复发性甲状腺癌44例的临床分析

Clinical Analysis of 44 Cases of Recurrent Thyroid Carcinoma

背景与目的:甲状腺癌绝大多数为分化较好的低度恶性癌,经规范治疗后,一般预后好,但仍有少数病例会复发。本研究旨在对其复发的原因、治疗及预后作一总结分析,以寻找复发原因和治疗措施。方法:对1980年1月至1996年1月间我科收治的44例甲状腺复发癌患者的临床和随访资料进行回顾性分析和总结。结果:44例复发甲状腺癌中,分化型甲状腺癌38例,其中乳头状癌28例、滤泡癌7例、髓样癌3例,未分化型即间变癌6例,分别占同期同种组织学类型甲状腺癌的4.1%(28/676)、18.9%(7/37)、8.1%(3/37)和42.9%(6/14)。33例为淋巴结复发(75%)。39例行复发癌灶局部广泛切除,术后辅以放疗;5例予单纯放疗。本组治疗后3年生存率分别为85.7%、71.4%、100%和0;5年生存率分别为60.7%、57.0%、66.7%和0;10年生存率分别为35.7%、42.9%、33.3%和0。结论:初次手术时遗漏的临床和亚临床淋巴结转移灶是甲状腺癌术后复发的主要原因。甲状腺复发癌以手术治疗为主,治疗后其预后仍较好。

BACKGROUND &OBJECTIVE:Although the most thyroid cancers are well differentiated low malignant neoplasms and their prognoses are relatively good generally if they were treated routinely, there are still a few cases of this tumor recurred. This study was designed to sum up and analyze the cause, treatment, and prognosis of these cases to seek for the cause and the proper treatment method of the recurrent cases. METHODS: From 1980 January to 1996 January,44 cases of the recurrent thyroid carcinoma of the total 764 cases of thyroid carcinoma were treated in Department of Head &Neck,Cancer Institute &Hospital, Affiliated Tianjin Medical University. The clinical and follow up data of these 44 cases were analyzed retrospectively. RESULTS: Forty four cases of the recurrent thyroid carcinoma accounted for 5.76%(44/764) of 764 cases of thyroid carcinoma treated. Thirty eight cases of these 44 cases were differentiated thyroid carcinoma (28 cases were papillary thyroid carcinoma,7 cases were follicular thyroid carcinoma, 3 cases were medullary thyroid carcinoma and 6 cases were anaplastic thyroid carcinoma).The percentages of them accounted for the same histopatho logic pattern thyroid carcinoma treated in the hospital at the same time were 4.1%(28/676),18.9%(7/37),8.1%(3/37),and,42.9%(6/14),separately. Thirty three of these 44 cases were lymphatic recurrence (75.0%). In spite of 5 cases were given radiotherapy only, the other 39 cases were treated surgically with extensive dissection of recurrent lesions and post operative radiotherapy. After treatment, the 3 year survival rates were 85.7%, 71.4%, 100.0%, and 0; the 5 year survival rates were 60.7%, 57.0%, 66.7%, and 0, and the 10 year survival rates were 35.7%,42.9%,33.3%,and 0,respectively. CONCLUSION: The clinical and subclinical metastatic lymph nodes left in the previous operations were the main cause of the recurrence of thyroid carcinoma. The recurrent thyroid carcinoma should be treated with surgical operation mainly, as most of them may have a relatively good prognosis after the treatment.