甲状腺髓样癌复发或转移的影响因素

Risk factors of recurrence or metastasis in patients with medullary thyroid carcinoma

目的:探讨甲状腺髓样癌(MTC)复发或转移的危险因素及无病生存期(DFS)的影响因素。方法:回顾性分析2014年8月至2019年8月在天津医科大学肿瘤医院就诊并进行手术的MTC患者的临床病理资料,根据随访中有无复发或转移分为复发或转移组与无复发或转移组。通过多因素logistic回归模型分析复发或转移的危险因素,Kaplan-Meier生存分析及Cox回归模型分析DFS的影响因素。结果:共纳入158例MTC患者,女83例,男75例,中位年龄52岁(19~74岁)。散发型MTC 146例(92.4%),家族遗传型MTC 12例(7.6%)。甲状腺双侧病灶33例(20.9%),多病灶57例(36.1%)。中位随访时间59.7个月(10.0~93.0个月),中位DFS为55.5个月(0~92.9个月)。25例(15.8%)出现复发或转移,11例(7.0%)死亡。肿瘤多发病灶、最大肿瘤长径>2 cm、T3/4、N1b、Ⅲ/Ⅳ期、淋巴结转移比率(LNR)>0.3、术前血清降钙素>2 000 ng/L、术后血清降钙素>40 ng/L、未获生化治愈均与MTC的复发或转移及DFS具有相关性(均 P<0.05)。临床分期Ⅲ/Ⅳ期( OR=36.57,95% CI:1.33~1 006.98, P=0.033)、最大肿瘤长径>2 cm( OR=5.81,95% CI:1.01~33.33, P=0.049)、多发病灶( OR=3.64,95% CI:1.03~12.88, P=0.045)和术后血清降钙素>40 ng/L( OR=15.03,95% CI:1.39~162.61, P=0.026)是复发或转移的危险因素。临床分期Ⅲ/Ⅳ期( HR=19.39,95% CI:1.40~268.19, P=0.027)、最大肿瘤长径>2 cm( HR=3.64,95% CI:1.02~13.02, P=0.047)和术后血清降钙素>40 ng/L( HR=10.68,95% CI:1.34~84.95, P=0.025)是DFS的影响因素。 结论:MTC初始治疗时较大的肿瘤长径、较高的临床分期及术后较高的血清降钙素水平是复发或转移的危险因素,也是DFS的影响因素。

Objective To analyze the risk factors of recurrence or metastasis of medullary thyroid carcinoma(MTC)and the influencing factors of disease-free survival(DFS).Methods The clinicopathological data of MTC patients who visited Tianjin Medical University Cancer Institute and Hospital and underwent surgery from August 2014 to August 2019 were retrospectively analyzed.The patients were divided into recurrence or metastasis group and no recurrence or metastasis group.Multivariate logistic regression analysis was used to analyze the risk factors for recurrence or metastasis.Kaplan-Meier survival analysis and Cox regression analysis were used to determine the risk factors of DFS.Results A total of 158 MTC patients were enrolled in final analysis,including 83 females and 75 males,with a median age of 52(19-74)years.There were 146 cases of sporadic MTC(92.4%)and 12 cases of familial MTC(7.6%),respectively.Bilateral thyroid lesions presented in 33 cases(20.9%)and multiple lesions presented in 57 cases(36.1%),respectively.The median follow-up time was 59.7(10.0-93.0)months and the median DFS was 55.5(0-92.9)months.Presence of multifocality,the largest tumor size>2 cm,T3/4,N1b,clinical stageⅢ/Ⅳ,lymph node metastasis ratio(LNR)>0.3,preoperative calcitonin>2000 ng/L,postoperative calcitonin>40 ng/L and no biochemical cure were significantly correlated with the recurrence or metastasis and DFS of MTC(all P<0.05).Clinical stageⅢ/Ⅳ(OR=36.57,95%CI:1.33-1006.98,P=0.033),the largest tumor size>2 cm(OR=5.81,95%CI:1.01-33.33,P=0.049),multifocality(OR=3.64,95%CI:1.03-12.88,P=0.045)and postoperative calcitonin>40 ng/L(OR=15.03,95%CI:1.39-162.61,P=0.026)were independent risk factors of recurrence or metastasis.Clinical stageⅢ/Ⅳ(HR=19.39,95%CI:1.40-268.19,P=0.027),the largest tumor size>2 cm(HR=3.64,95%CI:1.02-13.02,P=0.047)and postoperative calcitonin>40 ng/L(HR=10.68,95%CI:1.34-84.95,P=0.025)were influencing factors for DFS(all P<0.05).Conclusion The larger tumor size,advanced clinical stage and higher postoperative calcitonin at the initial treatment of MTC are risk factors for recurrence or metastasis and influencing factors for DFS.