Department of Head and Neck Surgery, the Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing 210009, China
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2021 Dec 25;50(6):707-715. doi: 10.3724/zdxbyxb-2021-0222.
Objective: To investigate the prognostic factors of patients with persistent/recurrent differentiated thyroid carcinoma (DTC) especially with external invasive persistent recurrent DTC after comprehensive treatment. Methods: The clinical data of 525 patients with persistent/recurrent DTC who underwent surgical treatment from August 2011 to June 2021 in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital were retrospectively analyzed. The prognostic factors affecting overall survival (OS) and relapse-free survival (RFS) of persistent/recurrent DTC, especially external invasive persistent/recurrent DTC were analyzed. Results: Among 525 patients, 318 patients underwent thyroidectomy, 359 patients underwent central lymph node dissection, and 409 patients underwent lateral cervical lymph node dissection. Among 493 followed-up patients, 5-year OS and RFS were 95.10% and 89.60%, 8-year OS and RFS were 91.80% and 81.30%. Cox regression analysis showed that in patients with persistent/recurrent DTC after comprehensive treatment, age ≥55 years at reoperation after recurrence, male gender and distant metastasis were independent risk factors of OS (all P<0.05); while the simultaneous invasion of thyroid and lymph nodes, multiple organ invasion and the number of previous operations ≥2 were independent risk factors of RFS (all P<0.05). In patients with external invasive persistent/recurrent DTC after comprehensive treatment, age ≥55 years at reoperation after recurrence and male gender were independent risk factors of OS (both P<0.05); while multiple organ invasion and the number of previous operations ≥2 were independent risk factors of RFS (both P<0.05). Conclusions: Male patients aged 55 years old and above, with distant metastasis have a higher risk of poorer prognosis in persistent/recurrent DTC; while patients with simultaneous external invasion of thyroid and lymph nodes, multiple organ invasion and the number of previous operations ≥2 are more likely to relapse. For external invasive persistent/recurrent DTC, male patients aged 55 years old and above have a higher risk of poorer prognosis; while patients with multiple organ invasion and the number of previous operations ≥2 are more likely to have recurrence.
探讨综合治疗后持续性/复发性分化型甲状腺癌（DTC）患者，尤其是伴有外侵持续性/复发性 DTC 的预后因素。方法：回顾性分析 2011 年 8 月至 2021 年 6 月江苏省肿瘤医院头颈外科收治的 525 例行手术治疗的持续性/复发性 DTC 患者的临床资料，分析影响持续性/复发性 DTC 患者总生存（OS）和无复发生存（RFS）的预后因素，尤其是外侵持续性/复发性 DTC。结果：525 例患者中，318 例行甲状腺切除术，359 例行中央区淋巴结清扫术，409 例行侧颈区淋巴结清扫术。493 例患者随访 5 年，OS 和 RFS 分别为 95.10%和 89.60%，8 年 OS 和 RFS 分别为 91.80%和 81.30%。Cox 回归分析显示，在综合治疗后持续性/复发性 DTC 患者中，复发后再次手术时年龄≥55 岁、男性及远处转移是 OS 的独立危险因素（均 P<0.05）；而甲状腺与淋巴结同时侵犯、多器官侵犯及手术次数≥2 是 RFS 的独立危险因素（均 P<0.05）。在综合治疗后伴有外侵持续性/复发性 DTC 患者中，复发后再次手术时年龄≥55 岁及男性是 OS 的独立危险因素（均 P<0.05）；而多器官侵犯及手术次数≥2 是 RFS 的独立危险因素（均 P<0.05）。结论：年龄≥55 岁、男性、伴有远处转移的持续性/复发性 DTC 患者预后较差；而伴有甲状腺与淋巴结同时侵犯、多器官侵犯及手术次数≥2 的患者更容易复发。对于伴有外侵的持续性/复发性 DTC，年龄≥55 岁、男性的患者预后较差；而多器官侵犯及手术次数≥2 的患者更容易复发。
