Matsubayashi S, Kawai K, Matsumoto Y, Mukuta T, Morita T, Hirai K, Matsuzuka F, Kakudoh K, Kuma K, Tamai H
Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Clin Endocrinol Metab. 1995 Dec;80(12):3421-4. doi: 10.1210/jcem.80.12.8530576.
Ninety-five patients with papillary thyroid carcinoma (PTC) who received primary surgical treatment in 1983 at Kuma Hospital and were followed until 1992 were the subjects of this study. Initial therapy was tumor resection for 5 patients, lobectomy for 23 patients, total thyroidectomy with unilateral modified neck dissection for 60 patients, and total thyroidectomy with bilateral modified neck dissection for 7 patients. Clinical stage at diagnosis was as follows. Class I included 28 patients with intrathyroidal disease, class II included 60 patients with positive cervical lymph nodes, and class II included 7 patients with tumor invasion into tissue outside of the thyroid gland. Recurrence of the tumor was evaluated according to lymphocytic infiltration in the thyroid gland. Group A consisted of 36 patients with PTC associated with lymphocytic infiltration, 26 with infiltration surrounding the tumor, 3 with infiltration inside of the tumor, and 7 with both. Group B consisted of the remaining 59 patients with PTC with no lymphocytic infiltration. There were no differences in age, sex, initial tumor size, or initial treatment between groups A and B. Antithyroglobulin antibody and/or antimicrosomal antibody were positive in 16 patients from group A and 4 patients from group B (P < 0.001). Class I included 14 patients from each group, class II included 22 patients from group A and 38 patients from group B, and class III included 7 patients, all from group B. Recurrence of the tumor was found in only 1 group A patient (2.8%), but in 11 patients of group B (18.6%). The percentage of patients free from recurrence over the 10 yr of follow-up in group A was significantly higher than that in group B (by Cox-Mantel test, P < 0.01). The time between initial treatment and recurrence was 2-10 yr. In comparing the clinical stage at the time of initial treatment, recurrence was found in 1 class II patient from group A (4.5%) and in 1 class I (7.1%), 6 class II (15.8%), and 4 class III (57.1%) patients from group B. No patients died during the 10 yr of follow-up. In conclusion, 1) lymphocytic infiltration surrounding the tumor or inside the tumor in PTC might be of use as a means for predicting a favorable prognosis; and 2) class II or class III patients with no lymphocytic infiltration had a high rate of recurrence.
本研究的对象为1983年在久留米医院接受初次手术治疗并随访至1992年的95例甲状腺乳头状癌（PTC）患者。初始治疗方案为：5例患者行肿瘤切除术，23例患者行叶切除术，60例患者行全甲状腺切除术加单侧改良颈部淋巴结清扫术，7例患者行全甲状腺切除术加双侧改良颈部淋巴结清扫术。诊断时的临床分期如下。I期包括28例甲状腺内疾病患者，II期包括60例颈部淋巴结阳性患者，III期包括7例肿瘤侵犯甲状腺外组织的患者。根据甲状腺内的淋巴细胞浸润情况评估肿瘤复发情况。A组由36例伴有淋巴细胞浸润的PTC患者组成，其中26例浸润位于肿瘤周围，3例浸润于肿瘤内部，7例两者均有。B组由其余59例无淋巴细胞浸润的PTC患者组成。A组和B组在年龄、性别、初始肿瘤大小或初始治疗方面无差异。A组16例患者和B组4例患者抗甲状腺球蛋白抗体和/或抗微粒体抗体呈阳性（P<0.001）。I期每组各有14例患者，II期A组有22例患者，B组有38例患者，III期7例患者均来自B组。仅1例A组患者（2.8%）出现肿瘤复发，而B组有11例患者（18.6%）复发。A组在10年随访期间无复发患者的百分比显著高于B组（通过Cox-Mantel检验，P<0.01）。初始治疗至复发的时间为2至10年。比较初始治疗时的临床分期，A组1例II期患者（4.5%）和1例I期患者（7.1%）复发，B组1例I期患者（7.1%）、6例II期患者（15.8%）和4例III期患者（57.1%）复发。在10年随访期间无患者死亡。总之，1）PTC中肿瘤周围或肿瘤内部的淋巴细胞浸润可能作为预测预后良好的一种手段；2）无淋巴细胞浸润的II期或III期患者复发率较高。
