单发性甲状腺峡部乳头状癌临床病理特点及手术方式分析

Clinicopathological features and surgical methods of solitary papillary thyroid isthmus carcinoma

目的分析单发性甲状腺峡部乳头状癌(solitary papillary thyroid isthmus carcinoma,SPTIC)的临床病理特点和不同手术方法的治疗效果及预后。方法选取2012年12月至2021年10月在吉林大学第一医院甲状腺外科行手术治疗的SPTIC患者161例,收集患者的性别、年龄、身体质量指数(body mass index,BMI)、病理等信息,分析SPTIC的临床病理特征。根据手术方法的不同分为A、B、C 3组,其中A组采用峡部切除术、B组行峡部扩大切除术、C组行甲状腺全部切除术。A组47例,男8例,女39例,年龄(42.6±9.1)岁;B组50例,男11例,女39例,年龄(45.3±11.3)岁;C组64例,男10例,女54例,年龄(46.9±11.4)岁。采用方差分析、多样本秩和检验、χ^(2)检验或Fisher’s确切概率法,比较3组临床病理特征及治疗效果,随访6~126个月后比较3组复发率及无复发生存率(recurrence free survival,RFS)。结果161例SPTIC患者中,女132例(82.0%),年龄<55岁130例(80.7%),BMI(25.1±3.6)kg/m^(2),合并被膜侵犯124例(77.0%),合并中央区淋巴结转移(central lymph node metastasis,CLNM)53例(32.9%)。亚组分析结果显示,肿瘤直径>1 cm的患者中男性占比、BMI≥26.0 kg/m^(2)的患者占比、被膜侵犯率、腺外侵犯率、CLNM率均更高(30.0%比14.0%,P=0.023;60.0%比33.9%,P=0.004;97.5%比70.2%,P<0.001;42.5%比9.9%,P<0.001;50.0%比27.3%,P=0.008);男性、BMI≥26.0 kg/m^(2)、肿瘤直径>1 cm的患者CLNM率更高(28.3%比13.0%,P=0.017;52.8%比34.3%,P=0.024;37.7%比18.5%,P=0.008)。手术效果方面,C组与A、B两组相比住院天数长、住院费用高、手术时间长、术后引流量多、术后甲状旁腺功能减退发生率高,差异有统计学意义(均P<0.05);A、B两组在以上方面相似,差异无统计学意义(均P>0.05)。随访过程中A、B两组各有3例复发,C组无复发,3组复发率(P=0.059)及RFS(P=0.082)差异均无统计学意义。结论SPTIC以微小癌居多,但肿瘤合并被膜侵犯的发生率较高,且癌灶大小超过1 cm时会更具侵犯性(被膜侵犯率、甲状腺外侵犯率均更高);治疗SPTIC应尽可能采取保守的手术方式(甲状腺峡部切除术或甲状腺峡部扩大切除术)。

ObjectiveTo analyze the clinicopathological features of solitary papillary thyroid isthmus carcinoma(SPTIC)and the therapeutic effect and prognosis of different surgical methods.MethodsA total of 161 patients with SPTIC who underwent surgical treatment in the Department of Thyroid Surgery of the First Hospital of Jilin University from Dec.2012 to Oct.2021 were selected.Gender,age,body mass index and pathology of the patients were collected and the clinicopathological characteristics of SPTIC were analyzed.They were divided into three groups according to different surgical methods:group A underwent isthmic excision,group B underwent extended isthmic excision,and group C underwent total thyroidectomy.There were 47 patients in group A(8 males and 39 females with an average age of 42.6±9.1 years),50 patients in group B(11 males and 39 females with an average age of 45.3±11.3 years),and 64 patients in group C(10 males and 54 females with an average age of 46.9±11.4 years).The clinicopathological features and therapeutic effect of the three groups were compared by ANOVA,multiple local rank sum test,χ^(2) test or Fisher's exact probability method,and the recurrence rate and recurrence free survival(RFS)of the three groups were compared after a follow-up of 6 to 126 months.ResultsAmong the 161 patients with SPTIC,132(82.0%)were female,130(80.7%)were younger than 55 years old,BMI(25.1±3.6)kg/m^(2),124(77.0%)were combined with capsule invasion.There were 53 cases(32.9%)with central lymph node metastasis(CLNM).Subgroup analysis showed that the proportion of males in patients with tumor diameter>1 cm,the proportion of patients with BMI≥26.0 kg/m^(2),the rate of capsular invasion,the rate of extrandular invasion and the rate of CLNM were higher(30.0%vs.14.0%,P=0.023;60.0%vs.33.9%,P=0.004;97.5%vs.70.2%,P<0.001;42.5%vs.9.9%,P<0.001;50.0%vs.27.3%,P=0.008);The CLNM rate was higher in male patients with BMI≥26.0 kg/m^(2) and tumor diameter>1 cm(28.3%vs.13.0%,P=0.017;52.8%vs.34.3%,P=0.024;37.7%vs.18.5%,P=0.008).Compared with groups A and B,group C had longer hospitalization days,higher hospitalization costs,longer operation time,more postoperative drainage flow and higher incidence of postoperative hypoparathyroidism,and the differences were statistically significant(all P<0.05).Groups A and B were similar in all aspects,with no statistical significance(P>0.05 for all).During the follow-up,3 patients in both group A and B relapsed,while no patients in group C relapsed,and there were no statistically significant differences in the recurrence rate(P=0.059)or RFS(P=0.082)among the three groups.ConclusionsThe majority of SPTIC were microcarcinomas,but the incidence of tumor combined with capsule invasion was higher,and the tumor size of more than 1 cm was more invasive(capsule invasion rate and extrathyroid invasion rate were higher).SPTIC should be treated as conservatively as possible(isthmic excision or enlarged isthmic excision).