多灶性甲状腺癌患者的手术疗效及预后影响因素

Surgical efficacy and prognostic influencing factors in patients with multifocal thyroid cancer

目的分析多灶性甲状腺癌患者的手术治疗效果及预后影响因素。方法回顾性分析2012年1月至2014年7月资阳市第一人民医院普外科收治的100例多灶性甲状腺癌患者的临床资料,所有患者均接受手术治疗,术后随访3年,统计手术治疗效果,采用单因素分析及多元Logistic回归分析患者预后影响因素。结果 (1)本组100例患者均获得随访,患者随访3年无死亡病例,生存率为100.0%,其中17例术后8~40个月后复发,复发率为17.0%;(2)单因素分析显示:年龄≥60岁、合并淋巴结转移、合并远处转移、临床分期为Ⅲ~Ⅳ期、肿瘤侵犯包膜外、行单侧甲状腺腺叶+峡部切除术患者、未行颈部淋巴结清扫患者术后复发率高于年龄<60岁、未合并淋巴结转移、无远处转移、临床分期为Ⅰ~Ⅱ期、肿瘤侵犯包膜内、行其他手术、行颈部淋巴结清扫者,差异均有统计学意义(P<0.05);(3)多元Logistic回归分析结果显示,年龄(OR=2.415)、临床分期(OR=2.674)、淋巴结转移(OR=1.554)、远处转移(OR=4.747)、肿瘤侵犯程度(OR=3.261)、手术方式(OR=1.216)均为导致多发性甲状腺癌患者术后复发的危险因素(P<0.05)。结论高龄、临床分期为Ⅲ~Ⅳ期、合并淋巴结转移、合并远处转移、肿瘤侵犯包膜外、行单侧甲状腺腺叶+峡部切除术多灶性甲状腺癌患者术后复发率高,行甲状腺次全切或全切术配合预防性淋巴结清扫,可提高手术根治性,降低肿瘤复发率。

Objective To analyze the surgical effects and influencing factors of the prognosis of patients with multifocal thyroid cancer. Methods The clinical data of 100 patients with multifocal thyroid cancer who were admitted to Department of General Surgery, the First People＇s Hospital of Ziyang City from January 2012 to July 2014 were analyzed retrospectively. All patients were followed up for 3 years after surgery to statistically analyze the surgical effects.The influencing factors of the prognosis were analyzed by univariate analysis and multivariate logistic regression analysis. Results（1） All the 100 patients were followed up, and there was no death during 3 years of follow-up. The survival rate was 100.0%. Among them, 17 cases had recurrence at 8-40 months after surgery, and the recurrence rate was17.0%.（2） Univariate analysis showed that recurrence rates were higher in patients of or older than 60 years old, patients with lymph node metastasis, patients with distant metastasis, patients in clinical stage Ⅲ-Ⅳ, patients with tumor invasion outside the capsule, patients undergoing unilateral thyroid gland and isthmus resection and patients not undergoing cervical lymph node dissection than in patients younger than 60 years old, patients without lymph node metastasis, patients without distant metastasis, patients in clinical stage Ⅰ-Ⅱ, patients with tumor invasion in the capsule, patients undergoing the other surgery and patients undergoing cervical lymph node dissection（P〈0.05）.（3） Multivariate Logistic regression analysis showed that age（OR=2.415）, clinical stage（OR=2.674）, lymph node metastasis（OR=1.554）, distant metastasis（OR=4.747）, the extent of tumor invasion（OR=3.261） and surgical method（OR=1.216） were the risk factors of recurrence in patients with multifocal thyroid cancer（P〈0.05）. Conclusion The recurrence rates are high in patients of advanced age, patients in clinical stage Ⅲ-Ⅳ, patients with lymph node metastasis, patients with distant metastasis,patients with tumor invasion outside the capsule, patients undergoing unilateral thyroid gland and isthmus resection. The application of subtotal resection or total thyroidectomy combined with prophylactic lymph node dissection can improve the surgical effects, and reduce the tumor recurrence rate.