Samaan N A, Schultz P N, Haynie T P, Ordonez N G
J Clin Endocrinol Metab. 1985 Feb;60(2):376-80. doi: 10.1210/jcem-60-2-376.
Well differentiated thyroid carcinoma was diagnosed in 1,127 patients at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston from 1951 to 1981. Of those 1,127 patients, 101 had documented pulmonary metastasis. A retrospective analysis was conducted, and these patients were followed up until 1983. The primary tumors in these patients were histologically classified as papillary (67%), follicular (22%), or Hurthle cell (11%). The age at diagnosis ranged from 5-87 yr. Lung metastasis was diagnosed by both chest x-ray and positive uptake of 131I in 49 patients. Forty-two patients had positive chest x-ray results and negative 131I scans, and 10 patients had positive 131I scans and negative chest x-ray results. The patients were treated with radioactive iodine (76%), chemotherapy (9%), external radiotherapy (2%), or supportive care only (14%). Sixty-seven patients subsequently died of thyroid carcinoma. Our studies showed the following. 1) Patients who were younger than 40 yr of age at diagnosis had better prognosis (71% survival) compared with those over 40 yr of age (16% survival; P less than 0.01). 2) Uptake of radioactive iodine by lung metastasis is a favorable prognostic factor, especially in patients with negative radiological findings. Patients treated with radioactive iodine have a longer survival than those not treated with radioactive iodine (P less than 0.002). 3) The incidence of pulmonary metastasis is significantly less in patients who are treated by total thyroidectomy than in those treated with less than total thyroidectomy (P less than 0.03). 4) The incidence of pulmonary metastasis is lowest in patients with papillary carcinoma (9%), compared with that in patients with follicular (13%) or Hurthle cell (25%) carcinoma.
1951年至1981年期间，德克萨斯大学MD安德森医院和休斯顿肿瘤研究所诊断出1127例高分化甲状腺癌患者。在这1127例患者中，101例有记录在案的肺转移。进行了回顾性分析，并对这些患者随访至1983年。这些患者的原发性肿瘤在组织学上分为乳头状（67%）、滤泡状（22%）或许特耳细胞（11%）。诊断时的年龄范围为5至87岁。49例患者通过胸部X光和131I阳性摄取诊断为肺转移。42例患者胸部X光结果阳性而131I扫描阴性，10例患者131I扫描阳性而胸部X光结果阴性。患者接受放射性碘治疗（76%）、化疗（9%）、外照射放疗（2%）或仅接受支持治疗（14%）。67例患者随后死于甲状腺癌。我们的研究显示如下：1）诊断时年龄小于40岁的患者预后较好（生存率71%），而40岁以上的患者预后较差（生存率16%；P<0.01）。2）肺转移摄取放射性碘是一个有利的预后因素，尤其是在放射学检查结果为阴性的患者中。接受放射性碘治疗的患者比未接受放射性碘治疗的患者生存期更长（P<0.002）。3）全甲状腺切除术治疗的患者肺转移发生率明显低于次全甲状腺切除术治疗的患者（P<0.03）。4）乳头状癌患者的肺转移发生率最低（9%），而滤泡状癌（13%）或许特耳细胞癌（25%）患者的肺转移发生率较高。
