老年甲状腺癌患者的手术治疗及预后分析

Surgical treatment and prognostic factors analysis in elderly patients with thyroid cancer

目的探讨老年甲状腺癌患者的手术治疗方法及影响预后的因素。方法回顾性分析2001年1月至2010年12月我院近10年收治的96例60岁以上老年甲状腺癌患者的手术治疗情况及预后因素。采用Kaplan-Meier法计算生存率，预后相关单因素分析采用Log—rank检验，多因素分析采用Cox模型。结果96例老年甲状腺癌患者的5年累积生存率为73．6％，中位生存时间为68个月。单因素分析结果显示：性别、年龄、淋巴结转移、远处转移、临床分期、肿瘤侵犯程度、同行改良颈淋巴结清扫术是预后影响因素（P〈0．05）。多因素分析结果显示，年龄、临床分期、肿瘤侵犯程度及远处转移是影响老年甲状腺癌患者预后的独立因素（P〈0．05）。结论老年甲状腺癌患者预后较差，年龄、临床分期、肿瘤侵犯程度及远处转移是影响预后的独立重要因素，需要对老年患者预后做正确评估并制定个体化手术方案。

Objective To investigate the surgical treatment and prognostic factors in elderly patients with thyroid cancer. Methods The surgical treatment and prognostic factors of 96 patients over the age of 60 years with thyroid cancer were analyzed retrospectively in our hospital from January 2001 to December 2010. The Kaplan-Meier method was applied to analyze survival rates,Log-rank test was used in the univariate analysis and multivariate Cox model was applied for the independent prognostic factors analysis. Results The 5-year survival for elderly patients was 73.6% and median survival time was 68 months. Univariate analysis indicated that sex, age, lymph node metastases, distant metastasis,clinical stage,extent of tumor invasion and modified cervical lymph node dissection were prognostic factors （all P〈0.05）. Multivariate analysis showed that age, clinical stage, extent of tumor invasion and distant metastasis were independent prognostic factors（P〈0.05）. Conclusions The elderly patients with thyroid cancer are in poor prognosis. Age, clinical stage, extent of tumor invasion and distant metastasis are independent important prognostic factors. Individualized surgical treatment should be made on the basis of correct assessment of prognosis.