摘要
背景与目的:非手术主动监测是甲状腺微小乳头状癌(PTMC)患者治疗的可选方案之一。但是延迟手术的长期临床结局目前仍然不清楚。因此,本研究通过比较确诊至手术时间的不同间隔PTMC患者的临床结局,探讨确诊至手术时间的间隔对PTMC患者长期临床结局的影响。方法:回顾性分析2015年1月-12月接受延迟甲状腺手术的PTMC患者资料,根据确诊至手术时间间隔,将PTMC患者分为短间隔组(<6个月)、中间隔组(6~12个月)和长间隔组(>12个月)。根据年龄、性别、手术范围、超声检查(US)测量的初始肿瘤直径、甲状腺外侵袭、多灶性肿瘤和颈部中央淋巴结转移等临床参数对患者进行匹配。比较各组患者动态风险分层(DRS)和患者结构性复发/疾病持续情况。结果:按纳入与排除标准共选择426例患者,其中女331例,男95例;平均年龄为(48.9±10.1)岁;首次诊断时颈部超声测量的平均肿瘤直径为(0.65±0.12)cm;214例患者接受甲状腺侧叶切除术,其他患者接受甲状腺全切除术。其中短间隔组290例、中间隔组106例、长间隔组30例,各组间临床病理参数存在差异,长间隔组的年龄大、男性与接收侧叶切除的比例较高、肿瘤直径较小、甲状腺外侵袭率较低(均P<0.05)。以3:3:1的比例将3组临床病理参数匹配后,147例患者纳入分析,其中短间隔组与中间隔组各63例,长间隔组21例。匹配后女性120例,男性27例;平均年龄为(50.0±8.2)岁;超声初始测量的平均肿瘤直径为(0.63±0.14)cm;98例患者接受甲状腺侧叶切除术;各组间临床病理参数无统计学差异(均P>0.05);各组间DRS分类无统计学差异(P=0.07);在平均随访(2.8±0.6)年期间,各组间的结构性复发/疾病持续(P=0.34)和无病生存率(P=0.25)无统计学差异。PTMC患者结构性复发/疾病持续的危险因素分析结果显示,男性(HR=2.43,95%CI=1.21~4.91,P=0.013)和多灶性肿瘤(HR=2.45,95%CI=1.24~4.83,P=0.010)是独立的危险因素,甲状腺手术延迟期与患者结构性复发/疾病持续发生风险无关。结论:延期手术与PTMC患者结构性复发/疾病持续发生风险无关,PTMC患者在密切监测下可以安全地延期手术治疗。
Background and Aims:Non-surgical active surveillance is an option for patients with papillary thyroid microcarcinoma(PTMC).However,the long-term clinical outcomes after delayed surgery remain unclear.Therefore,this study was conducted to investigate the influence of the time interval from diagnosis to surgery on the long-term clinical outcomes of PTMC patients by comparing the clinical outcomes of PTMC patients with different intervals from initial diagnosis to surgery.Methods:The clinical data of PTMC patients undergoing delayed thyroid surgery from January to December 2015 were retrospectively analyzed.According to the interval from diagnosis to surgery,the patients were classified into short-interval group(<6 months),mid-interval group(6-12 months)and long-interval group(>12 months).Then,the patients were matched according to clinical variables such as age,sex,surgical scope,initial tumor diameter measured by ultrasound(US),extrathyroidal invasion,multifocal tumors,and central cervical lymph node metastasis.The dynamic risk stratifications(DRS)and patient structural relapse/disease persistence among the groups of patients were compared.Results:A total of 426 patients were enrolled according to the inclusion and exclusion criteria.Of the patients,331 cases were females and 95 cases were males;the average age was(48.9±10.1)years;the average tumor size of the initial US determination was(0.65±0.12)cm;214 cases received thyroid lobectomy and the remaining cases were subjected to total thyroidectomy.There were 290 cases in short-interval group,106 cases in mid-interval group and 30 cases in long-interval group,and the clinicopathologic features showed significant differences among the three groups,in which,the age was old,the proportions of male sex and cases receiving lateral lobectomy were high,tumor size was small and the incidence of extrathyroidal invasion was high in long-interval group(all P<0.05).Then,147 patients were included for analysis after the clinicopathologic variables of the three groups of patients were matched with a in a 3:3:1 ratio,where there were 63 cases each in short-interval group and mid-interval group,and 21 cases in long-interval group.Of the patients after matching,120 cases were females and 27 cases were males;the average age was(50.0±8.2)years;the average tumor size at the initial US was(0.63±0.14)cm;no significant differences were noted in clinicopathologic variables among groups(all P>0.05);the DRS classification showed no significant difference among the three groups(P=0.07).During the average(2.8±0.6)years of follow-up,there were no significant differences in the development of structural recurrent/persistent disease(P=0.34)and disease-free survival rates(P=0.25)among the three groups.The results of analysis of risk factors for structural recurrent/persistent disease in the PTMC patients showed that male sex(HR=2.43.95%CI=1.21–4.91,P=0.013)and multifocal tumors(HR=2.45,95%CI=1.24–4.83,P=0.010)are risk factors,and the period of delay of thyroid surgery is irrelevant to structural recurrent/persistent disease in the PTMC patients.Conclusion:In PTMC patients,delayed surgery is not associated with increased risk of structural recurrent/persistent disease.The surgical treatment can be safely delayed in PTMC patients with under active surveillance.
作者
李莉
刘晖
LI Li;LIU Hui(Department of General Surgery,Tianjin Haihe Hospital,Tianjin 300350,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第5期574-580,共7页
China Journal of General Surgery
关键词
甲状腺肿瘤
甲状腺癌
乳头状
延迟手术
病人结局评价
Thyroid Neoplasms
Thyroid Cancer,Papillary
Delayed Surgery
Patient Outcome Assessment
