摘要
目的 探讨散发性甲状腺髓样癌(sporadic medullary thyroid carcinoma,SMTC)不同手术方式的疗效及预后.方法 回顾性分析2009年2月至2023年11月吉林大学中日联谊医院甲状腺外科接受手术治疗的101例SMTC患者的临床病理特征信息和随访资料.101例SMTC中男36例,女75例,男女比例为1.0∶2.1;中位年龄47岁,范围21～72岁.根据手术方式分为观察组(78例)和对照组(23例),观察组手术方式符合专家共识,对照组手术方式不符合专家共识,比较两组临床特征、疗效及预后情况.结果 与观察组相比,对照组TNM分期中Ⅱ期患者更多,Ⅲ期患者更少,术中冰冻病理结果提示为MTC的占比更低,中央区淋巴结清扫(central lymph node dissection,CLND)数目更少[7(4,11)vs.4(2,7)个,P=0.031],中央区淋巴结转移(central lymph node metastasis,CLNM)数目更少[1(0,4)vs.0(0,1)个,P=0.017],颈侧区淋巴结清扫(lateral lymph node dissection,LLND)数目更少[21(16,30)vs.2(0,8)个,P=0.002],术后随访时间更长(73.1±38.5 vs.117.5±39.9 个月,P=0.001),术后 5 年血清降钙素(calcitonin,Ctn)水平更高[0.6(0.5,5.8)vs.5(0.4,37.5)pg/mL,P=0.046].两组经手术治疗后Ctn均获得明显下降,观察组术后Ctn处于缓解水平57例(73.1％),稳定水平13例(16.7％),进展水平8例(10.2％);对照组术后Ctn处于缓解水平20例(86.9％),进展水平3例(13.1％),没有处于稳定水平的患者.观察组术后1例(1.3％)复发,对照组2例(8.7％)复发.结论 规范彻底的手术可最大程度清扫转移淋巴结,有效降低复发率,取得较好的疗效,改善患者远期预后,且不会增加手术风险和术后并发症.
Abstract
Objective To investigate the efficacy and prognosis of different surgical approaches in sporad-ic medullary thyroid carcinoma.Methods A retrospective analysis was conducted on 101 patients with sporadic medullary thyroid carcinoma(MTC)who underwent surgical treatment at the Department of Thyroid Surgery,China-Japan Union Hospital of Jilin University,from Feb.2009 to Nov.2023.The patients included 36 males and 75 fe-males,with a male-to-female ratio of 1∶2.1.The median age of the patients was 47 years old,with an age range of 21 to 72 years old.The study divided participants into two groups based on their surgical methods:an observation group(78 cases)and a control group(23 cases).The observation group received surgical methods in accordance with expert consensus,while the control group did not.The study compared the efficacy and prognosis of the two groups.Results Statistical differences were found between the two groups in terms of stage Ⅱ and Ⅲ in TNM stag-ing,intraoperative frozen pathological findings,number of lymph node resections in the central group,number of lymph node metastases in the central group,number of lymph node resections in the lateral cervical region,postop-erative follow-up time,and five-year postoperative serum procalcitonin(Ctn)levels(P＜0.05).Both groups of pa-tients obtained a significant decrease in Ctn after surgical treatment.In the observation group,Ctn was at the remis-sion level in 57 cases(73.1％),at the stable level in 13 cases(16.7％),and at the progression level in 8 cases(10.2％),while in the control group,Ctn was at the remission level in 20 cases(86.9％),at the progression level in 3 cases(13.1％),and there were no patients at the stable level after the operation.One patient(1.3 per cent)in the observation group had a recurrence after surgery;Two patients(8.7 per cent)in the control group had a recurrence.Conclusions Standardised and thorough surgery can maximise the clearance of metastatic lymph nodes,effective-ly reduce the recurrence rate,achieve better efficacy,and improve the long-term prognosis of patients without in-creasing the risk of surgery and postoperative complications.
基金项目
国家科技部外专局基金资助项目(DL2023129007L)
吉林省卫生科研人才专项基金资助项目(2022SCZ22)
维普
万方数据