Clinical Behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: Study of 299 cases
Clinical Behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: Study of 299 cases
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DOI：
10.1210/jc.2003-031982
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发表时间：
2004-08-01
影响因子：
5.8
通讯作者：
Belfiore, A
中科院分区：
文献类型：
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作者：
Pellegriti, G;Scollo, C;Belfiore, A
为了研究小的（小于或等于1.5 cm）甲状腺乳头状癌复发的预测因素，我们对在我们机构接受治疗和随访的患者进行了一项回顾性病历回顾性研究。在1975年至2001年期间，299例患者因大小不超过1.5 cm的分化型甲状腺乳头状癌接受手术。在292例患者中进行了甲状腺近全或全切除术，7例患者进行了腺叶切除术。在77例患者中观察到持续/复发性疾病;在这些患者中，37例患者的唯一体征是TSH刺激的血清甲状腺球蛋白（Tg）升高。10例患者发生远处转移，68例发生局部转移。在多变量分析中，持续性/复发性疾病与以下因素相关：1）非偶发性甲状腺癌; 2）就诊时淋巴结转移; 3）双侧肿瘤。远处转移的发生与硬化变体和出现淋巴结转移有关。肿瘤大小（小于或等于1.0 cm vs. 1.1-1.5 cm）不能预测复发。没有患者死于该病，但14.4%的患者在最后一次随访时有疾病的证据。在L-T（4）停药期间第一次术后评估时血清Tg水平低于1.0 ng/ml是无复发的准确预测因素。总之，大约四分之一大小不超过1.5 cm的甲状腺乳头状癌患者在手术后出现复发/持续疾病。基线组织病理学特征和术后第一次评估时L-T（4）的血清Tg水平可以准确预测复发风险。
To investigate predictors of relapse in small (less than or equal to1.5 cm) papillary thyroid cancers, we performed a retrospective chart review study of patients treated and followed up in our institution according a standard prospective protocol. Between 1975 and 2001, 299 patients were operated for a differentiated papillary thyroid cancer no larger than 1.5 cm in size. Near-total or total thyroidectomy was performed in 292 patients, and lobectomy in seven patients.Persistent/recurrent disease was observed in 77 patients; in 37 of these patients, the only sign was increased TSH-stimulated serum thyroglobulin (Tg). Ten patients developed distant metastases, and 68 locoregional metastases. At multivariate analysis, persistent/recurrent disease was associated with: 1) nonincidental thyroid cancer; 2) lymph node metastases at presentation; and 3) bilateral tumor. Development of distant metastases was associated with the sclerosant variant and the presence of lymph node metastases at presentation. Tumor size (less than or equal to1.0 cm vs. 1.1-1.5 cm) was not predictive of relapse. No patient died because of the disease, but 14.4% had evidence of disease at their last follow-up visit.Serum Tg level below 1.0 ng/ml at the first postsurgical evaluation during L-T(4) withdrawal was an accurate predictor of no relapse.In conclusion, approximately one of four patients with a papillary thyroid cancer no more than 1.5 cm in size develops relapsing/persisting disease after surgery. Baseline histopathological characteristics and serum Tg levels off L-T(4) at first postsurgical evaluation can accurately predict the risk of relapse.