Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. ...Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.展开更多
目的通过研究单侧偏峡部甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者出现对侧中央区淋巴结(contralateral central lymph nodes,Cont-CLNs)转移相关的临床及病理危险因素,建立淋巴结转移预测模型,从而为手术清扫淋巴结的范围...目的通过研究单侧偏峡部甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者出现对侧中央区淋巴结(contralateral central lymph nodes,Cont-CLNs)转移相关的临床及病理危险因素,建立淋巴结转移预测模型,从而为手术清扫淋巴结的范围提供参考。方法收集江苏大学附属医院2012年2月至2022年6月期间符合入组标准的单侧PTC患者共381例,根据病灶位置分为单侧偏峡部组(n=152)和单侧腺叶组(n=229),对于是否出现Cont-CLNs转移进行相关性分析。对于152例单侧偏峡部组患者,再根据是否出现Cont-CLNs转移进一步分成转移组和未转移组,采用单因素分析研究患者的性别、年龄、病灶分布腺叶、肿瘤大小、肿瘤部位、病理亚型、被膜侵犯、促甲状腺激素(thyroid stimulating hormone,TSH)水平、合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)、患侧中央区淋巴结(ipsilateral central lymph nodes,Ipsi-CLNs)转移与Cont-CLNs转移的关系。结合单因素分析结果并参考其他文献中相关单侧PTC出现Cont-CLNs转移的高危因素全部纳入logistic多因素分析,得出独立危险因素并建立预测模型。结果相关性分析结果表明,单侧偏峡部组出现Cont-CLNs转移概率高于单侧腺叶组(24.3%比14.4%,χ^(2)=6.009,P=0.014)。进一步的单因素分析结果显示,单侧偏峡部PTC患者出现Cont-CLNs转移与患者的年龄(P=0.02)、肿瘤大小(P<0.01)、被膜受到侵犯(P<0.01)以及存在Ipsi-CLNs转移(P<0.01)具有相关性,与患者性别、腺叶分布、肿瘤部位、病理亚型、TSH水平高低以及是否合并HT无相关性(P>0.05)。logistic多因素分析结果显示:被膜侵犯和Ipsi-CLNs转移是单侧偏峡部PTC患者出现Cont-CLNs转移的独立危险因素;并且上述logistic多因素预测模型经拟合优度Hosmer and Lemeshow检验提示效果良好。结论被膜侵犯和Ipsi-CLNs转移是单侧偏峡部PTC患者出现Cont-CLNs转移的高危因素,建议在临床实践中此类患者在清扫Ipsi-CLNs同时应当预防性行Cont-CLNs清扫。展开更多
文摘Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.
文摘目的通过研究单侧偏峡部甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者出现对侧中央区淋巴结(contralateral central lymph nodes,Cont-CLNs)转移相关的临床及病理危险因素,建立淋巴结转移预测模型,从而为手术清扫淋巴结的范围提供参考。方法收集江苏大学附属医院2012年2月至2022年6月期间符合入组标准的单侧PTC患者共381例,根据病灶位置分为单侧偏峡部组(n=152)和单侧腺叶组(n=229),对于是否出现Cont-CLNs转移进行相关性分析。对于152例单侧偏峡部组患者,再根据是否出现Cont-CLNs转移进一步分成转移组和未转移组,采用单因素分析研究患者的性别、年龄、病灶分布腺叶、肿瘤大小、肿瘤部位、病理亚型、被膜侵犯、促甲状腺激素(thyroid stimulating hormone,TSH)水平、合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)、患侧中央区淋巴结(ipsilateral central lymph nodes,Ipsi-CLNs)转移与Cont-CLNs转移的关系。结合单因素分析结果并参考其他文献中相关单侧PTC出现Cont-CLNs转移的高危因素全部纳入logistic多因素分析,得出独立危险因素并建立预测模型。结果相关性分析结果表明,单侧偏峡部组出现Cont-CLNs转移概率高于单侧腺叶组(24.3%比14.4%,χ^(2)=6.009,P=0.014)。进一步的单因素分析结果显示,单侧偏峡部PTC患者出现Cont-CLNs转移与患者的年龄(P=0.02)、肿瘤大小(P<0.01)、被膜受到侵犯(P<0.01)以及存在Ipsi-CLNs转移(P<0.01)具有相关性,与患者性别、腺叶分布、肿瘤部位、病理亚型、TSH水平高低以及是否合并HT无相关性(P>0.05)。logistic多因素分析结果显示:被膜侵犯和Ipsi-CLNs转移是单侧偏峡部PTC患者出现Cont-CLNs转移的独立危险因素;并且上述logistic多因素预测模型经拟合优度Hosmer and Lemeshow检验提示效果良好。结论被膜侵犯和Ipsi-CLNs转移是单侧偏峡部PTC患者出现Cont-CLNs转移的高危因素,建议在临床实践中此类患者在清扫Ipsi-CLNs同时应当预防性行Cont-CLNs清扫。
