多灶性甲状腺乳头状微小癌术后复发及相关因素分析

Postoperative recurrence of multifocal papillary thyroid microcarcinoma and related factors analysis

目的 探讨多灶性甲状腺乳头状微小癌（papillary thyroid microcarcinoma，PTMC）术后复发的相关危险因素。方法 回顾性分析温州医科大学附属第二医院2001年1月至2011年6月间手术病理证实的126例多灶性PTMC患者的临床资料，采用Logistic多因素回归分析，对可能影响多灶性PTMC术后复发的临床病理因素进行分析。结果 126例中位年龄为46（15～78）岁，中位随访时间为75（24～150）个月。多灶性PTMC的术后复发率为14．3％（18／126），总的生存率为98．4％。多因素分析显示，肿瘤侵犯甲状腺包膜（P=0．008）、淋巴结转移（P=0．027）、非甲状腺全／近全切除（P=0．022）为影响多灶性PTMC术后复发的独立性危险因素。结论 腺体外浸润及伴有颈部淋巴结转移是多灶性PTMC术后复发的危险因素，行甲状腺全／近全切除有助于降低术后复发率。

Objective To investigate the risk factors related with the recurrence of multifocal papillary thyroid microcarcinoma（PTMC）. Methods The data of 126 patients undergoing surgery from Jan. 2001 to Jun. 2011 proved to be muhifocal PTMC by pathology were retrospectively analyzed. Logistic muhifactor regression analysis was used to analyze the clinicopathological factors that may influence the recurrence of PTMC. Results The median age of the 126 patients was 46 years（ ranging from 15 to 78 years old）. The recurrence rate was 14. 3% （18/126）and the overall survival rate was 98.4% with the medium follow-up of 75 months（ ranging from 24 to 150 months）. Multivariate analysis showed that extra-thyoidal extension, neck lymph node metastasis and non-total（ or near total）thyroidectomy were the independent risk factors for the recurrence of multifocal PTMC （P = 0. 008, 0. 027, 0. 022 respectively）. Conclusions Extension beyond the thyroid and metastatic neck lymph node predict a high risk of recurrence. Total or near total thyroidectomy can reduce the risk of recurrence.