Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Br J Surg. 2021 Apr 30;108(4):395-402. doi: 10.1093/bjs/znaa129.
Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features.
Consecutive patients with PTC and at least one high-risk feature treated in 2000-2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis.
Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P < 0.001). With a median follow-up of 93 months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1 : 1 case-control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784).
Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.
尽管没有高级别证据表明这是一种较差的策略，但对于具有高危特征的甲状腺乳头状癌（PTC）患者，并不提倡行 lobectomy。本研究旨在探讨手术范围与具有高危特征的 PTC 患者生存之间的关系。
本研究纳入了 2000 年至 2012 年期间接受治疗的 PTC 且至少具有一个高危特征的连续患者。高危特征定义为：原发肿瘤大于 4cm、肉眼甲状腺外扩展、肉眼多发病灶和证实存在淋巴结转移，包括病理性侧颈部转移（pN1b）或 5 个以上中央淋巴结转移。采用 Cox 比例风险模型测量整个队列和配对分析中手术范围与疾病特异性生存（DSS）之间的关系。
在总共 2059 名具有高危特征的患者中，1224 名患者接受了 lobectomy，835 名患者接受了全甲状腺切除术。与接受 lobectomy 的患者相比，接受全甲状腺切除术的患者双侧癌的发生率显著更高（分别为 79.4%和 2.7%），多发病灶（80.8%和 32.8%）和双侧颈部转移（30.9%和 3.3%）的发生率也显著更高（均 P<0.001）。中位随访 93 个月后，多变量分析显示手术范围与整个队列的 DSS 无关（风险比 1.36，95%置信区间 0.75 至 2.48；P=0.310）。在对 528 名患者进行 1:1 病例对照匹配后，lobectomy 组和全甲状腺切除术组的 10 年 DSS 率（分别为 94.3%和 95.2%）或 10 年无复发生存率（分别为 75.8%和 79.2%）均无显著差异（P=0.323，P=0.784）。
对于具有高危特征的 PTC 患者，lobectomy 并不与结局明显恶化相关。
