Beressi N, Campos J M, Beressi J P, Franc B, Niccoli-Sire P, Conte-Devolx B, Murat A, Caron P, Baldet L, Kraimps J L, Cohen R, Bigorgne J C, Chabre O, Lecomte P, Modigliani E
Department of Endocrinology, University Paris XIII, Hopital Avicenne, Bobigny, France.
Thyroid. 1998 Nov;8(11):1039-44. doi: 10.1089/thy.1998.8.1039.
Clinical characteristics and prognosis of 80 patients (53 women and 27 men) with sporadic medullary thyroid carcinomas (MTC), less than 1 cm in size (micro-MTC), operated on between 1971 and 1996 are reported (73 total and 7 partial thyroidectomies). These patients, obtained from a national database of 899 patients with MTC, were compared with 357 cases of sporadic MTC greater than 1 cm and 149 subjects with familial MTC less than 1 cm (familial micro-MTC). Median age at surgery was 52.5 years, a distribution similar to larger sporadic MTC. Micro-MTC was identified due to elevated calcitonin (47.5%), clinically identified lymph node (10.0%), distant metastases (6.3%) or pathologic finding at surgery (36.2%). Diarrhea and/or flushing were observed in 6 patients including 4 with clinically identified lymph node. Among patients who had lymph node dissection at surgery (68.8%), lymph node involvement with tumor was observed in 30.9%, and was significantly more frequent in multifocal (7/11) than in unifocal micro-MTC (p < 0.03). All sporadic micro-MTC were unilateral. Survival rate was 93.9% +/- 4.4% (SE) at 10 years, greater than that observed in sporadic macro-MTC (p = 0.04). Normal postoperative basal calcitonin (CT) was obtained in 71.1% of micro-MTC patients versus 33.6% in sporadic macro-MTC (p < 0.01). Sporadic micro-MTC is much more frequent than expected, 15% of MTC in our series. Although specific survival rate and percentage of biological cure in micro-MTC are significantly better than for larger tumors, the frequency of lymph node involvement, however, justifies an aggressive surgical approach including total thyroidectomy and bilateral central lymph node dissection.
报告了1971年至1996年间接受手术治疗的80例（53例女性和27例男性）散发性甲状腺髓样癌（MTC）患者的临床特征和预后，肿瘤大小小于1 cm（微小MTC）（73例全甲状腺切除术和7例部分甲状腺切除术）。这些患者来自一个包含899例MTC患者的国家数据库，与357例肿瘤大于1 cm的散发性MTC患者以及149例肿瘤小于1 cm的家族性MTC患者（家族性微小MTC）进行了比较。手术时的中位年龄为52.5岁，这一分布与较大的散发性MTC相似。微小MTC的发现是由于降钙素升高（47.5%）、临床发现淋巴结（10.0%）、远处转移（6.3%）或手术中的病理发现（36.2%）。6例患者出现腹泻和/或潮红，其中4例有临床发现的淋巴结。在手术时进行了淋巴结清扫的患者中（68.8%），30.9%观察到肿瘤累及淋巴结，多灶性微小MTC（7/11）中这一情况比单灶性微小MTC更常见（p<0.03）。所有散发性微小MTC均为单侧。10年生存率为93.9%±4.4%（SE），高于散发性大MTC（p = 0.04）。微小MTC患者术后基础降钙素（CT）正常的比例为71.1%，而散发性大MTC患者为33.6%（p<0.01）。散发性微小MTC比预期更常见，在我们的系列中占MTC的15%。尽管微小MTC的特定生存率和生物学治愈百分比明显优于较大肿瘤，但淋巴结受累的频率表明应采取积极的手术方法，包括全甲状腺切除术和双侧中央淋巴结清扫。
