Martins R G, Caplan R H, Lambert P J, Rooney B, Kisken W A
Section of Endocrinology, Gundersen/Lutheran Medical Center, La Crosse, WI 54601, USA.
J Am Coll Surg. 1997 Oct;185(4):388-97.
Most reports regarding the treatment of thyroid cancer originate from university referral centers. In this article, we report our experience in managing thyroid cancer of follicular cell origin at a non-university institution over a 26-year period.
We reviewed the medical records of all patients treated for thyroid cancer at the Gundersen/Lutheran Medical Center from 1969 to 1995. Histologic types, demographic and clinical characteristics, laboratory results, treatment, complications, and followup observations were tabulated. Risk was assigned according to the age, presence of distant metastasis, extent of the primary tumor, and site of the primary tumor (AMES) staging system.
The histologic classification was as follows: papillary, 139; follicular, 24; Hürthle cell, 14; and anaplastic, 11. Low-risk lesions were identified in 96%, 79%, and 71% of the patients with papillary, follicular, and Hürthle cell (collectively designated differentiated) carcinoma, respectively. We treated 60% of our patients with differentiated thyroid cancer with near-total or total thyroidectomy. Clinically involved cervical lymph nodes were removed singly or by modified neck dissection. We frequently ablated thyroid remnants after operation with 29.9 mCi (1,110 MBq) of 131I, after which we treated the patient with suppressive doses of levothyroxine. Patients were evaluated yearly with thyroglobulin measurements and, in some high-risk patients, with total-body 131I scans. Cancer recurred in 13%, 8%, and 7% of our patients with papillary, follicular, and Hürthle cell carcinoma, respectively. Only three patients died of differentiated thyroid cancer; eight are alive with malignancy. In anaplastic thyroid cancer, cervical lymph node metastases, local invasion, and distant metastases were present in 18%, 64%, and 45% of patients at the time of initial evaluation. Total or near-total thyroidectomy was possible in only four of nine patients treated surgically. External radiation (11 patients) and chemotherapy (two patients) were used. Additional metastases developed in 45% of the patients, and nine patients died within a year. Permanent hypoparathyroidism or hoarseness complicated 2.7% of the thyroid operations.
Although our followup was relatively short, the results of treating thyroid cancer by general surgeons at a nonuniversity hospital compare favorably with results obtained from university referral centers.
大多数关于甲状腺癌治疗的报告都来自大学转诊中心。在本文中，我们报告了我们在一所非大学机构26年间处理滤泡细胞源性甲状腺癌的经验。
我们回顾了1969年至1995年在冈德森/路德会医疗中心接受甲状腺癌治疗的所有患者的病历。将组织学类型、人口统计学和临床特征、实验室检查结果、治疗、并发症及随访观察结果制成表格。根据年龄、远处转移情况、原发肿瘤范围及原发肿瘤部位（AMES分期系统）来确定风险。
组织学分类如下：乳头状癌139例；滤泡状癌24例；许特尔细胞癌14例；未分化癌11例。乳头状癌、滤泡状癌和许特尔细胞癌（统称为分化型）患者中，分别有96%、79%和71%被确定为低风险病变。我们对60%的分化型甲状腺癌患者进行了近全甲状腺切除术或全甲状腺切除术。对临床受累的颈部淋巴结进行单独切除或改良颈清扫术。术后我们经常用29.9毫居里（1110兆贝可）的131碘消融甲状腺残余组织，之后用抑制剂量的左甲状腺素治疗患者。每年通过检测甲状腺球蛋白对患者进行评估，对一些高风险患者还进行全身131碘扫描。乳头状癌、滤泡状癌和许特尔细胞癌患者的癌症复发率分别为13%、8%和7%。只有3例患者死于分化型甲状腺癌；8例患者仍患有恶性肿瘤。在未分化甲状腺癌中，初次评估时18%的患者有颈部淋巴结转移，64%的患者有局部侵犯，45%的患者有远处转移。接受手术治疗的9例患者中只有4例可行全甲状腺切除术或近全甲状腺切除术。采用了外照射（11例患者）和化疗（2例患者）。45%的患者出现了额外的转移，9例患者在1年内死亡。2.7%的甲状腺手术出现了永久性甲状旁腺功能减退或声音嘶哑等并发症。
尽管我们的随访时间相对较短，但非大学医院普通外科医生治疗甲状腺癌的结果与大学转诊中心的结果相比毫不逊色。
