四川省肿瘤医院2002至2011年全身麻醉甲状腺恶性肿瘤患者临床病理学分析

Clinicopathologic analysis of patients of thyroid malignancies by general anesthesia in Sichuan Cancer Hospital between 2002 and 2011

目的分析四川省肿瘤医院行全麻手术的甲状腺恶性肿瘤的构成比及病理学特征,为西部地区甲状腺恶性肿瘤的诊治及预防提供参考。方法回顾性分析四川省肿瘤医院2002年1月至2011年12月行全麻手术、术后病理诊断明确的甲状腺恶性肿瘤患者的临床病理资料。结果 (1)10年间,我院收治手术的甲状腺恶性肿瘤患者共552例,男144例,女408例,比例约为1∶2.8;其中乳头状癌480例(86.96%);滤泡状癌19例(3.44%);髓样癌25例(4.52%);低或未分化癌16例(2.90%);淋巴瘤8例(1.45%);鳞癌4例(0.72%)。(2)淋巴结转移者314例(56.88%),男、女淋巴结转移分别为92例(63.89%)、222例(54.41%),差异有统计学意义(χ2=3.90,P=0.048)。<45岁和≥45岁淋巴结转移分别为173例(56.35%)、141例(57.55%),差异无统计学意义(χ2=0.08,P=0.777)。(3)男性≥45岁患者淋巴结转移者60例(71.43%),与男性<45岁淋巴结转移者[32例(53.33%)(χ2=4.97,P=0.026)],女性<45岁淋巴结转移者[140例(51.09%)(χ2=5.70,P=0.017)],女性≥45岁淋巴结转移者[82例(50.93%)(χ2=9.52,P=0.002)]比较,差异均有统计学意义。结论在这10年的研究中,499例(90.40%)甲状腺恶性肿瘤起源于甲状腺滤泡细胞,起源于非甲状腺滤泡细胞者少见,女性患者数明显多于男性。2002年至2008年,本院收治的甲状腺恶性肿瘤患者增长缓慢,近三年增长明显。淋巴结转移率男性大于女性,男性≥45岁淋巴结转移发生率最高,与男性<45岁、女性<45岁和≥45岁淋巴结转移发生率差异均有统计学意义。<45岁和≥45岁淋巴结转移发生率差异无统计学意义。

Objective To analyze the clinicopathologic features of thyroid malignancies occurring in the Sichuan Cancer Hospital,and provide the reference for the diagnosis,treatment,prevention of thyroid malignancies in the western of China.Methods Retrospective analyze clinicopatholngic features of patients with thyroid malignancies by general anesthesia in Sichuan Cancer Hospital between 2002 and 2011.Results During the 10-year study period,552 patients with thyroid malignancy were identified,and the male-female ratio was 1∶2.8.The majority had thyroid cancer of follicular cell origin--499 differentiated thyroid cancers （DTC） and 16 （2.90％ of primary thyroid malignancies） anaplastic thyroid cancers.The DTC patients included 480 （86.96％）with papillary thyroid cancers （PTC）,and 19（3.44％） follicular thyroid cancers（FTC）.The component ratio of PTC in every year was 85.71％,81.82％,86.67％,83.33％,80.00％,95.92％,88.00％,92.00％,82.69％,87.61％,respectively.Tumours of nonfollicular cell origin were 37,included 25 （4.52％） medullary thyroid cancers （MTC）,and all were apparently sporadic,8 （1.45％） primary thyroid lymphomas,and 4 （0.72％） squamous cell carcinoma.314 （56.88％） patients with lymph node metastasis were identified,and the male were 92 patients （63.89％）,female 222 patients （54.41％）,the difference was statistically significant （x2 =3.90,P =0.048）.＜ 45 years old and ≥ 45 years old lymph node metastasis were 173 patients （56.35％）,141 patients （57.55％）,the difference was not statistically significant（x2 =0.08,P =0.777）.The rate of lymph node metastasis of men ≥ 45 years old were 60 patients （71.43％）,the differences were statistically significant among the men less than 45 yearsold were 32 patients （53.33％） （x2 =4.97,P =0.026）,women less than 45 years old were 140 patients （51.09％） （x2 =5.70,P =0.017）and≥45 years old were 82 patients（50.93％） （x2 =9.52,P =0.002）.Conclusions In the 10-year study period the majority（90.40％）of thyroid malignancies were of follicular cell origin,tumors of non-follicular cell origin were uncommon,thyroid malignancies was more common among females.From 2002 to 2008,the cases of thyroid malignancies were increased slowly,and the last three years increased substantially.The highest proportion is PTC,but the proportion of PTC does not change significantly in each year.the peak incidence age of males was 30-69,and females 30-49.The rate of lymph node metastasis of males was more than females.The rate of lymph node metastasis of men ≥45 years old was the highest among the men less than 45 years old,women less than 45 years old and ≥ 45 years old,the differences were statistically significant.The rate of lymph node metastasis between less than 45 years old and ≥45 years old was not statistically significant.