Coburn M, Teates D, Wanebo H J
Department of Surgery, Roger Williams Medical Center, Brown University, Providence, Rhode Island.
Ann Surg. 1994 Jun;219(6):587-93; discussion 593-5. doi: 10.1097/00000658-199406000-00001.
This retrospective study compared treatment and survival of patients with recurrent well-differentiated thyroid cancer that was diagnosed exclusively by I131 scanning, or by clinical examination.
Despite the usual excellent prognosis of differentiated thyroid cancer, approximately half of patients who developed a recurrence eventually succumb to the disease. It has been speculated, but not proven, that recurrent disease detected solely by I131 scanning may offer a better prognosis than recurrences detected clinically and be amendable to I131 ablative therapy without the addition of surgical resection.
Seventy-four cases of recurrent differentiated thyroid cancer were identified retrospectively and examined regarding the location of recurrence, mode of detection of recurrent disease, treatment of recurrence, and outcome of patients. Using Fischer exact testing, outcome results for recurrences detected exclusively by I131 scan was compared to that of clinically diagnosed recurrences; among clinically detected recurrent cases, treatment with surgery only was compared to surgery/I131 ablation. Kaplan-Meier actuarial survival curves were generated for clinically detected recurrent cancer treated by surgery only and compared to those treated by surgery and I131 ablation using Gehan-Wilcoxon and log-rank analysis.
Recurrences located most commonly were regional (53%), followed by local (28%), distant metastasis (13%), and combined locoregional (6%). Among patients whose recurrence was detected scintigraphically, only 9.5% had persistence of disease or were dead of disease compared to 54.0% of patients with clinically detected recurrences. Radioactive iodine ablation in scintigraphically detected recurrences salvaged 18 of 20 patients (90%). Among clinically detected recurrences, surgery alone salvaged 12 of 21 patients (57%), whereas the addition of I131 ablation to surgery salvaged only 3 of 15 patients (20% p = 0.05).
The probability of dying or living with persistent disease after treatment of recurrent thyroid cancer is less for I131 detected recurrences compared to clinically diagnosed recurrences; I131 ablation without surgery constitutes adequate therapy for scintigraphically detected recurrences. In clinically recurrent disease, the addition of I131 ablation to curative resection does not appear to improve survival.
本回顾性研究比较了仅通过I131扫描或临床检查诊断出的复发性高分化甲状腺癌患者的治疗情况和生存率。
尽管分化型甲状腺癌通常预后良好，但约一半出现复发的患者最终会死于该疾病。据推测，但未经证实，仅通过I131扫描检测到的复发性疾病可能比临床检测到的复发预后更好，并且无需额外进行手术切除即可接受I131消融治疗。
回顾性确定74例复发性分化型甲状腺癌病例，并检查复发部位、复发性疾病的检测方式、复发的治疗方法以及患者的预后。使用Fisher精确检验，将仅通过I131扫描检测到的复发的预后结果与临床诊断的复发结果进行比较；在临床检测到的复发病例中，将仅手术治疗与手术/I131消融治疗进行比较。为仅接受手术治疗的临床检测到的复发性癌症生成Kaplan-Meier精算生存曲线，并使用Gehan-Wilcoxon和对数秩分析与接受手术和I131消融治疗的患者的生存曲线进行比较。
最常见的复发部位是局部区域（53%）,其次是局部（28%）、远处转移（13%）和局部区域联合复发（6%）。在通过闪烁扫描检测到复发的患者中，只有9.5%的患者疾病持续存在或死于该疾病，而临床检测到复发的患者中这一比例为54.0%。闪烁扫描检测到的复发患者中，放射性碘消融挽救了20例患者中的18例（90%）。在临床检测到的复发病例中，仅手术治疗挽救了21例患者中的12例（57%），而手术加I131消融仅挽救了15例患者中的3例（20%，p=0.05）。
与临床诊断的复发相比，I131检测到的复发性甲状腺癌治疗后死亡或疾病持续存在的可能性较小；对于闪烁扫描检测到的复发，不进行手术的I131消融构成了充分的治疗。在临床复发性疾病中，在根治性切除的基础上加用I131消融似乎并不能提高生存率。
