摘要
目的 探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）密切随访管理的合理性并探索适合随访患者的具体条件.方法 选取两种PTMC的随访适应证,即日本Kuma医院制订的随访标准和中国抗癌协会甲状腺癌专业委员会（CATO）制订的随访标准,分别应用于2008年1月至2010年12月复旦大学附属肿瘤医院PTMC术后的患者,回顾性分析比较各组患者临床病理特点和预后的差异.采用卡方分析和Fisher精确概率检验法比较各组临床病理特点,采用Kaplan-Meier生存分析描述各分组无病生存情况.结果 778例PTMC患者满足条件纳入本研究中,其中共565例（72.6％）满足Kuma随访条件,112例（14.4％）满足CATO随访条件.根据标准,入组患者分为Kuma高危组（213例）、Kuma低危组（565例）和CATO高危组（666例）、CATO低危组（112例）.Kuma低危组与Kuma高危组相比,表现出较低的中央区淋巴结转移率,差异有统计学意义（30.6％比47.9％,P＜0.05）.在评价CATO标准时,发现低危组的患者在多灶病变（6.3％比16.4％）、腺外侵犯（1.8％比7.5％）、中央区淋巴结转移（19.6％比38.0％）方面,均低于高危组,差异均有统计学意义（P值均＜0.05）.评价各组预后,CATO低危组与CATO高危组相比,拥有明显较低的复发率（0.9％比6.0％,P＜0.05）和更长的无病生存时间（P＜0.05）.而Kuma低危组和Kuma高危组预后分析并未显示出差异.结论 CATO标准相对更为严格,该部分患者临床病理危险因素更少,预后更好.我们认为CATO密切随访标准筛选出的患者更加适合密切随访管理.
Objective To investigate the rationality of management of active surveillance for papillary thyroid microcarcinoma （PTMC） and the main indications for active surveillance for PTMC.Methods In this study,two criteria were used to evaluate patients with PTMC：low-risk PTMC conditions defined by Kuma hospital and Chinese Association of Thyroid Oncology （CATO） consensus on PTMC management of active surveillance.The patients had received surgical treatment.Clinicopathological characteristics and prognosis of the patients in different groups were compared.Results A total of 778 patients were enrolled in the study,565 （72.6%） of them met Kuma screening criteria and only 112 （14.4%） met CATO screening criteria.Kuma low-risk subgroup had lower incidence of cervical lymph node metastasis than Kuma high-risk PTMC subgroup （30.6% vs 47.9%,P 〈 0.05）.There were significant differences in multifocal lesions（6.3% vs 16.4%）,extrathyroidal extension （1.8% vs 7.5%） and cervical lymph node metastasis（19.6% vs 38.0%） between low-risk and high-risk CATO PTMC subgroups.Patients in the CATO low-risk PTMC subgroup had lower recurrence and longer disease-free survival （DFS） than those in the CATO high-risk PTMC subgroup.But there was no significant difference in recurrence or DFS between Kuma low-risk and high-risk Kuma PTMC subgroups.The Chi-square test of Fisher＆#39;s exact probabilities test was used to compare clinicopathological characteristics of patients between different groups.Rates of disease-free survival were calculated using the Kaplan-Meier method.Conclusion CATO screening criteria is relativelv strict and may be more suitable for Chinese patients with active surveillance for PTMC.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2017年第6期430-434,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
甲状腺肿瘤
癌
乳头状
随访研究
病理学
临床
复发
无病生存
Thyroid neoplasms
Carcinoma,papillary
Follow-up studies
Pathology,clinical
Recurrence
Disease-free survival
