甲状腺髓样癌的手术范围

The extent of surgery for thyroid medullary cancer.

作者信息

Pelizzo M R, Bernante P, Piotto A, Toniato A, Girelli M E, Busnardo B, Rupolo M, Fassina A, Pennelli N

机构信息

Institute of General Surgery I, University of Padova, Italy.

出版信息

Tumori. 1994 Dec 31;80(6):427-32. doi: 10.1177/030089169408000604.

DOI:10.1177/030089169408000604

PMID:7900231

Abstract

AIMS

Evaluation of the impact of the extent of primary surgery and reintervention on the outcome of patients with medullary thyroid carcinoma.

METHODS

Seventy-two patients with medullary thyroid carcinoma (MTC) were surgically treated between 1967 and 1992.

RESULTS

Fifty-five cases were sporadic, 5 patients had MEN 2A, 4 MEN 2B syndrome and 8 familial non-MEN MTC; 1 patient had stage I disease, 30 patients stage II, 36 stage III and 5 stage IV. Sixty-four had their initial treatment at our center, and 8 came for subsequent treatment. At first treatment, 8 patients were subjected to partial thyroidectomy, 10 to total thyroidectomy, 53 to total thyroidectomy with neck dissection, and 1 to only radical neck dissection; postoperative serum calcitonin (Ct) levels returned to normal in 3, 6 and 27 patients, respectively. In the patient with only radical neck dissection, Ct levels remained elevated. No patient with Ct normalization after surgery became responsive to pentagastrin in the follow-up. Thirteen patients had a reoperation due to nodal relapse. At a mean follow-up of 5.7 years (6-252 months), the 10-year survival rate was 84.5% with a significant difference between patients under and over 40 years of age (96.4 vs 57%), between stage I-II (100%) and stage III, IV (83.8%, 0% respectively). At the last follow-up, 36 (50%) patients were alive and disease free and 26 were alive with disease (15 with distant metastases). Of the 10 deaths, 7 were due to tumor recurrence, 3 to 120 months after surgery.

CONCLUSIONS

Data suggest that an earlier diagnosis rather than more extensive surgery could improve survival and reduce recurrences. However, the least treatment required is total thyroidectomy plus central neck and upper mediastinum clearance and in addition, according to the extent of nodal involvement, mono- or bilateral neck dissection. To avoid ineffective reoperation due to distant (mainly liver) micrometastases, persistent residual microscopic disease requires a more aggressive restaging.

摘要

目的

评估原发性手术范围及再次干预对甲状腺髓样癌患者预后的影响。

方法

1967年至1992年间对72例甲状腺髓样癌（MTC）患者进行了手术治疗。

结果

55例为散发性，5例患有MEN 2A，4例患有MEN 2B综合征，8例为家族性非MEN MTC；1例为I期疾病，30例为II期，36例为III期，5例为IV期。64例在本中心接受初始治疗，8例前来接受后续治疗。初次治疗时，8例行甲状腺部分切除术，10例行甲状腺全切除术，53例行甲状腺全切除加颈部淋巴结清扫术，1例仅行根治性颈部淋巴结清扫术；术后血清降钙素（Ct）水平分别在3例、6例和27例患者中恢复正常。仅行根治性颈部淋巴结清扫术的患者，Ct水平仍升高。术后Ct恢复正常的患者在随访中对五肽胃泌素均无反应。13例患者因淋巴结复发而再次手术。平均随访5.7年（6 - 252个月），10年生存率为84.5%，40岁以下和40岁以上患者之间（96.4%对57%）、I - II期（100%）和III、IV期（分别为83.8%、0%）之间存在显著差异。在最后一次随访时，36例（50%）患者存活且无疾病，26例存活但患有疾病（15例有远处转移）。在10例死亡病例中，7例死于肿瘤复发，3例在术后120个月内死亡。