甲状腺乳头状癌病理分型和淋巴结转移与预后的关系

The pathological type of papillary thyroid carcinoma in its relation with lymph node metastasis and prognosis

目的探讨甲状腺乳头状癌病理分型与淋巴结转移及预后的关系。方法回顾性分析1954—1988年578例甲状腺乳头状癌临床资料。结果肿瘤无包膜380例,有淋巴结转移者265例;有包膜198例,有淋巴结转移者138例。无包膜型中弥漫硬化型的淋巴结转移率高于微小型(P<0·05)。分支乳头与滤泡型、毛玻璃核与滤泡型比较,差异有统计学意义(P<0·05)。分支乳头与水肿乳头、滤泡型与水肿乳头比较,差异有统计学意义(P<0·01)。全部患者随访15年以上,死亡74例,死亡率12·8%。无包膜型380例死亡54例(14·2%);包膜型198例死亡20例(10·1%)。包膜侵犯情况与死亡率无关(P>0·05)。水肿乳头亚型102例,死亡4例,死亡率低于分支乳头、滤泡亚型(P<0·01)。结论甲状腺乳头状癌病理分型对判断淋巴结转移及预后有指导意义,水肿乳头亚型预后较好。

Objective To detect the relationship between the pathological type and lymph node metastasis and prognosis in papillary thyroid carcinoma patients. Method Clinicopathological data were retrospectively analyzed on 578 cases of papillary thyroid carcinoma patients undergoing surgery between 1954-1988. Result There were 265 cases with lymph node metastasis among 380 unenvelop cases of papillary thyroid carcinoma, and 138 cases with lymph node metastasis among 198 envelop cases. Lymph node metastasis in diffuse sclerosis type was higher than that in the microminiature （P〈 0.05） . The differences were significant between branch papillary and follicle, and between the round glass nucleus and follicle （all P〈0.05）. The differences were significant between branch papillary and dropsy papillary, and between the follicle and dropsy papillary （all P〈 0.01）. A follow-up of 15 years revealed 74 deaths （12.8%） , including 54 deaths out of 380 unenvelop cases （14.2%） , and 20 deaths （10.1%） out of 198 envelop cases（P〉0.05）. The mortality rate in dropsy papillary type was lower than branch papillary and follicle subtype（all P〈0.01）. Conclusion Lymph node metastasis and prognosis vary among different pathological types in patients with papillary thyroid carcinoma.