Management and outcome, of recurrent well-differentiated thyroid carcinoma
Management and outcome, of recurrent well-differentiated thyroid carcinoma
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DOI：
10.1001/archotol.130.7.819
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发表时间：
2004-07-01
影响因子：
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通讯作者：
Freeman, JL
中科院分区：
文献类型：
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作者：
Palme, CE;Waseem, Z;Freeman, JL
背景：高分化甲状腺癌 (WDTC) 的 AMES（年龄、远处转移、肿瘤范围和大小）、AGES（年龄、肿瘤大小、组织学分级、肿瘤范围、远处转移）和 MACIS（远处转移、年龄、原发肿瘤切除的完整性、局部浸润和肿瘤大小）预后系统是众所周知的。疾病复发与不良结果相关；然而，多次治疗失败的预后重要性尚未明确报道。 目的：确定可能与 WDTC 多次复发相关的患者、肿瘤和治疗因素。 设计和设置：所有接受残余或复发 WDTC 治疗的患者均从安大略省多伦多西奈山医院耳鼻喉头颈外科科的甲状腺癌数据库中回顾性确定（1963-2000 年）。收集相关患者、肿瘤和治疗因素的数据。主要结果指标：患者、肿瘤和治疗因素预测多种治疗失败的发生、疾病特异性生存率和总生存率。结果：总共确定了 574 名患者（115 名男性，459 名女性；中位年龄，42 岁[范围，9-92 岁]），其最终组织病理学诊断为乳头状癌，468 例为滤泡状癌， 76例，混合30例。 TNM 分期如下：1 期 409 例（71%）、11 期 66 例（12%）、111 期 68 例（12%）和 IV 期 31 例（5%）。初始治疗包括 217 例患者 (38%) 接受甲状腺全切除术、357 例患者 (62%) 接受甲状腺次全切除术、492 例患者 (86%) 接受辅助碘 131 治疗。 73 名患者 (13%) 出现复发性 WDTC（21 名男性，52 名女性；中位年龄，44 岁 [范围，18-84 岁]）。患者被分为 3 组：第 1 组（无复发，n = 50±1）、第 2 组（仅 1 次复发，n = 42）和第 3 组（多次复发，n = 3±1）。第 2 组数据如下：复发部位（局部，25；远处，7；未指定，10）和治疗（手术，12；碘 131、42）；第 3 组：首次复发部位（局部，16；远处，11；未指定，4）和治疗（手术，14，碘 131、22；姑息治疗，1）。 3 组的 20 年精算疾病特异性生存率分别为 100%、94% 和 60%（中位随访时间为 7 年；范围为 1-34 年）。男性、晚期、甲状腺外扩散和甲状腺全切除术是多变量回归中多次复发的预测因素（所有 P < .05）。结论：男性、晚期初始阶段和原发肿瘤内存在甲状腺外扩散最多。 WDTC 患者发生多次复发的重要独立预测因素。这些患者的预后较差，无肿瘤生存率显着降低。
Background: The AMES (age, distant metastasis, tumor extent, and size), AGES (age, tumor size, histologic grade, tumor extent, distant metastasis), and MACIS (distant metastasis, age, completeness of primary tumor resection, local invasion, and tumor size) prognostic systems for well-differentiated thyroid carcinoma (WDTC) are well known. The development of disease recurrence is associated with a poor outcome; however, the prognostic importance of multiple treatment failures has not been clearly reported.Objectives: To identify patient, tumor, and treatment factors that may be associated with the development of multiple recurrences in WDTC.Design and Setting: All patients treated for residual or recurrent WDTC were retrospectively identified from the thyroid cancer database at the Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario (1963-2000). Data on relevant patient, tumor, and treatment factors were collected.Main Outcome Measures: Patient, tumor, and treatment factors predicting the development of multiple treatment failures, disease-specific survival, and overall survival.Results: A total of 574 patients (115 male, 459 female; median age, 42 years [range, 9-92. years]) were identified, whose final histopathologic diagnosis was papillary carcinoma in 468, follicular carcinoma in 76, and mixed in 30 cases. TNM staging was as follows: 409 (71%) stage 1, 66 (12%) stage 11, 68 (12%) stage 111, and 31 (5%) stage IV. Initial management included total thyroidectomy for 217 patients (38%), subtotal thyroidectomy for 357 (62%), and adjuvant iodine 131 therapy for 492 (86%). Seventy-three patients (13%) developed recurrent WDTC (21 male, 52 female; median age, 44 years [range, 18-84 years]). Patients were divided into 3 groups: group I (no recurrence, n = 50 1), group 2 (1 recurrence only, n = 42), and group 3 (multiple recurrences, n = 3 1). Group 2 data were as follows: site of recurrence (locoregional, 25; distant, 7; unspecified, 10) and treatment (surgery, 12; iodine 131, 42) and for group 3: site of first recurrence (locoregional, 16; distant, 11; unspecified, 4) and treatment (surgery, 14, iodine 131, 22; palliation, 1). Actuarial disease-specific survival at 20 years was 100%, 94%, and 60%, respectively, for the 3 groups (median follow-up, 7 years; range, 1-34 years). Male sex, advanced stage, extrathyroidal spread, and primary treatment with total thyroidectomy were predictive factors for multiple recurrences on multivariate regression (all P < .05).Conclusions: Male sex, advanced initial stage, and presence of extrathyroidal spread within the primary tumor are the most. significant independent predictors of developing multiple recurrences in patients with WDTC. These patients have a poor prognosis with a significant reduction in tumor-free survival.