Clinical Analysis of Multifocal Papillary Thyroid Carcinoma
|School||Dalian Medical University|
|Course||General surgery Sciences|
|Keywords||Thyroid tumors Papillary carcinoma Thyroidectomy Neck dissection Adjuvant therapy Gene therapy|
Objective: To investigate multifocal papillary thyroid carcinoma clinical features and surgical treatment. Methods: A retrospective analysis of January 2003 - December 2005 between the First Affiliated Hospital of Dalian Medical University received the first surgery and pathologically confirmed 253 cases of papillary thyroid carcinoma, including multifocal papillary thyroid carcinoma 81 cases, single lesion group compared with multifocal multifocal group and clinicopathologic differences between groups and to study its clinical features. Results: collect multifocal papillary thyroid carcinoma 81 cases, accounting for the same period 32.0% of papillary thyroid carcinoma. Bilateral lesions in 53 cases (65.4%), unilateral in 28 cases (34.6%). Multifocal lesions containing tiny group of cancer 57 cases (70.3%); merger Hashimoto's disease 22 cases (27.2%); combined nodular goiter 35 cases (43.2%); invade surrounding tissue 26 cases (32.1%); cervical lymph node metastasis 52 cases (64.2%); distant metastasis in 8 cases (9.8%); 5-year survival rate was 93.8%. Which multifocal group containing tiny cancer, Hashimoto's thyroiditis merger, consolidation nodular goiter, lymph node metastasis, and other aspects of the surrounding tissue invasion were significantly higher than a single lesion group, and there are obvious differences between the The statistical significance (P lt; 0.05). Follow-up, 5 patients died, including three patients underwent 131I adjuvant therapy after surgery 12 to 36 months of death, cause of death was asphyxiation, swallowing can not, with systemic organ failure and other transfers; 2 cases underwent surgery 3rd, respectively at 9 months after surgery and died 14 months; 2 patients postoperative cervical lymph node recurrence reoperation. Survival curve showed multifocal group than in the same period a single focal PTC group is slightly lower, the difference was not statistically significant (P gt; 0.05), total 1,2,5-year survival rates were 98.1%, 96.5%, 93.8% American Cancer Society (AJCC) staging and prognosis (X ~ 2 = 49.061, P = 0.000). Conclusion: multiple foci of papillary thyroid carcinoma is one of the characteristics of its higher degree of biological malignancy, multifocal papillary thyroid carcinoma occurred in the bilateral thyroid lesions containing nodular goiter, Hashimoto's thyroiditis and small cancers more. Surgical options should be based on clinical practice need to be flexible selection, in order to achieve the best effect as the goal. Excessive removal of thyroid tissue will reduce the physiological function of organs and affect the patient's quality of life, too little thyroid tissue excised is easy to relapse, required reoperation, increase the patient's suffering and economic burden. Lymph node dissection should be careful, it has been found in clinical cervical lymph node metastasis in patients taking neck dissection; in order to avoid the occurrence of postoperative complications and serious impact on the prognosis of patients, such as those without lymph node metastasis, can not clean as possible without dissection. Minimally invasive thyroid surgery will become the future direction of development, whether for the treatment of MPTC further study. Long-term post-operative patients should be taking thyroid hormones, periodic review of blood levels of thyroid hormone to regulate the dose to prevent recurrence and metastasis; selective application of radioactive iodine treatment; papillary thyroid carcinoma to radiotherapy and chemotherapy are lack of sensitivity, should not use ; thyroid cancer cure breakthrough is expected to gene therapy, with the development of transgenic technology, the molecular basis of thyroid cancer will also be clarified, thyroid cancer gene therapy will become an effective means of treatment. AJCC staging is still multifocal papillary thyroid carcinoma important prognostic factor.