Pelizzo M R, Toniato A, Grigoletto R, Bernardi C, Pagetta C
Istituto di Chirurgia Generale, Università degli Studi, Padova.
Minerva Chir. 1998 Jun;53(6):471-82.
A total of 463, out of 677 patients operated on for papillary thyroid carcinoma between 1967-1995, were selected, on the basis of a 5-year minimal follow-up (max 28, mean 11.15 +/- 5.29), for uni and multivariate analysis of survival curves. Patient sex, age over and under 45 years, tumour size smaller and larger than 15 mm, stage, any TNM parameter, histological variety, surgical procedure on the thyroid and nodes were the factors assessed in order to express the prognosis.
Male:female ratio was 1:3, the mean age 42.2 years; only 25.9% of patients presented with smaller than 15 mm tumor, about 57% with positive nodes and 8.85% with distant metastases; total or near total thyroidectomy was performed in 86% and nodal dissection in 70% of patients. The 5, 10, 15, 20 year survival rate resulted to be 96.94%, 94.36%, 91.38% and 88.69%; 23 patients, but none aged less than 45 years, died (poorly differentiated and locally advanced carcinoma). Age over 45 years, T4 and M+ stages resulted of high prognostic importance while nodal involvement, interrelated with T and M, showed no independent impact; stage gradually worsened but no difference was found between stage I and II. Adverse effect of male sex resulted from its interrelation with more advanced stages. The relapse rate was found higher in male sex and in patients aged over 45 years, interrelated with T and N extension: no tumor smaller than 15 mm recurred and no relation was found between recurrence and surgical procedure.
Longer follow-up is needed to compare the higher curative effectiveness of total thyroidectomy and nodal dissection versus more conservative treatments.
在1967年至1995年间接受甲状腺乳头状癌手术的677例患者中，选取了463例进行生存曲线的单因素和多因素分析，这些患者至少随访5年（最长28年，平均11.15±5.29年）。评估的因素包括患者性别、45岁以上和45岁以下年龄、肿瘤大小小于和大于15mm、分期、任何TNM参数、组织学类型、甲状腺及淋巴结的手术方式，以评估预后情况。
男女比例为1:3，平均年龄42.2岁；仅25.9%的患者肿瘤小于15mm，约57%有淋巴结转移阳性，8.85%有远处转移；86%的患者接受了全甲状腺切除或近全甲状腺切除，70%的患者进行了淋巴结清扫。5年、10年、15年、20年生存率分别为96.94%、94.36%、91.38%和88.69%；23例患者死亡（均为低分化和局部晚期癌），但年龄均不小于45岁。45岁以上年龄、T4和M+分期具有较高的预后重要性，而与T和M相关的淋巴结受累未显示出独立影响；分期逐渐加重，但I期和II期之间未发现差异。男性的不良影响源于其与更晚期的相关性。男性和45岁以上患者的复发率较高，与T和N的扩展相关：肿瘤小于15mm者无复发，复发与手术方式之间无关联。
需要更长时间的随访来比较全甲状腺切除和淋巴结清扫与更保守治疗相比的更高治愈率。
