Bellantone R, Lombardi C P, Boscherini M, Ferrante A, Raffaelli M, Rubino F, Bossola M, Crucitti F
Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy.
J Surg Oncol. 1998 Aug;68(4):237-41. doi: 10.1002/(sici)1096-9098(199808)68:4<237::aid-jso6>3.0.co;2-5.
The clinical characteristics and patient outcome of a group of patients treated for differentiated thyroid carcinoma (DTC) were analyzed in order to assess the relative influence of different prognostic factors.
We retrospectively reviewed data about sex, age, size and histologic behavior of the tumor, extrathyroid extension of the tumor, lymph node status, distant metastasis at diagnosis, surgical procedures, and overall survival from 234 patients treated for DTC. Data were submitted to a statistical analysis.
Using a univariate analysis, we found that survival rates were significantly influenced by age (P = 0.0001), size (P = 0.018), extrathyroidal extension (P = 0.000001), lymph node involvement (P = 0.03), and distant metastases (P = 0.049). Age and size were independent prognostic factors at multivariate analysis (t = 2.694 and t = 2.443, respectively).
On the basis of our results and of a review of the literature, we conclude that total thyroidectomy is the treatment of choice in DTC, except for small (<1 cm) papillary carcinoma, that could be treated by lobectomy plus isthmectomy, while lymphadenectomy is indicated only in case of macroscopic involvement.
分析一组分化型甲状腺癌（DTC）患者的临床特征及预后，以评估不同预后因素的相对影响。
我们回顾性分析了234例接受DTC治疗患者的性别、年龄、肿瘤大小及组织学行为、肿瘤甲状腺外侵犯、淋巴结状态、诊断时的远处转移、手术方式及总生存期等数据。对数据进行统计学分析。
单因素分析显示，生存率受年龄（P = 0.0001）、肿瘤大小（P = 0.018）、甲状腺外侵犯（P = 0.000001）、淋巴结受累（P = 0.03）及远处转移（P = 0.049）的显著影响。多因素分析显示年龄和肿瘤大小是独立的预后因素（分别为t = 2.694和t = 2.443）。
基于我们的研究结果及文献回顾，我们得出结论，除小（<1 cm）乳头状癌可行甲状腺叶切除加峡部切除外，DTC的治疗首选全甲状腺切除术，而仅在有肉眼可见受累时才进行淋巴结清扫。
