青少年甲状腺癌患者预后因素分析

Prognostic factors of papillary thyroid carcinoma in young people

目的 分析青少年甲状腺癌患者的治疗效果及影响预后的相关因素.方法 对1996年12月-2005年10月于中山大学肿瘤防治中心住院收治的69例青少年甲状腺乳头状癌患者进行回顾性研究.采用Kaplan-Meier法计算预后情况,各因素间比较使用Log-rank检验,多因素分析运用Cox回归模型.结果 69例患者中,男26例,女43例.患者中位年龄24岁,平均23.1岁.中位随访时间113个月（73 ～174个月）.20.3％（14/69）患者在随访期间出现复发,1.4％患者（1/69）死亡.所有患者术后均予甲状腺素治疗.原发灶包膜外侵犯的患者与无包膜外侵犯的患者10年无病生存率分别为29.6％和80.1％ （P＜0.01）.Cox多因素回归分析表明原发灶包膜外侵犯的青少年PTC患者预后较差（P=0.004）.结论 青少年甲状腺乳头状癌患者预后好,手术治疗是此类患者的首选治疗方式.原发灶包膜外侵犯是影响青少年PTC复发的独立因素.

Objective To analyze the treatment effect and factors affecting the prognosis in young people of papillary thyroid carcinoma （PTC）.Methods A total of 69 PTC patients were reviewed retrospectively in Sun Yatsen University Cancer Center from Dec 1996 to Oct 2005.The prognostic status were compared using the Kaplan-Meier methods,the factors were analyzed by Log-rank test and the multiple factors were estimated by the Cox regression models.Results There were 26 males and 43 females.The median age was 24 years （mean：23.1 years）.The average follow-up time was 113 months ranging from 73 to 174 months.20.3% patients （14/69） experienced recurrence during follow-up time and 1.4% patient （1/69） died.All the patients received levothyroxine after operation.The 10 year disease-free survival （DFS） rate of patients with or without extra thyroidal extension （ETE） of PTC was 29.6% and 80.1%,respectively （P 〈 0.01）.Multivariate analysis showed that young PTC people with ETE had a worse prognosis （P =0.004）.Conclusions Young papillary thyroid carcinoma patients had a favorable outcome.Surgical procedure was the first choice for this kind of patients.ETE was an independent factor for the recurrence of young PTC patients.