Proye C, Gontier A, Capuano G, Combemale F, Carnaille B, Decoulx M, Wemeau J L, Lecomte-Houcke M
Clinique Chirurgicale Adulte Est, CHRU de Lille, Hôpital Huriez.
Ann Endocrinol (Paris). 1997;58(3):233-9; discussion 240-1.
Evaluation of frequency and outcome of loco-regional persistance and recurrences of differentiated thyroid carcinomas after surgery.
from 1964 to December 1990, we operated and followed up more than 5 years (from 5 to 31 years): 589 thyroid cancers (309 papillary, 262 follicullar et 18 Hürthle cells); 145 patients were lost to follow-up (24%), 33% of them were microcarcinomas. Surgery consisted ultimately in 411 total thyroidectomies, 51 sub-total thyroidectomies, 113 lobectomies with isthmusectomies, 9 isthmusectomies or tumorectomies and 4 tracheotomies. Neck dissection was not routinely performed but rather selectively (n = 137). All Patients were put under suppressive hormone therapy. After total thyroidectomy, ablative 131 iodine was almost routinely done. All patients have been controlled by clinical examination, radio-iodine scanning and, since 1983, by sequential thyroglobulin assays. We have analysed the course of patients according to L. J. Degroot's staging (Stage I: Patient with intrathyroidal disease. Stage II: Patient with cervical node involvement. Stage III: Patient with extra-thyroidal neck invasive disease. Stage IV: Distant metastasis).
Stage I, n = 383, Stage II, n = 96. Total = 479. Local recurrences in the bed of total thyroidectomy were exceptional: n = 2/323 (0.6%). Recurrences in the thyroid remnant after non total thyroidectomy were rare: n = 3/156 (2%). Cervical nodal recurrences were also rare: n = 7/479 (1.5%). Stage III (n = 73): 34/306 papillary, 9/78, well differentiated follicular, 25/175 poorly differentiated follicular. 2/9 follicular of other type and 3/18 hurtle cell. In 67 patients, the loco-regional sterilization was achieved, 5 of which were reoperated for nodal cervical metastasis. 6 patients died from continuing loco-regional disease and 10 presented distant metastases. 4 of which died from. Among opered patients are still alive (52/73 = 71,2%) no loco-regional recurrence persisted.
The true problem is not recurrence but the persistance after surgery in stage III patients, despite the application of 1131. The determining factor of the persistance and recurrence is the initial stage of the carninomatous disease at the time of treatment.
评估分化型甲状腺癌术后局部区域持续性病变及复发的频率和结果。
1964年至1990年12月，我们对589例甲状腺癌患者进行了手术并随访5年以上（5至31年），其中包括309例乳头状癌、262例滤泡状癌和18例许特耳细胞癌；145例患者失访（24%），其中33%为微小癌。手术方式最终包括411例全甲状腺切除术、51例次全甲状腺切除术、113例甲状腺叶切除加峡部切除术、9例峡部切除术或肿瘤切除术以及4例气管切开术。颈部清扫术并非常规进行，而是选择性实施（n = 137）。所有患者均接受抑制性激素治疗。全甲状腺切除术后，几乎常规进行131碘消融治疗。所有患者均通过临床检查、放射性碘扫描以及自1983年起通过连续甲状腺球蛋白检测进行监测。我们根据L. J. 德格鲁特分期法（I期：甲状腺内病变患者。II期：有颈部淋巴结受累患者。III期：甲状腺外颈部侵犯性病变患者。IV期：远处转移患者）分析了患者的病程。
I期，n = 383；II期，n = 96。总计479例。全甲状腺切除术后手术床局部复发情况罕见：n = 2/323（0.6%）。非全甲状腺切除术后甲状腺残余组织复发情况少见：n = 3/156（2%）。颈部淋巴结复发也很罕见：n = 7/479（1.5%）。III期（n = 73）：34例乳头状癌中的306例、9例高分化滤泡状癌中的78例、25例低分化滤泡状癌中的175例、9例其他类型滤泡状癌中的2例以及18例许特耳细胞癌中的3例。67例患者实现了局部区域病变清除，其中5例因颈部淋巴结转移再次手术。6例患者死于持续性局部区域疾病，10例出现远处转移，其中4例死亡。在接受手术的患者中仍存活（52/73 = 71.2%），无局部区域复发持续存在。
真正的问题不是复发，而是III期患者术后尽管应用了131碘仍存在持续性病变。持续性病变和复发的决定因素是治疗时癌性疾病的初始阶段。
