甲状腺髓样癌手术切除范围及预后影响因素研究

Study on the scope of surgical resection and prognostic factors of medullary thyroid carcinoma

目的分析甲状腺髓样癌(MTC)手术切除范围及预后影响因素。方法回顾性分析2015年1月至2017年6月期间首诊于天津医科大学肿瘤医院MTC病人的临床资料。分析临床病理特征与中央区、侧颈区淋巴结转移及生化治愈的关系;探讨影响病人无进展生存期的危险因素。结果77例病人,术前降钙素水平正常者5例,升高者72例。行全甲状腺切除28例,单侧腺叶切除49例。仅行中央区淋巴结清扫39例,中央区及患侧侧颈淋巴结清扫38例。MTC病人中央区淋巴结转移与性别、侵出腺叶、肿瘤直径、TNM分期、术前降钙素、降钙素水平/肿瘤直径具有相关性(P<0.05)。侧颈淋巴结转移与年龄、TNM分期具有相关性(P<0.05)。生化治愈率66.1%(39/59),与中央区淋巴结转移、TNM分期、肿瘤直径、术前降钙素水平及降钙素水平/肿瘤直径具有相关性(P<0.05)。中位随访时间35(7~69)个月。侵出腺叶、中央区淋巴结转移、淋巴结转移、淋巴结切除范围、TNM分期、术前降钙素水平和生化治愈是MTC病人无进展生存期的影响因素(P<0.05)。结论MTC病人建议至少行患侧腺叶切除及中央区淋巴结清扫,必要时行全甲状腺切除,根据超声、CT及降钙素水平等检查结果行预防性/治疗性侧颈淋巴结清扫。规范化的手术治疗是达到较高生化治愈率,减少复发的关键。

Objective To analyze the surgical resection range and prognosis of medullary thyroid carcinoma.Methods The clinical data of 77 cases of MTC patients firstly treated in Tianjin Medical University Cancer Institute and Hospital from January 2015 to June 2017 were reviewed retrospectively.The relationship between clinicopathological features and biochemical cure and metastasis of central and lateral cervical lymph node was analyzed.The risk factors for progressionfree survival were studied.Results Among 77 patients,5 had normal preoperative calcitonin level and 72 had elevated preoperative calcitonin level.Total thyroidectomy was performed in 28 cases and unilateral lobectomy in 49 cases.In MTC patients,lymph node metastasis in central region was correlated with gender,extra-thyroidal extension,tumor diameter,TNM staging,preoperative calcitonin level and calcitonin/tumor diameter(P<0.05);Lateral lymph node metastasis was correlated with age and TNM staging(P<0.05).The biochemical cure rate was 66.1%(39/59),which was correlated with central lymph node metastasis,TNM staging,tumor diameter,preoperative calcitonin level and calcitonin/tumor diameter(P<0.05).The median follow-up period was 35 months(7 to 69 months).Extra-thyroidal extension,central lymph node metastasis,lymph node metastasis,range of lymph node resection,TNM staging,preoperative CT level and biochemical cure were risk factors for progress-free survival(P<0.05).Conclusion The lobectomy and central lymph node dissection are recommended for MTC patients,total thyroidectomy if necessary,and preventive/therapeutic lateral lymph node dissection should be performed based on ultrasound,CT examination and calcitonin level.Standardized surgery is the key to achieve a higher biochemical cure rate and reduce recurrence.