McCaffrey T V, Bergstralh E J, Hay I D
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905.
Head Neck. 1994 Mar-Apr;16(2):165-72. doi: 10.1002/hed.2880160211.
Well-differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus. Invasion of these structures produces symptoms of airway insufficiency, dysphagia, and hemoptysis. This study was designed to define more clearly the significance of invasion of papillary thyroid carcinoma on survival. At the Mayo Clinic, 262 patients treated for invasive papillary thyroid carcinoma between 1940 and 1990 were retrospectively evaluated. In this group the sites of invasion were muscle 53%, trachea 37%, laryngeal nerve 47%, esophagus 21%, larynx 12%, and other sites 30%. Complete tumor removal was accomplished in 56% of cases. Kaplan-Meier survival curves were calculated for the population. The overall survival was 79% at 5 years, 63% at 10 years, and 54% at 15 years. When the Cox proportional hazard model was applied to the survival data, the factors that had significant influence on survival were invasion of the trachea and the esophagus. Completeness of resection approached statistical significance. Muscle invasion, laryngeal invasion, and recurrent laryngeal nerve invasion had no significant independent influence on survival. These data suggest that when papillary thyroid carcinoma extends beyond the thyroid capsule and invades adjacent structures, the site invaded will influence survival. Survival may be improved in those cases in which complete surgical excision of the tumor is performed.
高分化甲状腺癌很少侵犯上呼吸道消化道。然而，一旦发生侵犯，就会导致严重的发病情况。甲状腺癌最常侵犯的结构是喉返神经、喉、咽和食管。这些结构受侵犯会产生气道功能不全、吞咽困难和咯血等症状。本研究旨在更明确地界定甲状腺乳头状癌侵犯对生存的意义。在梅奥诊所，对1940年至1990年间接受侵袭性甲状腺乳头状癌治疗的262例患者进行了回顾性评估。在该组中，侵犯部位为肌肉占53%、气管占37%、喉神经占47%、食管占21%、喉占12%、其他部位占30%。56%的病例实现了肿瘤完全切除。计算了该人群的Kaplan-Meier生存曲线。5年总生存率为79%，10年为63%，15年为54%。当将Cox比例风险模型应用于生存数据时，对生存有显著影响的因素是气管和食管的侵犯。切除的完整性接近统计学意义。肌肉侵犯、喉侵犯和喉返神经侵犯对生存没有显著的独立影响。这些数据表明，当甲状腺乳头状癌超出甲状腺包膜并侵犯相邻结构时，受侵犯的部位会影响生存。在那些进行了肿瘤完全手术切除的病例中，生存可能会得到改善。
