120例分化型甲状腺癌随访8年的预后因素分析

Prognosis factors analysis of 120 cases differentiated thyroid cancer after follow-up of 8 years

背景与目的:由于分化型甲状腺癌病程长、预后好,难以组织大规模、多中心的随机临床研究,在我国也没有分化型甲状腺癌的手术治疗共识,影响预后的因素也鲜有大宗报道,本研究旨在探讨不同手术方式、组织学类型及肿瘤分期对分化型甲状腺癌患者预后的影响,寻找可预测分化型甲状腺癌患者预后的指标。方法:本研究回顾性分析1995年1月—2005年12月北京大学第一医院普通外科收治的可供分析的分化型甲状腺癌120例,平均随访8年,应用Kaplan-Meier生存分析及COX多因素回归模型分析颈部淋巴结清扫、甲状腺全切、组织学类型及肿瘤分期与无病生存率及总生存率的关系。结果:经过平均96.6个月随访,无病生存率为78.3%,总生存率为94.2%。疾病分期晚的患者无病生存率低(P=0.029);滤泡状癌较乳头状癌无病生存率低(P=0.001),总生存率低(P=0.003)。是否行颈部淋巴结清扫及甲状腺全切对预后差异无统计学意义(P>0.05)。结论:肿瘤分期、组织学类型是分化型甲状腺癌主要的预后影响因素。

Background and purpose ： The prognosis ofdifferentiated thyroid cancer is relative well, therefore it is difficult to organize randomized multicentric large clinical trial. In China, there is no operation consensus of differentiated thyroid cancer, and the influential factors of prognosis reports are scarce. This paper aimed to investigate the impact of different type of resection, pathological type and cancer stage on the outcome of differentiated thyroid cancer, and to define the prognostic factors in patients with differentiated thyroid cancer. Methods： From Jan. 1995 to Dec. 2005, 120 patients with differentiated thyroid cancer were eligible for the present research. Kaplan-Meier survival analysis and COX multivariate analysis were used to study the relationship between disease-free survival （DFS）, overall survival （OS） and cervical lymph node dissection, total thyroidectomy, pathological type and cancer stage. Results： With a median follow-up of 96.6 months, the DFS rate was 78.3%, the OS rate was 94.2%. Multivariate analysis showed the advanced cancer stage had the poorer disease-free survival （P=-0.029）; patients of follicular carcinoma had poorer disease-free survival （P=0.001） and overall survival （P=0.003） compared with papillary carcinoma. Cervical lymph node dissection and total thyroidectomy had no significant impact on the outcome. Conclusion： Cancer stage and pathological type were the significant prognostic factors for differentiated thyroid cancer.