Yamashita H, Noguchi S, Murakami N, Kawamoto H, Watanabe S
Department of Pathology, Oita Medical University, Japan.
Cancer. 1997 Dec 15;80(12):2268-72.
In patients with thyroid papillary carcinoma, age and the presence or absence of distant metastasis are regarded as the main prognostic factors. However, the histologic characteristics of thyroid papillary carcinoma that develops distant metastasis have not yet been clarified.
The histologic findings and prognosis of 50 patients with thyroid papillary carcinoma who later developed distant metastasis (metastatic group) were compared with those of 50 patients without local recurrence or distant metastasis (control group). The age, tumor size, and gender ratio of the control group were matched with those of the metastatic group. Univariate analyses (chi-square test and/or Fisher's exact test) and multivariate analyses (logistic regression) were performed.
Univariate analyses showed that the incidence of nonpure papillary carcinoma, absence of bone at the periphery of the tumor, invasion of the perithyroidal muscle, large lymph node deposits, and extranodal invasion were significantly higher in the metastatic group. Multivariate analyses revealed that only extranodal invasion was statistically significant (P = 0.0045) and that the odds ratio of extranodal invasion in distant metastasis was 9. Moreover, the risk of death from thyroid carcinoma was higher among the patients with extranodal invasion than those without (P <0.01).
The presence of extranodal invasion in patients with thyroid papillary carcinoma is an indicator of distant metastasis and poorer prognosis.
在甲状腺乳头状癌患者中，年龄以及有无远处转移被视为主要的预后因素。然而，发生远处转移的甲状腺乳头状癌的组织学特征尚未明确。
将50例后来发生远处转移的甲状腺乳头状癌患者（转移组）的组织学表现及预后与50例无局部复发或远处转移的患者（对照组）进行比较。对照组的年龄、肿瘤大小和性别比例与转移组相匹配。进行单因素分析（卡方检验和/或Fisher精确检验）和多因素分析（逻辑回归）。
单因素分析显示，转移组中非纯乳头状癌的发生率、肿瘤周边无骨质、甲状腺周围肌肉侵犯、大淋巴结沉积及结外侵犯显著更高。多因素分析显示，只有结外侵犯具有统计学意义（P = 0.0045），远处转移中结外侵犯的优势比为9。此外，有结外侵犯的患者死于甲状腺癌的风险高于无结外侵犯的患者（P <0.01）。
甲状腺乳头状癌患者存在结外侵犯是远处转移及预后较差的一个指标。
