甲状腺髓样癌的临床特征与检测血清降钙素的意义

Clinical features of medullary thyroid carcinoma and significance of detecting serum calcitonin

目的分析甲状腺髓样癌的临床特征及检测血清降钙素的意义,为临床诊断、治疗提供参考。方法回顾性分析重庆医科大学附属第一医院2011-01~2016-09收治的甲状腺髓样癌共41例临床资料。患者均行手术治疗。分析术前血清降钙素水平与肿瘤直径大小、包膜是否侵犯、淋巴结转移、远处转移、肿瘤分期之间的关系。结果35例患者术前血清降钙素水平升高,血清降钙素水平与临床分型、肿瘤直径大小、病灶多少等无统计学意义(P>0.05)。但肿瘤有包膜侵犯者较无包膜侵犯者,有淋巴结转移者较无淋巴结转移者,Ⅲ~Ⅳ期患者较Ⅰ~Ⅱ期患者,术前血清降钙素水平显著增高(P<0.05)。41例甲状腺髓样癌患者术后2~5年内生存率约为82%,5~8年内生存率为78%,总体生存率在78%以上。结论术前降钙素水平与肿瘤包膜是否受侵犯、淋巴结是否转移、临床分期有关,提示血清降钙素水平可为术前诊断、手术方式的选择、评估预后和检测复发转移等提供参考。

Objective To analyze the clinical features of medullary thyroid carcinoma and the significance of detecting serum calcitonin and provide the reference foR clinical diagnosis and treatment. Methods The clinical data of 41 patients with medullary thyroid canceRadmitted to the First Affiliated Hospital of Chongqing Medical University from January 2011 to SeptembeR2016 were retrospectively analyzed. All the patients underwent surgical treatment. The relationship between preoperative serum calcitonin level and tumoRsize, capsule invasion, lymph node metastasis, distant metastasis and tumoRstage was analyzed. Results The levels of preoperative serum calcitonin were elevated in 35 patients, but there were no statistical significances between the serum calcitonin level and clinical classification, tumoRsize, single oR multiple lesions( P>0.05). However, the patients with tumoRenvelop invasion had significantly higheRlevels of preoperative serum calcitonin than those without tumoR envelop invasion( P<0.05);the patients with lymph node metastasis had significantly higheRlevels of preoperative serum calcitonin than those without lymph node metastasis and the patients in stage Ⅲ~Ⅳ had significantly higheR levels of preoperative serum calcitonin than those in stage Ⅰ~Ⅱ( P<0.05). The survival rate of 41 patients with medullary thyroid carcinoma was about 82% within 2~5 years and 78% within 5~8 years afteRoperation, and the overall survival rate was oveR78%. Conclusion The level of calcitonin before surgery is related to whetheRthe tumoR capsule is invaded, lymph node metastasis and clinical stage, suggesting that serum calcitonin level can provide reference foRpreoperative diagnosis, selection of methods, evaluation of prognosis and detection of recurrence and metastasis.