Papillary thyroid carcinoma with distant metastases: Survival predictors and the importance of local control
Papillary thyroid carcinoma with distant metastases: Survival predictors and the importance of local control
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DOI：
10.1016/j.surg.2007.06.011
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发表时间：
2008-01-01
期刊：
影响因子：
3.8
通讯作者：
Yamamoto, Noriko
中科院分区：
文献类型：
--
作者：
Sugitani, Iwao;Fujimoto, Yoshihide;Yamamoto, Noriko
背景。远处转移的存在是甲状腺乳头状癌（PTC）患者预后不良的最重要预测因素。一些患者的远处转移生长非常缓慢，预后相对较好，因此预测预后并不容易。此外，许多远处转移的患者表现为局部进展，在这种情况下，对宫颈肿瘤的手术控制尚无共识。从1976年到2002年，1023例接受原发性甲状腺切除术的PTC患者中，42例患者在最初表现为远处转移，44例患者在随访期间出现远处转移。我们回顾了这86例患者的记录。发现远处转移后的平均随访时间为7年。我们对局部晚期肿瘤患者的治疗方法是根治性切除，包括广泛的颈部清扫和受累器官的扩大切除，即使有远处转移。86例远处转移患者的5年和10年的疾病特异性生存率分别为65%和45%。多因素分析显示，发现远处转移灶时年龄较大、远处转移灶累及肺以外部位、远处转移灶直径>= 2cm、存在大淋巴结转移灶（>= 3cm）、原发肿瘤伴低分化成分均预示预后较差。除1例患者外，我们的积极治疗方法使所有患者都能治愈切除，只有5例患者（6%）死于局部疾病。宫颈复发患者预后较无复发患者差。尽管目前采用的治疗远处转移的方式对生存没有明确的影响，但一些PTC远处转移患者，包括年轻的分化良好的小肺转移患者，似乎有相对有利的结果。PTC的局部手术控制即使在远处转移的患者中也是重要的，特别是当远处转移看起来生长缓慢时。
Background. The presence of distant metastases is the most important predictive factor of poor outcomes in patients with papillary thyroid carcinoma (PTC). Some patients have very slow-growing distant metastases with relatively favorable outcomes, so predicting prognosis is not easy. Furthermore, many patients with distant metastases show locally advanced disease, and no consensus is available for operative control of cervical tumor in this situation.Methods. Among 1023 patients with PTC who underwent primal thyroidectomy from 1976 to 2002 42 patients displayed distant metastases at initial presentation and 44 patients developed distant metastases during follow-up. We reviewed the records retrospectively of these 86 patients. Mean duration of follow-up after detection of distant metastases was 7 years. Our treatment approach for patients with locally advanced neoplasms was radical resection including extensive neck dissection and extended resection of the involved organs, even when distant metastases were present.Results. Disease specific survival of the 86 patients with distant metastases at 5 and 10 years was 65% and 45%, respectively. Using multivariate analysis, older age at time of distant metastases detection, distant metastases involving sites other than the lung, distant metastases diameter >= 2 cm, presence of large nodal metastases (>= 3 cm), and a primal neoplasm with poorly differentiated components were all predictive of worse prognosis. Our aggressive approach allowed curative resection in all but 1 patient, and only 5 patients (6%) succumbed to local disease. Patients with cervical recurrences displayed worse prognosis than those without.Conclusions. Although the currently employed modalities of therapy for distant metastases do not have definitive impact on survival, some PTC patients with distant metastases, including younger patients with well-differentiated, small lung metastases appear to have relatively favorable outcomes. Local operative control of PTC is important even in patients with distant metastases, particularly when the distant metastases appear to be slow-growing.