中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (6): 412-417.doi: 10.19401/j.cnki.1007-3639.2019.06.002

• 专家述评与论著 • 上一篇    下一篇

125例复发/持续性分化型甲状腺癌再次手术及其预后影响因素分析

张立阳,刘春浩,曹 越,刘洪沨,高维生,李小毅   

  1. 中国医学科学院北京协和医学院北京协和医院基本外科,北京 100730
  • 出版日期:2019-06-30 发布日期:2019-07-12
  • 通信作者: 李小毅 Email: li.xiaoyi@263.net

Experiences of 125 cases of re-operated persistent/recurrent differentiated thyroid cancer

ZHANG Liyang, LIU Chunhao, CAO Yue, LIU Hongfeng, GAO Weisheng, LI Xiaoyi   

  1. General Surgery Department of Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Published:2019-06-30 Online:2019-07-12
  • Contact: LI Xiaoyi E-mail: li.xiaoyi@263.net

摘要: 背景与目的:分化型甲状腺癌虽然预后良好,但仍有一部分患者存在复发和(或)转移风险。通过总结再次手术的125例复发/持续性分化型甲状腺的临床资料,探讨其复发/持续原因及部位、再次手术风险及其预后的影响因素。方法:回顾性分析中国医学科学院北京协和医学院北京协和医院2008—2017年同一组医生收治的行手术治疗的复发/持续性性分化型甲状腺癌患者的病历资料。采用2015年美国甲状腺协会动态危险度评估系统对术后随访患者的治疗反应进行评估分级。结果:患者共125例,其中男性26例,女性99例;平均年龄42岁。再次手术原因包括残余腺体复发/持续45例(45/125,36.0%),中央组淋巴结复发/持续56例(56/125,44.8%),侧方淋巴结复发/持续58例(58/125,46.4%)。再次手术后并发症包括新发的永久性甲状旁腺功能减退者3例(3/125,2.4%),喉返神经麻痹者4例(4/125,3.2%)。患者术后平均随访61个月,5年完全缓解率为69.6%(87/125)。多因素分析结果显示,既往手术次数是影响患者预后的独立危险因素(OR=2.948,95% CI:1.125~7.725,P=0.028)。结论:残余腺体及局部淋巴结复发/持续是分化型甲状腺癌持续/复发的主要原因。再次手术风险较高,但有经验的甲状腺专科医生可以将风险控制在较低水平。分化型甲状腺癌复发/持续后再次手术治疗预后良好,既往手术次数是影响患者预后的独立危险因素。

关键词: 分化型甲状腺癌, 持续, 复发, 动态危险度评估系统

Abstract: Background and purpose: Most of differentiated thyroid cancer (DTC) has favorable prognosis, however, there are still a certain number of patients with recurrence after first operation. This study aimed to report the treatment outcome of 125 cases of persistent/recurrent DTC, and to predict risk factors for prognosis in DTC. Methods: A total of 125 cases of recurrent/persistent DTC patients who underwent surgery between 2008 and 2017 were retrospectively analyzed. The American Thyroid Association (ATA) dynamic risk stratification (DRS) was used to evaluate treatment outcome during follow-up. Results: A total of 125 DTC patients were enrolled in this study, including 26 male patients and 99 female patients, with mean age of 42 years. Forty-five (45/125, 36.0%) cases recurred in remnant thyroid, and nodal recurrence occurred in the central neck in 56 (56/125, 44.8%) patients, lateral neck in 58 (58/125, 46.4%) patients. The post-operation complications included 3 cases of permanent hypoparathyroidism and 4 cases of permanent recurrent laryngeal nerve palsy. The mean follow-up time was 61 months, and 5-year complete remission rate was 69.6% (87/125). Multivariate analysis showed that the number of previous operations was an independent variable predictor of prognosis in DTC patients (OR=2.948, 95% CI: 1.125-7.725, P=0.028). Conclusion: Remnant thyroid recurrence and lymph node metastasis are the main reasons for disease recurrence/persistence in DTC. We recommend experienced surgeons conduct reoperation because of high risk of complications. The number of previous operations is an independent variable predictor of prognosis in DTC patients.

Key words: Differentiated thyroid cancer (DTC), Persistent, Recurrent, Dynamic risk stratification