Gavilán I, Astorga R, Sasián S, Acosta D, Aguilar M, Leal A, Escobar L, Córdoba J A, Girón J A
Sección de Endocrinología, Hospital Universitario Puerta del Mar. Cádiz.
Rev Clin Esp. 1996 Feb;196(2):92-8.
To analyze the clinical features and possible prognostic factors involved in the clinical course of a series of 26 patients with the diagnosis of thyroid medullar carcinoma (TMC).
An analysis was made of the variables age, sex, clinical course to diagnosis, paraneoplastic manifestations (flush, diarrhoea), clinical type (sporadic, non-associated, familial MEN IIa associated TMC, familial MEN IIb associated TMC), histologic uni or multicentricity, and stage of disease as possible predictive factors for the evolution.
The most remarkable prognostic factor was tumoral stage. The likelihood of a patient diagnosed with stage I or II being free of metastatic disease was 1, 0.66 and 0.33 at 15, 16 and 17 years, respectively. In contrast, those patients in stage III at diagnosis had a likelihood of being free from metastasis 5 years after diagnosis and therapy of 0. With regard to sex, a better clinical course was observed among males than among females, statistically significant at 3 and 5, but not at 10 years. No statistical significance was reached with the other possible prognostic factors investigated.
Given the obvious influence of tumoral stage of disease on prognosis, an early access to medical attention is desirable for diagnosis and treatment of TMC, as well as an early detection of family cases by a screening test.
分析26例确诊为甲状腺髓样癌（TMC）患者的临床特征及临床病程中可能的预后因素。
对年龄、性别、诊断时的临床病程、副肿瘤表现（潮红、腹泻）、临床类型（散发性、非相关性、家族性MEN IIa相关TMC、家族性MEN IIb相关TMC）、组织学单中心或多中心性以及疾病分期等变量进行分析，作为病情发展的可能预测因素。
最显著的预后因素是肿瘤分期。诊断为I期或II期的患者在15年、16年和17年时无转移疾病的可能性分别为1、0.66和0.33。相比之下，诊断为III期的患者在诊断和治疗后5年无转移的可能性为0。关于性别，男性的临床病程优于女性，在3年和5年时具有统计学意义，但在10年时无统计学意义。所研究的其他可能预后因素未达到统计学意义。
鉴于疾病的肿瘤分期对预后有明显影响，对于TMC的诊断和治疗，需要尽早就医，同时通过筛查试验尽早发现家族性病例。
