Papillary microcarcinoma of the thyroid - Prognostic significance of lymph node metastasis and multifocality
Papillary microcarcinoma of the thyroid - Prognostic significance of lymph node metastasis and multifocality
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作者：
Chow, SM;Law, SCK;Lau, WH
背景众所周知，甲状腺乳头状微小癌（PMC）的患者预后非常好。随着甲状腺乳头状癌（PTC）中PMC发病率的不断上升，有必要确定影响预后的因素并制定治疗方案。作者对1999年或之前确诊并在香港伊利沙伯医院临床肿瘤科接受治疗的203例PMC患者进行了回顾性分析。10年的病因特异性生存率、局部无失败生存率和远处转移无失败生存率分别为100%、92.1%和97.1%。5例患者有肺转移; 2例患者在诊断后12.9年和14.8年死于转移，3例患者在放射性碘（RAI）治疗后获得临床缓解。12例患者LR复发。LR复发的患者通过手术、RAI治疗和外部放射治疗的组合是高度可挽救的;除1例（拒绝治疗）外，所有患者在末次随访时均无疾病存活。多变量分析未发现任何独立的生存预后因素。当诊断时存在颈淋巴结（LN）转移和多灶性疾病时，LN复发的风险增加6.2倍（P = 0.01）和5.6倍（P = 0.02）。RAI消融使LN复发率降低至0.27（P = 0.04）。LN转移的存在使远处转移率增加11.2倍（P = 0.03）。年龄不是预测疾病复发或生存的重要因素。肿瘤大小小于或等于5 mm和> 5 mm的细分并不影响预后，但肿瘤小于或等于5 mm的患者没有与PMC相关的死亡率。尽管PMC患者总体预后良好，但PMC与1.0%的疾病相关死亡率、5.0%的LN复发率和2.5%的远处转移率相关。因此，PMC患者的治疗应与常规PTC患者的治疗没有区别：即，如果存在不良预后因素，则考虑RAI和/或外部放射治疗的完整手术。(C)2003年美国癌症协会。
BACKGROUND. It is known that patients with papillary microcarcinoma (PMC) of the thyroid gland have a very favorable prognosis. The rising incidence of PMC among papillary thyroid carcinoma (PTC) necessitates the identification of prognostic factors and the formulation of treatment protocols.METHODS. The authors conducted a retrospective analysis of 203 patients with PMC who were diagnosed on or before 1999 and were treated at the Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong.RESULTS. The cause specific survival, locoregional (LR) failure free survival and, distant metastases failure free survival rates at 10 years were 100%, 92.1%, and 97.1%, respectively. Five patients had lung metastases; 2 patients died of their metastases 12.9 years and 14.8 years after diagnosis, and 3 patients achieved clinical remission after radioiodine (RAI) treatment. Twelve patients had LR recurrences. Patients with LR recurrence were highly salvageable with a combination of surgery, RAI treatment, and external radiotherapy; all but one (who refused treatment) were alive without disease at last follow-up. Multivariate analyses did not reveal any independent prognostic factor for survival. The risk of cervical lymph node (LN) recurrence increased 6.2-fold (P = 0.01) and 5.6-fold (P = 0.02) when LN metastases and multifocal disease were present at diagnosis. RAI ablation reduced the LN recurrence rate to 0.27 (P = 0.04). The presence of LN metastasis increased the rate of distant metastasis 11.2-fold (P = 0.03). Age was not a significant factor in predicting disease recurrence or survival. Subdivision by tumor sizes less than or equal to 5 mm and > 5 mm did not affect the outcome, but no patient with tumors less than or equal to 5 mm had mortality related to PMC.CONCLUSIONS. Despite the overall excellent prognosis for patients with PMC, PMC was associated with a 1.0% disease-related mortality rate, a 5.0% LN recurrence rate, and a 2.5% distant metastasis rate. Therefore, the treatment of patients with PMC should be no different from the treatment of patients with conventional PTC: i.e., complete surgery with consideration for RAI and/or external radiation therapy if poor prognostic factors are present. (C) 2003 American Cancer Society.