Guo F L, Li L J, Ruan X H, Fu G M, Zhao J Z, Hou X K, Gao M, Zheng X Q
Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin Key Laboratory of General Surgery in Construction, Tianjin 300121, China.
Zhonghua Yi Xue Za Zhi. 2022 Dec 27;102(48):3849-3855. doi: 10.3760/cma.j.cn112137-20220610-01296.
To analyze the risk factors of recurrence or metastasis of medullary thyroid carcinoma (MTC) and the influencing factors of disease-free survival (DFS). The clinicopathological data of MTC patients who visited Tianjin Medical University Cancer Institute and Hospital and underwent surgery from August 2014 to August 2019 were retrospectively analyzed. The patients were divided into recurrence or metastasis group and no recurrence or metastasis group. Multivariate logistic regression analysis was used to analyze the risk factors for recurrence or metastasis. Kaplan-Meier survival analysis and Cox regression analysis were used to determine the risk factors of DFS. A total of 158 MTC patients were enrolled in final analysis, including 83 females and 75 males, with a median age of 52 (19-74) years. There were 146 cases of sporadic MTC (92.4%) and 12 cases of familial MTC (7.6%), respectively. Bilateral thyroid lesions presented in 33 cases (20.9%) and multiple lesions presented in 57 cases (36.1%), respectively. The median follow-up time was 59.7 (10.0-93.0) months and the median DFS was 55.5 (0-92.9) months. Presence of multifocality, the largest tumor size>2 cm, T3/4, N1b, clinical stage Ⅲ/Ⅳ, lymph node metastasis ratio (LNR)>0.3, preoperative calcitonin>2 000 ng/L, postoperative calcitonin>40 ng/L and no biochemical cure were significantly correlated with the recurrence or metastasis and DFS of MTC (all <0.05). Clinical stage Ⅲ/Ⅳ (=36.57, 95%: 1.33-1 006.98, =0.033), the largest tumor size>2 cm (=5.81, 95%: 1.01-33.33, =0.049), multifocality (=3.64, 95%: 1.03-12.88, =0.045) and postoperative calcitonin>40 ng/L (=15.03, 95%: 1.39-162.61, =0.026) were independent risk factors of recurrence or metastasis. Clinical stage Ⅲ/Ⅳ (19.39, 95%1.40-268.19, =0.027), the largest tumor size>2 cm (=3.64, 95% 1.02-13.02, =0.047) and postoperative calcitonin>40 ng/L (10.68, 95% 1.34-84.95, =0.025) were influencing factors for DFS (all 0.05). The larger tumor size, advanced clinical stage and higher postoperative calcitonin at the initial treatment of MTC are risk factors for recurrence or metastasis and influencing factors for DFS.
分析甲状腺髓样癌（MTC）复发或转移的危险因素及无病生存期（DFS）的影响因素。回顾性分析2014年8月至2019年8月在天津医科大学肿瘤医院就诊并接受手术的MTC患者的临床病理资料。将患者分为复发或转移组和无复发或转移组。采用多因素logistic回归分析复发或转移的危险因素。采用Kaplan-Meier生存分析和Cox回归分析确定DFS的危险因素。最终纳入158例MTC患者进行分析，其中女性83例，男性75例，中位年龄52（19 - 74）岁。散发性MTC 146例（92.4%），家族性MTC 12例（7.6%）。双侧甲状腺病变33例（20.9%），多发病变57例（36.1%）。中位随访时间为59.7（10.0 - 93.0）个月，中位DFS为55.5（0 - 92.9）个月。多灶性、最大肿瘤直径>2 cm、T3/4、N1b、临床分期Ⅲ/Ⅳ、淋巴结转移率（LNR）>0.3、术前降钙素>2 000 ng/L、术后降钙素>40 ng/L及生化未治愈与MTC的复发或转移及DFS显著相关（均P<0.05）。临床分期Ⅲ/Ⅳ（=36.57，95%：1.33 - 1 006.98，P=0.033）、最大肿瘤直径>2 cm（=5.81，95%：1.01 - 33.33，P=0.049）、多灶性（=3.64，95%：1.03 - 12.88，P=0.045）及术后降钙素>40 ng/L（=15.03，95%：1.39 - 162.61，P=0.026）是复发或转移的独立危险因素。临床分期Ⅲ/Ⅳ（19.39，95% 1.40 - 268.19，P=0.027）、最大肿瘤直径>2 cm（=3.64，95% 1.02 - 13.02，P=0.047）及术后降钙素>40 ng/L（10.68，95% 1.34 - 84.95，P=0.025）是DFS的影响因素（均P<0.05）。MTC初始治疗时肿瘤直径较大、临床分期较晚及术后降钙素较高是复发或转移的危险因素及DFS的影响因素。
