甲状腺癌860例临床特点及手术预后影响因素研究

Studies on risk factors on prognosis of 860 postoperative patients with thyroid carcinoma

目的探讨甲状腺癌的临床生物学特性、预后总生存（OS）期及影响预后的主要因素。方法对1997--2007年上海长征医院首次行手术治疗的860例甲状腺癌患者临床资料进行双向性队列研究分析预后及影响因素。结果（1）860例甲状腺癌患者平均年龄（47．01±13．36）岁，女性占78．1％。96．0％为分化型甲状腺癌，82．0％为I-Ⅱ期。（2）甲状腺癌的肿瘤相关致死率为2．40％（21例），0s期为（91．23±29．10）个月。（3）多因素分析结果显示，甲状腺癌分类为甲状腺髓样癌或未分化癌、有腺外侵犯（包括远处转移、血管侵犯、甲状腺被膜侵犯）、病理Ki67比值〉1．O％、血清CEA〉0．41ug／L是甲状腺癌OS期的主要影响因素（P〈0．05）。结论甲状腺癌患者多数分化程度高，肿瘤分期早。整体预后较佳，致死率低，平均生存时间较长，以女性多发，男性预后差于女性。术前检查如血清CEA、有无腺外侵犯（包括远处转移、血管侵犯、甲状腺被膜侵犯）以及病理免疫Ki67比值对甲状腺癌患者的预后预测及评估有一定提示作用。

Objective To investigate Overall Survival （OS） of thyroid carcinoma and their correlations with clinical data and pathological results. Methods A bi-cohort study was conducted in 860 patients with thyroid carcinoma who underwent operations for the first time from 1997 to 2007, and their clinical data including demographic characteristics, preoperative clinical manifestations, serum tests and ultrasonography, pathological results and OS were reviewed. Follow-up deadline was June 30th, 2012 and follow-up was death. Results （ 1 ） A total of 860 patients of thyroid carcinoma with mean age of （47.0 ± 13.4） years old, and 78.1% were female. Of these ,96. 0% for differentiated thyroid carcinoma. （2） The tumor-associated mortality rate was 2.40% （21 cases） and OS was （91.23 ± 29. 10）months. （3） Multivariate analysis showed that 6 factors were the major factors affecting the OS of postoperative thyroid carcinoma （ P 〈 0. 05 ）, including tumor type, M stage, vascular invasion, thyroid capsular invasion, tissue Ki67 values, serum CEA level. Conclusion The prognosis of thyroid carcinoma was relatively well with low carcinoma-related morbidity rate and relatively long OS. The risk factors of tumor type, metastasis,vascular invasion,thyroid capsular invasion,value tissue Ki67 and serum CEA level were the main risk factors affecting OS of postoperative thyroid carcinoma.