determine risk factors of occult carcinoma. The Cox proportional hazards model was used to analyze the risk factors of recurrence. A scoring model was constructed according to independent risk factors of contralateral occult carcinoma.
19.2% of clinically solitary PTC patients had occult carcinoma, among which 3.7% patients had ipsilateral occult carcinoma and 15.5% patients had contralateral occult carcinoma. Factors such as male, the presence of benign nodule, and vascular invasion increase the risk of ipsilateral occult carcinoma. Tumor size >1 cm, the presence of benign nodule, extrathyroidal extension, central lymph node metastasis, lateral lymph node metastasis are independent predictors of contralateral occult carcinoma. Contralateral occult carcinoma is the independent predictor of recurrence. A 10-point risk-scoring model was established to predict the contralateral occult carcinoma in clinically solitary PTC patients.
Lobectomy is sufficient for clinically solitary PTC patients with risk factors of ipsilateral occult carcinoma. For clinically solitary PTC patients with score ≥4, careful preoperative evaluations are required to rule out the contralateral occult carcinoma. Even if contralateral occult carcinoma is not detected preoperatively, TT is recommended for high-risk patients.
本研究旨在探讨临床单发甲状腺乳头状癌（PTC）患者隐匿性癌的危险因素，并强调风险评分模型对确定最佳手术范围的预测价值。
回顾性分析 2 家医院行甲状腺全切除术（TT）的 573 例临床单发 PTC 患者。收集临床病理特征，进行单因素和多因素分析以确定隐匿性癌的危险因素。采用Cox 比例风险模型分析复发的危险因素。根据对侧隐匿性癌的独立危险因素构建评分模型。
19.2%的临床单发 PTC 患者存在隐匿性癌，其中 3.7%的患者同侧存在隐匿性癌，15.5%的患者对侧存在隐匿性癌。男性、存在良性结节和血管侵犯等因素增加同侧隐匿性癌的风险。肿瘤大小＞1cm、存在良性结节、甲状腺外侵犯、中央区淋巴结转移、侧区淋巴结转移是对侧隐匿性癌的独立预测因素。对侧隐匿性癌是复发的独立预测因素。建立了一个 10 分风险评分模型来预测临床单发 PTC 患者的对侧隐匿性癌。
对于存在同侧隐匿性癌危险因素的临床单发 PTC 患者，行腺叶切除术即可。对于评分≥4 的临床单发 PTC 患者，需要仔细的术前评估以排除对侧隐匿性癌。即使术前未发现对侧隐匿性癌，高危患者也推荐行 TT。
