DOES THE METHOD OF MANAGEMENT OF PAPILLARY THYROID-CARCINOMA MAKE A DIFFERENCE IN OUTCOME
DOES THE METHOD OF MANAGEMENT OF PAPILLARY THYROID-CARCINOMA MAKE A DIFFERENCE IN OUTCOME
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DOI：
10.1007/bf00348202
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发表时间：
1994-01-01
影响因子：
2.6
通讯作者：
SHUKLA, MS
中科院分区：
文献类型：
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作者：
DEGROOT, LJ;KAPLAN, EL;SHUKLA, MS
我们分析了一组269例甲状腺乳头状癌患者的数据，平均随访12年，以确定（1）预后分类方案是否可用于预测适当的手术方法;（2）治疗对预后的影响;（3）预后“极好”的患者是否受益于更广泛的手术切除和I-131消融。美国联合委员会Cady等人开发的预后分类方案，Hay等人，欧洲甲状腺协会和我们自己的临床分类方案都适当地将患者分为风险类别组。在每个系统中，一些被归类为低风险组的患者最终死于肿瘤。考虑到预后方案的优良但不完美的精度，需要详细的病理分析，理想的术后甲状腺扫描，我们得出结论，预后分类方案不允许在手术台上决定适当的手术范围。在我们机构随访的患者，由三位经验丰富的外科医生之一进行手术，通常进行I-131消融，与随访组中由其他外科医生进行手术且未进行常规消融的其他患者进行比较。有显着较少的死亡和复发的患者管理我们的方法。然而，当这些组仅限于考虑接受更广泛手术、术后I-131消融或两者兼而有之的患者时，组间差异变得不显著。这一发现表明，比较在我们机构治疗的患者和最初在其他地方治疗的患者，预后的差异主要是由于常规使用更广泛的手术和术后放射性碘消融。45岁以下甲状腺内疾病或颈淋巴结阳性且肿瘤直径小于2.5 cm的患者预后良好，随访期间无肿瘤死亡。然而，广泛的手术和I-131消融术与复发率显著降低相关。这些数据支持使用肺叶切除术加对侧肺叶次全切除术或甲状腺近全切除术作为大于1 cm的甲状腺癌和45岁以上患者的主要手术程序;它们还支持术后使用I-131消融提供最佳预后，减少死亡和复发。
We have analyzed data on a group of 269 patients with papillary thyroid carcinoma followed on average for 12 years to determine (1) if a prognostic classification scheme can be used to predict an appropriate surgical approach; (2) the effect of treatment on prognosis; and (3) if patients with a ''excellent'' prognosis benefit from more extensive surgical resection and I-131 ablation. Prognostic classification schemes developed by the American Joint Commission, Cady et al., Hay et al., the European Thyroid Association, and our own clinical class scheme each appropriately divided patients into risk category groups. With each system, some patients classified in the low risk group eventually died of the tumor. Considering the excellent but not perfect precision of the prognostic schemes, the need for detailed pathologic analysis, and ideally postoperative thyroid scanning, we conclude that the prognostic classification schemes do not allow the decision at the operating table regarding the appropriate extent of surgery. Patients followed at our institution, operated on by one of three experienced surgeons, and usually given I-131 ablation were compared to other patients in the follow-up group operated on by other surgeons and not routinely ablated. There were significantly fewer deaths and recurrences among the patients managed by our method. However, when the groups were restricted to those considering only patients who had more extensive surgery, postoperative I-131 ablation, or both, the differences between the groups became insignificant. This finding indicates that the difference in prognosis, comparing patients treated at our institution and those initially treated elsewhere, was primarily due to the routine use of more extensive surgery and postoperative radioactive iodide ablation. Patients under age 45 with intrathyroidal disease or positive neck nodes and tumors less than 2.5 cm in diameter had an excellent prognosis, as shown by the absence of deaths due to tumor during the follow-up period. However, extensive surgery and I-131 ablation was associated with a significant reduction in recurrences. These data support the use of lobectomy plus contralateral subtotal lobectomy or near-total thyroidectomy as the primary operative procedures for thyroid cancers larger than 1 cm in size and in patients beyond age 45; they also support the use of I-131 ablation postoperatively to provide the best prognosis with reduction in deaths and recurrences.