甲状腺癌相关多原发癌的临床及病理特征分析

Clinicopathologic features of multiple primary cancers involving thyroid carcinomas

目的:分析甲状腺癌相关多原发癌的临床及病理特征。方法:回顾性分析2014年12月至2018年8月西京医院甲乳血管外科确诊并收治住院的2867例甲状腺癌患者临床及病理资料,从中筛选出49例甲状腺癌作为第二原发癌的多原发癌患者,分析其临床及病理特征。结果:首发癌为乳腺癌最常见,占71.7%,其次为宫颈癌、卵巢癌、肺癌等。以肿瘤发生时间分类:同时性多原发癌13例(26.5%),异时性多原发癌36例(73.5%)。但同时性与异时性多原发甲状腺癌的多灶性、病灶大小及淋巴结转移情况差异均无统计学意义。合并甲状腺癌的多原发癌患者与单发性甲状腺癌患者相比,≥45岁比例(75.5%vs 45.9%,P<0.01)、女性比例(98.0%vs 75.6%,P<0.01)及有恶性肿瘤家族史患者比例(20.4%vs 9.6%,P<0.05)均明显提高。甲状腺癌作为第二原发癌的微小病灶(≤1 cm)更多(81.6%vs 58.6%,P<0.01),具有更低的侵袭性;单侧病灶的比例高(79.6%vs 70.5%),淋巴结转移的比例低(42.9%vs 49.8%),但两组间的差异均无统计学意义。结论:年龄≥45岁且有家族史的女性恶性肿瘤患者,尤其是乳腺癌患者,建议其在治疗后的复查期间进行甲状腺癌筛查。

Objective:To analyze the clinicopathologic features of multiple primary cancers(MPC)involving thyroid carcinomas.Methods:The medical records of 2867 thyroid carcinoma patients were reviewed in this retrospective study.All patients were diagnosed at Xijing Hospital between December 2014 and August 2018.Among them,49 patients were MPC involving thyroid carcinomas.Clinicopathologic features were investigated.Results:Breast cancer was the most frequent initial cancer(71.7%),followed by cervical cancer,ovarian cancer,lung cancer,et al.13 patients(26.5%)were synchronous MPC,and 36 patients(73.5%)were metachronous MPC.Significant association between synchronous and metachronous MPC was not found in lesions,tumor size and status of lymph node metastasis.Compared to patients with thyroid carcinoma alone,MPC were more frequently occurred in older 45 years old(75.5%vs 45.9%,P<0.01),female(98.0%vs 75.6%,P<0.01)and patients with family cancer history(20.4%vs 9.6%,P<0.05).The micro tumor rate was higher in MPC than in thyroid carcinoma alone(81.6%vs 58.6%,P<0.01).The unilateral lesions rate was higher(79.6%vs 70.5%)and less lymph node metastasis was obtained(42.9%vs 49.8%)in patients with MTC than those with thyroid cancer alone.Therefore,aggressive features seem not showed in patients with MPC involving thyroid carcinoma.Conclusion:Female cancer patients with family cancer history and aged older than 45 years old,especially those with breast cancer,were suggested undergo thyroid carcinoma screening during follow-up period.