Department of Surgery, Ito Hospital, Tokyo, Japan.
Department of Pathology, Ito Hospital, Tokyo, Japan.
Ann Surg Oncol. 2021 Jul;28(7):3576-3583. doi: 10.1245/s10434-020-09397-3. Epub 2020 Nov 25.
Completion total thyroidectomy with radioactive iodine (RAI) therapy is not uniformly recommended for minimally invasive follicular thyroid carcinomas (MI-FTCs) without distant metastasis, but may be considered for cases with a risk factor of recurrence, such as age ≥ 45 years.
The present study aimed to investigate the outcomes for patients with MI-FTC using a stratification age of 55 years.
The records of 478 patients with MI-FTC confirmed by surgical specimens at Ito Hospital from January 2005 to December 2014 were retrospectively reviewed. Twenty patients had distant metastasis at diagnosis and were subsequently classified as M1.
Among the 478 patients with MI-FTC, univariate analysis identified that age ≥ 55 years (p = 0.002) and M1 (p < 0.001) were related to cause-specific survival. In 458 patients with M0 MI-FTC, male sex (p = 0.041), age ≥ 55 years (p = 0.001), and tumor size > 40 mm (p < 0.001) were related to poor disease-free survival (DFS) in univariate analysis. Multivariate analysis showed that age ≥ 55 years (p = 0.005) and tumor size > 40 mm (p = 0.005) were independent prognostic factors for DFS. The 10-year DFS rates of patients aged < 45 years, 45 years ≤ age < 55 years, and ≥ 55 years were 97.0%, 95.5%, and 86.4%, respectively.
The change in the recommended age for completion total thyroidectomy with RAI, from 45 to 55 years, seemed reasonable.
对于无远处转移的微小浸润滤泡状甲状腺癌（MI-FTC），并非一致推荐行全甲状腺切除术加放射性碘（RAI）治疗，但对于有复发风险的病例，如年龄≥45 岁，可考虑该治疗方案。
本研究旨在通过分层年龄为 55 岁，探讨 MI-FTC 患者的治疗结局。
回顾性分析 2005 年 1 月至 2014 年 12 月在 Ito 医院经手术标本证实的 478 例 MI-FTC 患者的病历资料。20 例患者初诊时即有远处转移，随后被归类为 M1 期。
在 478 例 MI-FTC 患者中，单因素分析发现年龄≥55 岁（p=0.002）和 M1（p<0.001）与特定病因生存率相关。在 458 例 M0 MI-FTC 患者中，男性（p=0.041）、年龄≥55 岁（p=0.001）和肿瘤直径>40mm（p<0.001）与无病生存率（DFS）较差相关。多因素分析显示，年龄≥55 岁（p=0.005）和肿瘤直径>40mm（p=0.005）是 DFS 的独立预后因素。年龄<45 岁、45 岁≤年龄<55 岁和年龄≥55 岁的患者 10 年 DFS 率分别为 97.0%、95.5%和 86.4%。
将全甲状腺切除术加 RAI 治疗的建议年龄从 45 岁改为 55 岁似乎是合理的。
