单侧散发性甲状腺髓样癌原发灶不同切除范围的预后分析

Total thyroidectomy versus lobectomy for unilateral sporadic medullary thyroid carcinoma

目的比较不同原发灶手术切除范围治疗单侧散发性甲状腺髓样癌患者的预后,分析影响患者预后的相关危险因素。方法回顾性分析2011年2月至2018年10月期间就诊于天津医科大学肿瘤医院的126例散发性甲状腺髓样癌患者,按照原发灶手术切除范围不同分为甲状腺全切组(A组)和甲状腺腺叶切除组(B组)。结果A组与B组患者在术后复发率(χ2=0.394,P=0.530)、死亡率(χ2=3.175,P=0.146)、生化治愈率(χ2=0.613,P=0.434)、无病进展生存期和总生存期(P=0.278、0.175)的差异均无统计学意义;肿瘤最大直径≥4 cm和侧颈淋巴结转移是影响散发性甲状腺髓样癌患者总生存期的独立危险因素。A组术后暂时性低钙血症(χ2=5.068,P=0.024)和永久性低钙血症(χ2=6.590,P=0.010)的发生率均高于B组。结论对于局限在一侧腺叶的散发性甲状腺髓样癌,行甲状腺腺叶切除患者的预后并不差于行全甲状腺切除术的患者,但是全甲状腺切除术后暂时性和永久性低钙血症发生率更高。

Objective To compare the prognosis of patients with unilateral sporadic medullary thyroid carcinoma treated by different surgical selection,and analyze the independent risk factors affecting the prognosis.Methods One hundred and twenty-six patients at Tianjin Medical University Cancer Institute and Hospital from Feb 2011 to Oct 2018 were retrospectively divided into group A(total thyroiclectomy)and group B(unilateral lobectomy).Results There were no significant differences in postoperative recurrence rate(χ2=0.394,P=0.530),mortality(χ2=3.175,P=0.146),biochemical cure rate(χ2=0.613,P=0.434),progression free survival and overall survival(P=0.278,0.175)between group A and group B;Tumor diameter≥4 cm and lateral cervical lymph node metastasis were independent risk factors affecting the overall survival.The incidence of postoperative temporary hypocalcemia(χ2=5.068,P=0.024)and permanent hypocalcemia(χ2=6.590,P=0.010)in group A was higher than that in group B.Conclusions Ipsolateral thyroidectomy can be applied to patients with unilateral sporadic medullary thyroid carcinoma with similar long term prognosis and tower incidence of temporary hypocalcemia and permanent hypocalcemia compared to total thyroidectomy.