• 1.大連醫(yī)科大學(xué)附屬第二醫(yī)院普外科(遼寧大連 116023);;
  • 2.中國(guó)醫(yī)科大學(xué)附屬第四醫(yī)院腫瘤治療中心(遼寧沈陽(yáng) 110032);

目的  探討甲狀腺乳頭狀癌術(shù)后復(fù)發(fā)的相關(guān)影響因素,為降低再手術(shù)風(fēng)險(xiǎn)及提高臨床療效提供依據(jù)。
方法  回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院2005年1月至2008年12月期間收治的206例甲狀腺乳頭狀癌患者的臨床資料。本組患者均獲訪(fǎng)3~5年,平均4.1年,采用單因素及多因素分析方法對(duì)甲狀腺乳頭狀癌術(shù)后復(fù)發(fā)與患者性別、年齡、腫瘤大小、甲狀腺包膜有無(wú)浸潤(rùn)、淋巴結(jié)有無(wú)轉(zhuǎn)移以及手術(shù)方式的相關(guān)性進(jìn)行分析。
結(jié)果  206例甲狀腺乳頭狀癌患者中,術(shù)后復(fù)發(fā)18例。單因素分析結(jié)果顯示,術(shù)后復(fù)發(fā)與患者性別、腫瘤大小、甲狀腺包膜是否被浸潤(rùn)、手術(shù)方式及淋巴結(jié)轉(zhuǎn)移情況均有關(guān)(P<0.05);多因素分析結(jié)果顯示,腫瘤大小、淋巴結(jié)轉(zhuǎn)移情況及手術(shù)方式與甲狀腺乳頭狀癌術(shù)后復(fù)發(fā)密切相關(guān)。
結(jié)論  腫瘤直徑越大、有淋巴結(jié)轉(zhuǎn)移和手術(shù)切除范圍不足可能是甲狀腺乳頭狀癌術(shù)后復(fù)發(fā)的高危因素。

引用本文: 馬振海,田曉峰,趙永福,邢光明,戴冬秋. 甲狀腺乳頭狀癌術(shù)后復(fù)發(fā)影響因素分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(12): 1410-1413. doi: 復(fù)制

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1. 康維明, 朱長(zhǎng)真, 田樹(shù)波, 等. 甲狀腺癌的外科治療[J]. 中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào), 2013, 35(4):373-377.
2. McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer[J]. Lancet, 2013,381(9871):1046-1057.
3. Shaha AR. Recurrent differentiated thyroid cancer[J]. Endocr Pract, 2012, 18(4):600-603.
4. 任國(guó)勝, 蘇新良. 分化型甲狀腺癌頸淋巴結(jié)清掃術(shù)式的選擇[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(8): 765-767.
5. 中華醫(yī)學(xué)會(huì)內(nèi)分泌學(xué)分會(huì), 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì), 中國(guó)抗癌協(xié)會(huì)頭頸腫瘤專(zhuān)業(yè)委員會(huì), 等. 甲狀腺結(jié)節(jié)和分化型甲狀腺癌診治指南[J]. 中國(guó)腫瘤臨床, 2012, 39(17): 1249-1272.
6. Durante C, Montesano T, Torlontano M, et al. Papillary thyroid cancer:time course of recurrences during postsurgery surveillance[J]. J Clin Endocrinol Metab, 2013, 98(2):636-642.
7. Cunningham MP, Duda RB, Recant W, et al. Survival discriminates for differentiated thyroid cancer[J]. AM J Surg, 1990, 160(4): 344-347.
8. 林益凱, 盛建明, 趙文和, 等. 多灶性甲狀腺乳頭狀癌168例臨床研究[J]. 中華外科雜志, 2009, 47(6): 450-453.
9. Sanders LE, Silverman M. Follicular and Hürthle cell carcinoma:predicting outcome and directing therapy[J]. Surgery, 1998, 124(6): 967-974.
10. Baek SK, Jung KY, Kang SM, et al. Clinical risk factors asso-ciated with cervical lymph node recurrence in papillary thyroid carcinoma[J]. Thyroid, 2010, 20(2): 147-152.
11. ItoY, Kudo T, Kobayashi K, et al. Prognostic factors for recurrence of papillary thyroid carcinoma in the lymph nodes, lung, and bone: analysis of 5 768 patients with average 10-year follow-up[J]. World J Surg, 2012, 36(6):1274-1278.
12. Huang BY, Lin JD, Chao TC, et al. Therapeutic outcomes of papillary thyroid cancer patients in different risk groups[J]. Oncology, 2011, 80(1-2):123-129.
13. 范自平, 喬智, 吳德敬. 甲狀腺癌診斷及復(fù)發(fā)因素分析[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(1): 68-72.
14. de Meer SG, Dauwan M, de Keizer B, et al. Not the number but the location of lymph nodes matters for recurrence rate and disease-free survival in patients with differentiated thyroid cancer[J]. World J Surg, 2012, 36(6):1262-1267.
15. 吳延升, 張侖, 王旭東, 等. 甲狀腺乳頭狀癌預(yù)后多因素分析[J]. 中國(guó)腫瘤臨床, 2007, 34(22):1294-1297.
16. Hiltzik D, Carlson DL, Tuttle RM, et al. Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients[J]. Cancer, 2006, 106 (6): 1286-1295.
  1. 1. 康維明, 朱長(zhǎng)真, 田樹(shù)波, 等. 甲狀腺癌的外科治療[J]. 中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào), 2013, 35(4):373-377.
  2. 2. McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer[J]. Lancet, 2013,381(9871):1046-1057.
  3. 3. Shaha AR. Recurrent differentiated thyroid cancer[J]. Endocr Pract, 2012, 18(4):600-603.
  4. 4. 任國(guó)勝, 蘇新良. 分化型甲狀腺癌頸淋巴結(jié)清掃術(shù)式的選擇[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(8): 765-767.
  5. 5. 中華醫(yī)學(xué)會(huì)內(nèi)分泌學(xué)分會(huì), 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì), 中國(guó)抗癌協(xié)會(huì)頭頸腫瘤專(zhuān)業(yè)委員會(huì), 等. 甲狀腺結(jié)節(jié)和分化型甲狀腺癌診治指南[J]. 中國(guó)腫瘤臨床, 2012, 39(17): 1249-1272.
  6. 6. Durante C, Montesano T, Torlontano M, et al. Papillary thyroid cancer:time course of recurrences during postsurgery surveillance[J]. J Clin Endocrinol Metab, 2013, 98(2):636-642.
  7. 7. Cunningham MP, Duda RB, Recant W, et al. Survival discriminates for differentiated thyroid cancer[J]. AM J Surg, 1990, 160(4): 344-347.
  8. 8. 林益凱, 盛建明, 趙文和, 等. 多灶性甲狀腺乳頭狀癌168例臨床研究[J]. 中華外科雜志, 2009, 47(6): 450-453.
  9. 9. Sanders LE, Silverman M. Follicular and Hürthle cell carcinoma:predicting outcome and directing therapy[J]. Surgery, 1998, 124(6): 967-974.
  10. 10. Baek SK, Jung KY, Kang SM, et al. Clinical risk factors asso-ciated with cervical lymph node recurrence in papillary thyroid carcinoma[J]. Thyroid, 2010, 20(2): 147-152.
  11. 11. ItoY, Kudo T, Kobayashi K, et al. Prognostic factors for recurrence of papillary thyroid carcinoma in the lymph nodes, lung, and bone: analysis of 5 768 patients with average 10-year follow-up[J]. World J Surg, 2012, 36(6):1274-1278.
  12. 12. Huang BY, Lin JD, Chao TC, et al. Therapeutic outcomes of papillary thyroid cancer patients in different risk groups[J]. Oncology, 2011, 80(1-2):123-129.
  13. 13. 范自平, 喬智, 吳德敬. 甲狀腺癌診斷及復(fù)發(fā)因素分析[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(1): 68-72.
  14. 14. de Meer SG, Dauwan M, de Keizer B, et al. Not the number but the location of lymph nodes matters for recurrence rate and disease-free survival in patients with differentiated thyroid cancer[J]. World J Surg, 2012, 36(6):1262-1267.
  15. 15. 吳延升, 張侖, 王旭東, 等. 甲狀腺乳頭狀癌預(yù)后多因素分析[J]. 中國(guó)腫瘤臨床, 2007, 34(22):1294-1297.
  16. 16. Hiltzik D, Carlson DL, Tuttle RM, et al. Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients[J]. Cancer, 2006, 106 (6): 1286-1295.