Mathonnet M, Cubertafond P, Teissier M P, Boutros-Toni F, Gainant A
Service de Chirurgie digestive, endocrinienne et générale, CHU Dupuytren, Limoges.
Chirurgie. 1994;120(12):117-22.
Involvement of regional lymph nodes is extremely common in medullary carcinoma of the thyroid gland (MTC). The aim of the present study was to determinate the prognostic of MTC correlated with the regional lymph node involvement. From 1975 to 1994, 23 MTC patients were treated. The surgical protocol included a total thyroidectomy with bilateral dissection of the jugulocarotid chain and of the paratracheal groove. We have distinguished two groups: group N+ (histological lymph nodes involvement) and group N- (absence of histological lymph nodes involvement). In each group we have evaluated the prognostic significance of age, sex, palpable lymph nodes, histological capsular effraction and presence of distant metastasis. The data were analyzed with the exact Fisher test and comparisons by Student t test. Significance was defined as p > 0.05. Survical curves were based on the method of Kaplan Meier. In Group N+ (n = 15), 9/15 patients died: they had palpable lymph nodes, histological capsular effraction and distant synchronous or metachronous metastasis. The median survival was 8 months, when patients have distant metastasis. Six patients are alive, 2 with an elevated thyrocalcitonin level without metastasis, and 3 with resection of metastatic MCT to regional lymph nodes. In groupe N- (n = 8), all patients are alive: 2/8 patients had palpable lymph nodes, 1/8 had histological capsular effraction, but none had distant metastasis. 2 patients underwent resection of regional lymph metastasis and one of pulmonary metachronous metastasis. Gender did not appear to affect the lymph involvement. Factors significantly associated in the group N+ included the following: age (p = 0.003), palpable lymph nodes (p = 0.015), capsular effraction (p > 0.00025), distant synchronous metastasis (p < 0.013). The regional lymph node metastasis had significant influence on the 5-year survival, 48% vs 100% (p = 0.006), and on disease free survival, 16.6% vs 62.5% (p = 0.018). The median time from resection of the primary tumor to the development of metastasis disease was 37 months for patients N+ vs 169 months for patients N-. Involvement lymph node did not affect the metastasis disease, regional involvement or distant metastasis (p > 0.05).
区域淋巴结受累在甲状腺髓样癌（MTC）中极为常见。本研究的目的是确定与区域淋巴结受累相关的MTC的预后。1975年至1994年，对23例MTC患者进行了治疗。手术方案包括全甲状腺切除术，双侧清扫颈总动脉链和气管旁沟。我们将患者分为两组：N+组（组织学上有淋巴结受累）和N-组（组织学上无淋巴结受累）。在每组中，我们评估了年龄、性别、可触及淋巴结、组织学包膜侵犯和远处转移的存在对预后的意义。数据采用精确Fisher检验和Student t检验进行分析。显著性定义为p>0.05。生存曲线基于Kaplan-Meier方法。在N+组（n = 15）中，15例患者中有9例死亡：他们有可触及的淋巴结、组织学包膜侵犯以及远处同步或异时转移。当患者有远处转移时，中位生存期为8个月。6例患者存活，2例甲状腺降钙素水平升高且无转移，3例区域淋巴结转移性MCT切除术后存活。在N-组（n = 8）中，所有患者均存活：8例患者中有2例可触及淋巴结，8例中有1例有组织学包膜侵犯，但均无远处转移。2例患者接受了区域淋巴结转移切除术，1例接受了肺部异时转移切除术。性别似乎不影响淋巴结受累情况。N+组中显著相关的因素包括：年龄（p = 0.003）、可触及淋巴结（p = 0.015）、包膜侵犯（p>0.00025）、远处同步转移（p<0.013）。区域淋巴结转移对5年生存率有显著影响，分别为48%和100%（p = 0.006），对无病生存率也有显著影响，分别为16.6%和62.5%（p = 0.018）。N+组患者从原发性肿瘤切除到转移疾病发生的中位时间为37个月，而N-组患者为169个月。淋巴结受累不影响转移疾病、区域受累或远处转移（p>0.05）。
