Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, Spain.
Rev Clin Esp (Barc). 2021 Mar;221(3):131-138. doi: 10.1016/j.rceng.2019.12.012. Epub 2021 Feb 15.
Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis.
We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis.
We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ± 65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ± 5.6 vs. 97.4 ± 10.3 months; p = .034).
The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.
尽管近年来甲状腺微小乳头状癌（PTMC）的发病率有所增加，但微小甲状腺外侵犯（mETE）在 PTMC 预后中的作用仍不清楚。本研究旨在分析与 mETE 相关的 PTMC 相关因素及其长期预后。
我们对组织学诊断为 PTMC 的患者进行了回顾性研究。我们排除了先前接受过甲状腺手术的患者、有其他同步恶性肿瘤的患者、PTMC 异位的患者以及两年内失访的患者。我们将第 1 组（无甲状腺外侵犯的 PTMC）与第 2 组（有 mETE 的 PTMC）进行比较，并进行了多变量分析。
我们观察到 11.2%（n=18）的患者存在 mETE 的 PTMC。多变量分析显示，mETE 与年龄≥45 岁（OR：4.383；95%CI：1.051-18.283，p=0.043）、肿瘤大小≥8mm（OR：5.913；95%CI：1.795-19.481；p=0.003）、双侧性（OR：4.430；95%CI：1.294-15.173；p=0.018）和转移性淋巴结（OR：12.588；95%CI：2.919-54.280；p=0.001）相关。在平均 119.8±65 个月的随访期间，第 2 组中仅发现 1 例复发（0%与 5.6%；p=0.112）。无患者死于该疾病。第 2 组的无病生存率较低（124.9±5.6 与 97.4±10.3 个月；p=0.034）。
PTMC 的 mETE 是与转移性淋巴结存在和无病生存率降低相关的预后不良因素。
