分化型甲状腺癌腺外侵犯临床特征及预后因素分析

Clinical features and prognostic factors of extrathyroidal extension in differentiated thyroid carcinoma

目的探讨分化型甲状腺癌(differentiated thyroid carcinoma,DTC)腺外侵犯(extrathyroidal extension,ETE)相关危险因素及其对预后的影响。方法回顾性分析郑州大学第一附属医院甲状腺外科2015年6月至2016年6月收治的592例初诊为DTC的临床资料,收集肿瘤最大径、淋巴结转移情况等临床病理资料,并随访其生存状况。采用χ^(2)检验和Logistic回归分析伴ETE者相关危险因素;采用Kaplan-Meier法和COX比例风险模型分析ETE对无病生存的影响。结果592例DTC中100例伴有ETE(16.9%)。单因素及多因素分析显示伴ETE的危险因素是:肿瘤最大径≥2 cm、多发病灶、颈侧区淋巴结转移(P<0.01)。中位随访时间为60个月,范围为29~64个月,36例复发。DTC伴ETE患者3年无病生存率86.9%,5年无病生存率83.2%,明显低于不伴ETE组(P<0.001)。单因素及COX多因素回归结果均显示伴有ETE(HR:10.564,95%CI 3.712~30.063,P<0.001)是影响DTC患者术后复发的独立危险因素。结论DTC伴ETE与肿瘤直径大、多发病灶等危险因素相关,伴有ETE者颈部淋巴结转移概率更高,且5年无病生存时间更低,是影响DTC复发的危险因素。具有以上临床病理学特征的患者术前应考虑ETE的可能,术后重点长期随访。

Objective To investigate the risk factors related to extrathyroidal extension(ETE)of differentiated thyroid carcinoma(DTC)and the specific effects on the prognosis.Methods The clinical data of 592 patients with newly diagnosed DTC admitted to our hospital from Jun.2015 to Jun.2016 were retrospectively analyzed.The data including the maximum tumor diameter and lymph node metastasis were collected,and the survival data were followed up.Chi-square test and Logistic regression were used to analyze the risk factors associated with ETE.Kaplan-Meier method and Cox proportional risk model were used to analyze the effect of ETE on disease-free survival.Results There were 100 ETE of 592 DTC patients(16.9%).Univariate analysis showed that the risk factors for ETE were the largest tumor diameter≥2 cm,multiple lesions,and lymph node metastasis in the lateral cervical region(P<0.01).The follow-up time was 29 to 64 months,and the median follow-up time was 60 months.The 3-year and 5-year DFS rates of patients with DTC and ETE were 86.9%and 83.2%respectively,which were significantly lower than those of patients without ETE(P<0.001).Univariate analysis showed that ETE(P<0.001)was a risk factor for postoperative recurrence in patients with DTC.Cox multivariate regression showed that ETE(HR:10.564,95%CI 3.712-30.063,P<0.001)was an independent risk factor for postoperative recurrence in patients with DTC.Conclusions DTC accompanied by ETE is associated with risk factors such as large tumor diameter and multiple lesions,which has a lower 5-year DFS.Patients with the above characteristics should consider the possibility of ETE before surgery,and focus on long-term follow-up after surgery.