Bayles S W, Kingdom T T, Carlson G W
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Laryngoscope. 1998 Sep;108(9):1402-7. doi: 10.1097/00005537-199809000-00029.
To evaluate approaches to thyroid carcinoma invading the aerodigestive tract, with particular attention to well-differentiated carcinomas.
Retrospective review of experience with thyroid carcinoma invading the aerodigestive tract over a 20-year period at a tertiary referral hospital.
The medical records of all patients with a diagnosis of thyroid cancer treated at Emory University Hospital, Atlanta, Georgia, from 1977 through 1997 were reviewed. Multiple clinical variables were analyzed including treatment, development of recurrence, and survival. Survival and time to local recurrence were determined by Kaplan-Meier analysis, and statistical comparisons were made using log-rank analysis.
Five hundred thirty-six cases were identified; 28 patients (5.2%) were identified with invasive disease involving the aerodigestive tract. Histologic findings at the time of invasion included 15 well-differentiated (WD) carcinomas and 13 poorly differentiated (PD) carcinomas. Eight of the 28 patients (5 WD, 3 PD) underwent surgical resection of some portion of the aerodigestive tract with curative intent. Ten patients (8 WD, 2 PD) underwent incomplete resection with tumor left adjacent to aerodigestive tract structures. All patients undergoing incomplete resection developed local recurrence. Six required salvage resection, as opposed to no recurrences in WD carcinomas following complete resection (P = .01). Survival at 5 years for WD carcinomas undergoing complete resection versus initial incomplete resection was 100% versus 50%, respectively (P = .27).
Review of our experience shows that complete resection of thyroid carcinoma invading the aerodigestive tract can offer prolonged palliation, improved local control, and the opportunity for cure in selected patients.
评估甲状腺癌侵犯气道消化道的治疗方法，尤其关注高分化癌。
对一家三级转诊医院20年间甲状腺癌侵犯气道消化道的治疗经验进行回顾性分析。
回顾1977年至1997年在佐治亚州亚特兰大市埃默里大学医院接受治疗的所有甲状腺癌患者的病历。分析了多个临床变量，包括治疗、复发情况和生存率。采用Kaplan-Meier分析确定生存率和局部复发时间，并使用对数秩检验进行统计学比较。
共识别出536例病例；28例（5.2%）被确定为侵犯气道消化道的浸润性疾病。侵犯时的组织学检查结果包括15例高分化（WD）癌和13例低分化（PD）癌。28例患者中有8例（5例WD，3例PD）以治愈为目的对气道消化道的部分进行了手术切除。10例患者（8例WD，2例PD）进行了不完全切除，肿瘤残留于气道消化道结构附近。所有接受不完全切除的患者均出现局部复发。6例需要补救性切除，而WD癌完全切除后无复发（P = 0.01）。WD癌完全切除与初次不完全切除的5年生存率分别为100%和50%（P = 0.27）。
回顾我们的经验表明，完全切除侵犯气道消化道的甲状腺癌可为部分患者提供延长的缓解期、改善局部控制并提供治愈机会。
