CAJ | 학술논문

目的:探讨多灶性甲状腺乳头状癌的临床特征及外科治疗方式.方法:回顾分析1997年1月至2006年12月间首次手术并经病理证实的甲状腺乳头状癌648例,其中多灶病例168例.比较单灶组与多灶组及多灶组间的临床病理学差异.结果:本组多灶性甲状腺乳头状癌发生率为25.9%,其中双侧甲状腺多发病灶者117例(69.6%).多灶组在男性(P=0.004)、甲状腺癌家族史(P=0.031)、体检(P=0.000)及B超发现颈部淋巴结肿大(P=0.001)、B超提示结节钙化灶(P=0.001)、颈淋巴结转移(P=0.008)及甲状腺外侵犯(P=0.001)发生率等方面叫显高于单灶患者.而单灶组在伴有良性甲状腺疾病的比例明显高于多灶组(P=0.000).多灶性甲状腺乳头状癌病例中,男性、体检颈部淋巴结大、肿瘤位于双侧及病灶数目≥3个倾向于肿瘤较大、颈部淋巴结转移或甲状腺外侵犯的比例较高;而伴有良性甲状腺疾病的多灶性癌恶性度相对较低.本组164例(97.6%)获得随访;平均随访46.1个月(2～127个月).随访中5例死亡,1例胸部X线片怀疑肺部转移,16个月健在;6例于术后3～41个月因颈淋巴结复发再次手术;2例于术后13个月、24个月残余腺体肿瘤复发手术切除.总的1、2、5、10年生存期分别为98.2%、97.4%、96.5%、96.5%.美国癌症联合会(AJCC)分期与预后相关(X<'2=168.832,P=0.000).结论:多发病灶是甲状腺乳头状癌的临床特征之一,其生物学恶性度更高.甲状腺全切+中央区淋巴结清扫可视为标准手术方式,在外侧区出现淋巴结肿大时需加行侧方清扫.AJCC分期仍是多灶性甲状腺乳头状癌的重要预后因素.
목적:탐토다조성갑상선유두상암적림상특정급외과치료방식.방법:회고분석1997년1월지2006년12월간수차수술병경병리증실적갑상선유두상암648례,기중다조병례168례.비교단조조여다조조급다조조간적림상병이학차이.결과:본조다조성갑상선유두상암발생솔위25.9%,기중쌍측갑상선다발병조자117례(69.6%).다조조재남성(P=0.004)、갑상선암가족사(P=0.031)、체검(P=0.000)급B초발현경부림파결종대(P=0.001)、B초제시결절개화조(P=0.001)、경림파결전이(P=0.008)급갑상선외침범(P=0.001)발생솔등방면규현고우단조환자.이단조조재반유량성갑상선질병적비례명현고우다조조(P=0.000).다조성갑상선유두상암병례중,남성、체검경부림파결대、종류위우쌍측급병조수목≥3개경향우종류교대、경부림파결전이혹갑상선외침범적비례교고;이반유량성갑상선질병적다조성암악성도상대교저.본조164례(97.6%)획득수방;평균수방46.1개월(2～127개월).수방중5례사망,1례흉부X선편부의폐부전이,16개월건재;6례우술후3～41개월인경림파결복발재차수술;2례우술후13개월、24개월잔여선체종류복발수술절제.총적1、2、5、10년생존기분별위98.2%、97.4%、96.5%、96.5%.미국암증연합회(AJCC)분기여예후상관(X<'2=168.832,P=0.000).결론:다발병조시갑상선유두상암적림상특정지일,기생물학악성도경고.갑상선전절+중앙구림파결청소가시위표준수술방식,재외측구출현림파결종대시수가행측방청소.AJCC분기잉시다조성갑상선유두상암적중요예후인소.
Objective To investigate the clinical features and treatment of muhifocal papillary thyroid carcinoma (PTC). Methods A retrospective survey was carried out in 648 patients with PTC who underwent surgery from January 1997 to December 2006. One hundred and sixty-eight cases of the patients presented with multiple tumor masses (≥ 2 ). The risk factors, including sex of the patients, age at diagnosis, family history of thyroid tumor, multiplicity and bilaterality of tumor, extra-thyroidal extension, lymph node involvement and other were analyzed between solitary PTC and multifocal PTC group. Results The mean age of the patients was 42 years( range, 14-78 years), included 49 male and 119 female. Tumor foci were found in both thyroid lobes in 117 cases(69.6% ). Patients with multifocal PTC were characterized by a higher ratio of male (P=0.004 ), family history of thyroid tumor (P=0.031), neck lymph node metastasis (P=0.008) and extra-thyroidal extension (P=0.001 ). However, solitary PTC tended to be with a higher rate of benign goiters in pathologic examination. In muhifocal PTC group, male, neck lymphadenectasis, ≥3 tumor masses or bilaterality of tumor tended to presented with larger tumor, more neck lymph node metastasis and extra-thyroidal extension; And a less malignant tumor in the cases detected with benign goiters in histological examination. By the end of 2007, 164 cases (97.6%) completed follow-up with a mean period of 46. 1 months ( range, 2-127 months), 5 died in the meantime. One patient has been followed-up for 16 months for suspect of lung metastases by chest X-ray. Recurrence occurred in 8 patients and were re-resected, 2 in remnant thyroid and 6 in neck lymph nodes. The overall 1-, 2-, 5-, and 10-year survival rate was 98. 2%, 97.4%, 96. 5% and 96.5%, respectively. American Joint Committee on Cancer (AJCC) stage was associated with prognosis significantly (X<'2>=168.832, P = 0.000 ). Conclusions Muhifocus is one of the clinical features of PTC and is more malignant than solitary PTC. Total thyroidectomy with central compartment neck dissection could be standard treatment. Lateral nodal dissection is not necessary except for the cases with lymph node metastasis. AJCC stage is still the best prognostic factor.