Staunton M D
Royal Marsden Hospital, London, UK.
Eur J Surg Oncol. 1994 Dec;20(6):613-21.
Contemporary management of patients with follicular pattern thyroid cancer remains uncertain. This retrospective multivariate analysis studied 410 such patients treated in a cancer hospital in the years 1932-72 and providing a follow-up of 20 years. In papillary carcinoma thyroxine administration (P < 0.005) and surgery (P < 0.001) improved survival together with youth (P < 0.001) and being female (P < 0.05). In follicular carcinoma, thyroxine therapy (P < 0.001) increased survival as did surgery but it failed to reach significance (P = 0.19); increasing age (P < 0.001), stage M1 (P < 0.05) and 'complete' radiotherapy (P < 0.05) decreased survival. In anaplastic carcinoma survival was improved by thyroxine therapy (P < 0.001), a new finding, but decreased by stages T3 (P < 0.001) and M1 (P < 0.05); however, radiotherapy, the mainstay in control of local disease, did not increase survival. Overall, total thyroidectomy reduced local recurrence with an increase in complications and no operation gained a significant increase in survival. Radio-iodine achieved no benefit in survival which raises the possibility of confounding. Thyroxine therapy is indicated as initial treatment of follicular cell thyroid cancer.
滤泡型甲状腺癌患者的现代治疗方法仍不明确。这项回顾性多变量分析研究了1932年至1972年间在一家癌症医院接受治疗的410例此类患者，并进行了20年的随访。在乳头状癌中，甲状腺素给药（P<0.005）、手术（P<0.001）与年轻（P<0.001）和女性（P<0.05）共同提高了生存率。在滤泡状癌中，甲状腺素治疗（P<0.001）与手术一样提高了生存率，但未达到显著水平（P=0.19）；年龄增加（P<0.001）、M1期（P<0.05）和“完全”放疗（P<0.05）降低了生存率。在未分化癌中，甲状腺素治疗提高了生存率（P<0.001），这是一个新发现，但T3期（P<0.001）和M1期（P<0.05）降低了生存率；然而，作为控制局部疾病主要手段的放疗并没有提高生存率。总体而言，全甲状腺切除术减少了局部复发，但并发症增加，未进行手术的患者生存率显著提高。放射性碘在生存方面没有益处，这增加了混淆的可能性。甲状腺素治疗被指定为滤泡细胞性甲状腺癌的初始治疗方法。
