甲状腺乳头状癌合并桥本甲状腺炎的外科治疗：单中心回顾性队列研究。
Surgical management of papillary thyroid carcinoma coexisting with Hashimoto's disease: a single-center retrospective cohort study.
机构信息
Department of Gastrointestinal Surgery, International Hospital, Peking University, Beijing, China.
出版信息
Front Endocrinol (Lausanne). 2024 Aug 7;15:1383945. doi: 10.3389/fendo.2024.1383945. eCollection 2024.
BACKGROUND
The mechanism and impact of Hashimoto's disease (HT) in patients with papillary thyroid carcinoma (PTC) remains a subject of ongoing debate. The optimal extent of thyroid resection is also controversial in cases of low-risk PTC.
OBJECTIVE
To investigate the clinical outcomes and prognoses associated with different extents of surgical resection in patients diagnosed with PTC coexisting with HT.
METHODS
We retrospectively analyzed data on the clinical features and treatment outcomes of patients with PTC concomitant with HT who underwent lobectomy with isthmusectomy and those who underwent total thyroidectomy at Peking University International Hospital between December 2014 and August 2023.
RESULTS
Twenty-one patients in group A underwent lobectomy with isthmusectomy and prophylactic central neck dissection, whereas twenty patients in group B underwent total thyroidectomy with prophylactic central lymph node (LN) dissection, except one who did not undergo LN dissection. Group A demonstrated shorter surgery time (105.75 min ± 29.35 vs. 158.81 min ± 42.01, p = 0.000), higher parathyroid hormone (PTH) levels on postoperative day 1 [26.96 pg/ml (20.25, 35.45) vs. 9.01 pg/ml (2.48, 10.93), p = 0.000] and a shorter postoperative hospital stay [2.95 d (2.0, 4.0) vs. 4.02 d (3.0, 5.0), p = 0.008] than those of group B, with statistically significant differences. Both groups exhibited similar recovery patterns in terms of PTH [32.10 pg/ml (22.05, 46.50) vs. 20.47 pg/ml (9.43, 34.03), p = 0.192] and serum calcium (2.37 mmol/L ± 0.06 vs. 2.29 mmol/L ± 0.19, p = 0.409) after 1 montsh following the surgery. According to the Kaplan-Meier curves, no significant difference in the 5-year disease-free survival rates were observed between patients in group A (100%) and group B (97.1%) (Log rank test: p = 0.420, Breslow test: p = 0.420).
CONCLUSION
Lobectomy with isthmusectomy and prophylactic central neck dissection is a safe and feasible treatment option for patients with low-risk PTC coexisting with HT.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn, identifier ChiCTR2300079115.
背景
桥本氏病（Hashimoto's disease，HT）在甲状腺乳头状癌（papillary thyroid carcinoma，PTC）患者中的发病机制和影响仍是一个持续争论的话题。对于低危 PTC 患者，甲状腺切除术的最佳范围也存在争议。
目的
探讨不同范围手术切除治疗合并 HT 的 PTC 患者的临床结局和预后。
方法
我们回顾性分析了 2014 年 12 月至 2023 年 8 月期间在北京大学国际医院行甲状腺叶切除术加峡部切除术和甲状腺全切除术加预防性中央淋巴结清扫术（central lymph node，LN）的合并 HT 的 PTC 患者的临床特征和治疗结果。
结果
A 组 21 例患者行甲状腺叶切除术加峡部切除术和预防性中央颈淋巴结清扫术，B 组 20 例患者行甲状腺全切除术加预防性中央 LN 清扫术（除 1 例未行 LN 清扫术）。A 组手术时间更短[105.75 分钟±29.35 分钟比 158.81 分钟±42.01 分钟，p=0.000]，术后第 1 天甲状旁腺激素（parathyroid hormone，PTH）水平更高[26.96 pg/ml（20.25，35.45）比 9.01 pg/ml（2.48，10.93），p=0.000]，术后住院时间更短[2.95 天（2.0，4.0）比 4.02 天（3.0，5.0），p=0.008]，差异均有统计学意义。两组术后第 1 个月的 PTH[32.10 pg/ml（22.05，46.50）比 20.47 pg/ml（9.43，34.03），p=0.192]和血清钙[2.37 mmol/L±0.06 比 2.29 mmol/L±0.19，p=0.409]恢复情况相似。根据 Kaplan-Meier 曲线，A 组（100%）和 B 组（97.1%）患者的 5 年无病生存率无显著差异（Log rank 检验：p=0.420，Breslow 检验：p=0.420）。
结论
对于低危 PTC 合并 HT 患者，甲状腺叶切除术加峡部切除术和预防性中央颈淋巴结清扫术是一种安全可行的治疗选择。
临床试验注册
http://www.chictr.org.cn，注册号 ChiCTR2300079115。
Zotero 插件