分化良好甲狀腺癌的分析研究

Analysis of Well-Differentiated Thyroid Cancers

劉文川(Wen-Chuan Liu) ； 蕭信昌(Hsin-Chang Hsiao) ； 張正權(Cheng-Chuan Chang)

《The Changhua Journal of Medicine》 6卷1期 (2000/01) Pp. 19-23

摘要

背景：分化良好之甲狀腺癌由於病程進行緩慢，臨床觀察期往往需要二、三十年的追蹤。因此對於治療的方針包括手術的程度、放射碘的角色及甲狀腺素抑制治療等之評估，仍存有爭議。本科將近年來所經歷分化良好甲狀腺癌病例做一臨床病理分析，以供日後研究此疾病之參考。
方法：回溯性分析：彰化基督教醫院耳鼻喉科，81年l月至87年12月共125例分化良好甲狀腺癌的病理及臨床資料，追蹤至88年6月。針對年齡、性別、腫瘤病理報告、遠處及頸部淋巴腺轉移之有無、手術方式、術後併發症及復發率、術後放射碘之使用等，提出報告。
結果：125位患者中，21位男性，104位女性。年齡自14至88歲。乳突狀腺癌有107例，濾泡腺癌有18例。腫瘤大小l-4cm者91例(75.9%)。40例(33.1%)有甲狀腺莢膜外侵犯，24例(19.8%)有頸部淋巴腺轉移，有2例併肺部轉移。手術方式採「全或近全甲狀腺切除」者有97例(77.60%)。整體術後併發症14.4%。90位(72%)患者接受術後放射碘治療。追蹤至今，有5例因復發再次接受手術，無因本疾病而死亡的病例。
結論：患者年齡、腫瘤組織類別、腫瘤大小、莢膜外侵犯及遠隔轉移之有無，是目前認為影響分化良好甲狀腺癌的預後因子。目前「全或近全甲狀腺切除術」為本科治療甲狀腺癌的主要方式。未來計劃能累積大規模的病例及長期前瞻性的追蹤，並根據預後因子訂定出合理的治療方針，以提高存活率、減少併發症、並避免不必要的醫療。

關鍵字

分化良好甲狀腺癌 ； 乳突狀腺癌 ； 濾泡腺癌

並列摘要

Background: Well-differentiated thyroid cancers (WDTC) are a clinically indolent disease. Due to the need for long-term follow-up, controversy regarding the treatment still exists. In order to establish rational management for WDTC, we undertook a retrospective review and analysis of a consecutive series of patients with WDTC treated at our hospital.
Methods: During the years 1992 to 1998, 125 patients with WDTC were treated at Changhua Christian Hospital. Hospital records were reviewed retrospectively for data regarding age, gender, histologic type, primary tumor size, extrathyroidal extension, treatment and complication, recurrence and survival rate.
Results: There were 104 female and 21 male patients in this study population, ranging in age from 14 to 88 years. Papillary cancer was found in 107 patients and follicular cancer in 18 patients. Pathologically, 91 patients (75.9%) had primary tumor measuring between 1 and 4 cm in size. Tumors in 40 patients (33.1%) had extracapsular extension, and nodal metastasis was found in 24 patients (19.8%). Two cases had pulmonary metastasis. Total thyroidectomy was performed in 97 patients (77.6%). The rate of surgical complications is 14.4% overall. Postoperative radioiodine ablation therapy was administered to 90 patients (72%). At the end of this study, five patients with recurrence received further operation and none of the entire population died of this disease.
Conclusion: On the reported literature, factors that affected the prognosis of WDTC were patient's age, histology, tumor size, extrathyroidal extension, and distant metastases. Although surgical treatment favors total or near total thyroidectomy at our institution, the role of subtotal thyroidectomy versus total thyroidectomy must be studied in a prospective, randomized trial. This report is based on the future goal which is to identify rational treatment strategy based on the prognostic factors and long- term follow up of prospective study in an effort to improve survival, reduce complication of surgery, and avoid unnecessary management.

並列關鍵字

well-differentiated thyroid cancers ； papillary carcinoma ； follicular carcinoma