Survival of differentiated thyroid carcinoma studied in 500 patients
Survival of differentiated thyroid carcinoma studied in 500 patients
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DOI：
10.1200/jco.1997.15.5.2067
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发表时间：
1997-05-01
影响因子：
45.3
通讯作者：
Saur, HB
中科院分区：
文献类型：
--
作者：
Lerch, H;Schober, O;Saur, HB
目的：分析局部复发分化型甲状腺癌患者行甲状腺切除术、放射性碘治疗及早期手术再干预行室导向淋巴结切除术后的生存影响因素。方法：回顾性分析500例分化型甲状腺癌患者的死亡率和生存率（Kaplan-Meier）。其中301例为乳头状甲状腺癌，199例为滤泡性甲状腺癌。380名女性和120名男性的平均年龄为46.8±16.4岁。所有患者均行手术甲状腺切除术，高剂量放射性碘治疗，局部复发的患者早期手术再干预行室导向淋巴结切除术，不进行常规辅助颈部外放疗。患者被监测长达23年，中位随访时间为5.6年。结果：500例患者中死亡29例，其中甲状腺癌19例。校正后的5年总生存率（Kaplan-Meier）为0.92。肿瘤分期pTl-3NO-1MO（低危）患者无甲状腺癌死亡（5年生存率0.97）；pT4期和/或M1期（高风险）患者的5年生存率为0.83。死亡原因为局部复发8例，转移性疾病11例。通过多变量分析，显著影响生存的危险因素是局部侵袭（pT4）、转移性疾病（M1）和年龄。结论：分化型甲状腺癌在局部复发的情况下，采用甲状腺全手术切除加高剂量放射性碘治疗和早期手术再干预，即使不进行颈部辅助外放疗，生存率也很高。(C) 1997年由美国临床肿瘤学会。
Purpose: To analyze the factors that influence survival of patients with differentiated thyroid carcinoma treated by surgical thyroidectomy, radioactive iodine, and early surgical reintervention with compartment-oriented lymphadenectomy in the case of locoregionol recurrence.Methods: The survival of 500 patients with differentiated thyroid carcinoma was analyzed retrospectively with regard to mortality and survival rare (Kaplan-Meier). A total,of 301 patients had papillary and 199 follicular thyroid carcinoma. The mean age of the 380 women and 120 men was 46.8+/-16.4 years at presentation. All patients were treated by surgical thyroidectomy, high-dose radioactive iodine, and early surgical reintervention with compartment-oriented lymphadenectomy in cases of locoregional recurrence, without routine adjuvant external radiotherapy of the neck. patients were monitored up to 23 years, with a median followup time of 5.6 years.Results: Twenty-nine of 500 patients died, 19 of thyroid cancer. The corrected overall 5-year survival rate (Kaplan-Meier) was 0.92. Among patients with tumor stage pTl-3NO-1MO (low risk), none died of thyroid carcinoma (5-year survival rate, 0.97); in patients with tumor stage pT4 and/or M1 (high risk), the 5-year survival rate was 0.83. The cause of death was locoregional recurrence in eight and metastatic disease in 11. Using multivariate analysis, risk factors that significantly influence survival were local invasion (pT4), metastatic disease (M1), and age.Conclusion: In differentiated thyroid carcinoma, the use of total surgical thyroidectomy followed by high-dose radioiodine therapy and early surgical reintervention in case of locoregional recurrence yields high survival rates, even without adjuvant external radiotherapy of the neck. (C) 1997 by American Society of Clinical Oncology.