Cady B, Sedgwick C E, Meissner W A, Bookwalter J R, Romagosa V, Werber J
Ann Surg. 1976 Nov;184(5):541-53. doi: 10.1097/00000658-197611000-00003.
Records of 792 patients with differentiated thyroid carcinoma seen at the Lahey Clinic Foundation over a 40-year period were analyzed; 631 patients had a minimum followup period of 15 years. Differentiated types currently constitute nearly 90% of thyroid carcinomas. The clinical presentation has improved substantially through the years, and the results of treatment generally have improved. The per cent of patients with primarily incurable and locally unresectable disease or distant metastases has decreased from 7% before 1950 to 1% currently, and this group resulted in almost one third of the total fatalities and one half of fatalities within the first 5 years after treatment. Clear relationships were demonstrated between older age, men, extraglandular extension, blood vessel invasion, major capsular involvement, multifocal disease, and higher mortality rates. Lymph node metastases were found to exert a protective effect in all categories of disease analyzed, and this effect was directly related to the number of lymph node metastases present such that no deaths occurred in those patients who had more than 10 node metastases. Surgical treatment recommended is subtotal thyroidectomy for patients at high risk of death from disease as defined by combinations of age, sex, and extraglandular extension. Patients at low risk or with small carcinomas can be treated satisfactorily by lobectomy. Lymph node resections should be of a limited type or a modified neck dissection and should be performed only therapeutically. No improvement, as judged by mortality or recurrence rates, could be demonstrated by the use of radio therapy after surgery, and its use should be discouraged. Thyroid hormone administered for suppression of endogenous thyroid-stimulating hormone production improved mortality rates significantly in patients with papillary and mixed forms of carcinoma in all age groups but did not affect survival in patients with follicular carcinoma of the thyroid.20
对在40年期间于拉希诊所基金会就诊的792例分化型甲状腺癌患者的记录进行了分析；631例患者的最短随访期为15年。分化型目前占甲状腺癌的近90%。这些年来临床表现有了显著改善，治疗结果总体上也有所改善。主要为无法治愈且局部不可切除疾病或远处转移的患者比例已从1950年前的7%降至目前的1%，而该组导致了几乎三分之一的总死亡病例以及治疗后前5年内一半的死亡病例。年龄较大、男性、腺外扩展、血管侵犯、主要包膜受累、多灶性疾病与较高死亡率之间存在明确关联。在所有分析的疾病类别中，发现淋巴结转移具有保护作用，且这种作用与存在的淋巴结转移数量直接相关，以至于有超过10个淋巴结转移的患者无死亡病例。对于因年龄、性别和腺外扩展等因素组合而被定义为疾病死亡高风险的患者，推荐的手术治疗是甲状腺次全切除术。低风险或患有小癌灶的患者可通过甲状腺叶切除术得到满意治疗。淋巴结切除术应采用有限型或改良颈部清扫术，且仅应在治疗目的时进行。手术后使用放射治疗，无论从死亡率还是复发率判断，均未显示出改善效果，应不鼓励使用。给予甲状腺激素以抑制内源性促甲状腺激素分泌，在所有年龄组的乳头状癌和混合型癌患者中显著提高了死亡率，但对甲状腺滤泡状癌患者的生存率没有影响。
