Vanderpump M P, Alexander L, Scarpello J H, Clayton R N
Department of Diabetes and Endocrinology, North Staffordshire Hospitals Trust, London.
Clin Endocrinol (Oxf). 1998 Apr;48(4):419-24. doi: 10.1046/j.1365-2265.1998.00469.x.
Thyroid cancer is the commonest endocrine malignancy yet it appeared to present infrequently to the endocrinologists at this large District General Hospital. The management of well-differentiated thyroid cancer remains controversial with a wide variation in clinical practice. The aim of this survey was to determine the characteristics of the patients diagnosed with thyroid cancer and whether any deficiencies existed in the management of subjects diagnosed with thyroid cancer over a five-year period using standards of care based upon long-term outcome data and recently published USA guidelines.
Retrospective case-note survey of all patients newly registered with thyroid cancer from 1990 to 1994 in North Staffordshire (estimated total population 450,000).
The annual incidence of all thyroid cancer was two per 100,000 of which well-differentiated tumours comprised 70%. Medical records were obtained in 48 new cases (91% of total) identified. Fifteen subjects who presented as surgical emergencies received only palliative treatment and had a poor outcome. Two patients presented with metastatic medullary thyroid carcinoma (3% of total). Thirty-one patients (97% of whom presented with a thyroid nodule) were referred electively to either surgical (n = 22), ENT (n = 2) or endocrinology (n = 7) outpatients with well-differentiated papillary (n = 17) and follicular (n = 14) tumours. Thirteen patients (42%) had fine-needle aspiration cytology performed preoperatively. Of the 22 tumours (71%) greater than 1.5 cm, five (27%) had a total thyroidectomy and two (9%) also had radioiodine ablation. There was inadequate serum thyrotrophin suppression postoperatively in 12 patients (39%) and only five (16%) were being monitored for recurrence with serum thyroglobulin measurements.
Deficiencies in the optimum management of small, well-differentiated thyroid cancers were identified. Improved communication between specialties has led to the development of an agreed management protocol to increase the quality of care offered to patients with thyroid cancer and for auditing the coordinated service in the future.
甲状腺癌是最常见的内分泌恶性肿瘤，但在这家大型地区综合医院，内分泌科医生接诊的此类病例似乎并不常见。分化型甲状腺癌的治疗仍存在争议，临床实践差异很大。本调查的目的是根据长期预后数据和最近公布的美国指南，确定确诊为甲状腺癌患者的特征，以及在五年期间对确诊为甲状腺癌的患者进行管理时是否存在任何不足。
对1990年至1994年在北斯塔福德郡新登记的所有甲状腺癌患者进行回顾性病例记录调查（估计总人口45万）。
所有甲状腺癌的年发病率为每10万人中有2例，其中分化良好的肿瘤占70%。在确诊的48例新病例（占总数的91%）中获取了病历。15例以外科急症就诊的患者仅接受了姑息治疗，预后较差。2例患者出现转移性甲状腺髓样癌（占总数的3%）。31例患者（其中97%表现为甲状腺结节）被选择性转诊至外科门诊（n = 22）、耳鼻喉科门诊（n = 2）或内分泌科门诊（n = 7），患有分化良好的乳头状癌（n = 17）和滤泡状癌（n = 14）。13例患者（42%）术前进行了细针穿刺细胞学检查。在22例直径大于1.5 cm的肿瘤中（71%），5例（27%）进行了全甲状腺切除术，2例（9%）还进行了放射性碘消融。12例患者（39%）术后血清促甲状腺素抑制不足，只有5例（16%）通过血清甲状腺球蛋白测量监测复发情况。
已确定在小型分化良好的甲状腺癌最佳管理方面存在不足。专科之间改善沟通已促成制定了一项商定的管理方案，以提高为甲状腺癌患者提供的护理质量，并在未来对协调服务进行审核。
