摘要
目的:分析首次治疗术式的选择对甲状腺乳头状癌(PTC)患者预后、情绪及经济的影响。方法:回顾性分析甲状腺癌术后拟行131I治疗的445例PTC患者。女329例,男116例。年龄9～68岁,平均年龄43岁。肿瘤病灶≥1cm或<1cm但合并包膜外侵犯或淋巴结转移或远处转移。根据首次手术是否行甲状腺全切或次全切除术式与否分为G1和G2两组,研究两组的预后因素有年龄、性别、病灶大小、颈淋巴结转移、有无包膜外侵犯、手术频次及首次治疗术式,其中着重通过复发率、情绪量表、经济花费方面分析首次治疗术式对PTC预后、情绪及经济的影响。结果:单因素分析导致PTC预后差的因素包括包膜外侵犯(P=0.001)、手术频次(P<0.001)和首次手术术式(P<0.001)。多因素分析显示,包膜外侵犯(P=0.001)和手术频次(P<0.001)是导致预后差的独立因子。术后3个月、1年、5年、10年随访,G2组术后各时间段复发率均明显高于G1组(31.8%/14.1%,χ20.4年=4.49;59.1%/19.6%,χ21年=15.14;63.6%/23.5%,χ25年=13.96;71.2%/26.1%,χ210年=16.47,P值均<0.05)。焦虑自评量表显示,G1、G2两组平均标准得分分别为(37.5±8.0)和(40.6±11.26)分,两组分值均高于我国正常人群(t值分别为6.037和7.068,P值均<0.05),且G2组评分明显高于G1组,t=0.534,P=0.000。抑郁自评量表显示,G1组、G2两组平均标准得分分别为(43.31±10.38)和(46.85±11.86)分,两组分值均高于我国正常人群(t值分别为5.974和6.466,P值均<0.05);且G2组评分明显高于G1组,t=2.574,P=0.017。再次手术至少让患者多负担7 228元,是只接受一次手术治疗费用的1.8倍,t=6.537,P=0.000。结论:外科首次治疗术式对于PTC复发和预后是非常重要的影响因素,对于肿瘤病灶≥1cm或<1cm但合并包膜外侵犯或淋巴结转移或远处转移的患者应行甲状腺全切或次全切除术。首次术式不当可引起PTC复发及转移概率明显增高,加重患者的精神和经济负担,影响患者的生活质量。
OBJECTIVE：To analyze the prognosis of papillary thyroid carcinoma（PTC） impacted by initial surgical procedure. METHODS： A retrospective study of 445 patients （329 female, it 16 male; age ： 9- 68, average age ： 43 yr） with PTC scheduled for ^131I treatment after surgery was conducted. Patients with 1）distant metastasis; 2）tumor size≥1 cm; 3）tumor 〈1 cm with extra-capsule invasion or lymph node metastasis were enrolled. Patient＇s initial surgical procedure varied from total thyroidectomy to nodular dissection and was classified into Gi and G2 groups according to initial surgical procedure adequate or not. Univariate and multivariate analysis of prognostic and tumor-related variables such as： age, gender,initial surgical procedure et al were performed. The self-rating anxiety and depression scales and the economic cost of patients influenced by surgery were also analyzed. RESULTS： Poor prognostic variables were extra-capsule invasion （P=0.001）,the frequency of surgery （P〈0. 001）,the initial operation pattern （P〈0. 001） by univariate analysis.The frequency of surgery （P〈0. 001） and extra-capsule invasion （P=0. 001） were the independent poor prognostic varia ble by multivariate analysis. Recurrence rate of G2 group were significantly higher than that of G1 group in their follow-up over 3 months,1 year,5 years,10 years,respectively （31.8%0/14. 1%0,Х0.4y^2=4.49;59. 1%0/19.6%,Х1y^2=15. 14;63.6%/ 23.5%,Х5y^2=13.96;71.2%/26. 1%,Х10y^2=16.47;P〈0.05）. The self-rating anxiety scale（SAS）：the average score of G1 ,G2 was （37.5±8.0） and （40.±11.26） ponits which were higher than the score of normal Chinese adults （t G1 = 6. 037,tG2=7. 068,P〈0.05）,moreover, the SAS score of G2 was significantly higher than that of G1 （t=0. 534,P= 0. 000）. The self-rating depression scale（SDS）： G1 and G2 groups average score were （43.31 ±10. 38） and （46. 85 ±11.86） ponits which were also higher than score of normal Chinese adults （tG1 =5. 974,t G2 =6. 466,P〈0.05）. There was a statistical difference between G1 and G2 （t= 2. 574, P= 0. 017）. Re-operation induced by inadequate initial surgery resulted in the additional burden of at least 7 228 RMB on average of each patient,which is 1.8 times than that of every patient who received only one operation（t= 6. 537, P= 0. 000）. CONCLUSIONS： Initial surgery is a vital factor for the prognosis of PTC. Patients with 1）distant metastasis; 2）tumor size≥1 cm; 3）tumor 〈1 cm with extra-capsule invasion or lymph node metastasis should treat total thyroidectomy or near-total thyroidectomy. Inadequate initial surgical procedure causes poor prognosis and have higher recurrence rate as well as added both mental and economic burden to the patients.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2012年第10期761-765,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
国家自然科学基金(30970850)
关键词
甲状腺肿瘤
预后
复发
手术术式
thyroid neoplasms
prognosis
recurrence
surgical procedure
