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題 名 | The Surgical Treatment and Prognostic Factors of Well-Differentiated Thyroid Cancers in Chinese Patients: A 20-Year Experience=中國人分化良好之甲狀腺癌的手術治療與預後因子:二十年處理經驗 |
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作 者 | 曾令民; 李建賢; 王惠暢; 石宜銘; 邱仁輝; 吳秋文; 雷永耀; 彭芳谷; | 書刊名 | 中華醫學雜誌 |
卷 期 | 58:2 1996.08[民85.08] |
頁 次 | 頁121-139 |
分類號 | 415.931 |
關鍵詞 | 預後; 甲狀腺切除; 甲狀腺癌; 腫瘤行為; Prognosis; Thyroidectomy; Thyroid cancer; Tumor behavior; |
語 文 | 英文(English) |
中文摘要 | 背景 分化良好之甲狀腺癌是一臨床病程及生長速度緩慢的腫瘤。因 此,唯有對大的病人群給予長時間的追縱才能對不同的治療方式提出正確的評 估。治療方法現仍有許多爭議,有系統的分析分化良好之甲狀腺癌的病史、治 療與預後,在台灣並無報告。 方法 回溯性分析台北榮民總醫院1971-1991年488位分化良好之甲狀腺癌(339 位女性,149位男性。男女比例為一比二點二八)的臨床及病理資料,追蹤日期 至1994年12月(平均追蹤年限8.5年)。影響存活率及復發率的因子以及治療情 形皆作分析。 結果 1971-1991年本院分化良好甲狀腺癌中之乳突狀甲狀腺癌所佔比例明顯 較1959-1976年為高。在1959-1976及1971-1991兩個時期,腫瘤行為改變;包 含女性病人增加,乳突狀甲狀腺癌所佔比例增加,降低原發腫瘤大小及診斷時 已合併遠處轉移比例。單一變數分析顯示年齡、性別、遠處轉移、甲狀腺包膜 外侵犯、腫瘤大小、頸部淋巴腺轉移、組織類別、手術方式及術後放射線碘使 用對存活率皆達到統計上的差異。病人診斷時男性大於四十歲女性大於五十歲 且腫瘤合併甲狀腺包膜外侵犯或原發腫瘤大於四公分以及所有合併遠處轉移的 病人皆列入高危險群,其餘則歸列於低危險群。依照各個手術者判定,實行全 甲狀腺或次全甲狀腺切除術,統計結果顯示,比一葉切除術或合併峽葉切除有 較高的併發症,但在復發率及存活率上並無較好的成績。高危險群病人接受全 甲狀腺或次全甲狀腺切除術後給予放射性碘131治療及甲狀腺激素抑制治療, 能提高存活率。低危險群病人,一葉甲狀腺切除或加上峽部切除術及術後甲狀 腺素抑制治療有最好存活率及最低併發症。臨床上懷疑淋巴結轉移,淋巴結廓 清術可提高存活率。 結論 本院分化良好甲狀腺癌病人自1971年以後腫瘤行為有變好趨勢。全甲 狀腺切除或次全甲狀腺切除只有對高危險群病人才能得到好處,對低危險群病 人則否。臨床上理學檢查發現大的淋巴結,淋巴結廓清術能提高存活率。 |
英文摘要 | Background. Well-differentiated thyroid cancers (WDTC) are usually slow-growing neoplasm with an indolent clinical course. Assessment of treatment modalities for them requires a long-term follow-up in a large population, and is still of much debate. A systematic analysis of the history, prognosis and therapy for this disease in Taiwan is lacking. Methods. A retrospective analysis of clinical and pathological records was conducted on 488 patients (149 male and 339 female, male : females = 1 : 2.28) treated for WDTC in the Veterans General HospitalTaipei from 1971 to 1991 with subsequently follow-up until December 1994 (Mean follow-up: 8.5 years). Factors influencing recurrence, survival and different treatment were analyzed. Results. Papillary thyroid cancer increased obviously as compared to our experience from 1959-1976. Changing tumor behaviors, including increasing female/male ratio, higher percentage of papillary cancer, decreasing primary tumor size and lower distant metastatic rate at the time of initial diagnosis, were noted. Factors influencing survival, as determined by univariate analysis, included age, gender, distant metastasis, extrathyroidal invasion, tumor size, nodal involvement, histological type, extent of surgical therapy and use of postoperative radioactive iodine. Those patients aged more than 45 at initial diagnosis, with primary tumors larger than 4 cm, with extrathyroidal invasion, and with distant metastasis at initial diagnosis were classified as being at high risk. The others were at low risk. Total or near total thyroidectomy (TTx), depending on the judgement of each surgeon, had much higher complication rate than lobectomy with/ without isthmusectomy, but offered no benefit effect on disease-free survival or overall survival rates. Postoperative radioactive iodine ablation treatment and thyroxine replacement in suppressive dose after TTx improved survival among high risk patients. Lobectomy with/without isthmusectomy in low risk patients, followed by thyroxine suppression therapy, was adequate to improve the postoperative outcome and with low complication rate. Lymph node resection in patients with clinically palpable nodes improved long-term prognosis. Conclusions. Changing tumor behavior of WDTC leading to favorable prognosis has been noticed since 1971. Total or near total thyroidectomy is worthwhile in high risk patients with WDTC but does not appear necessary in low-risk patients. Lymph node dissection for metastatic lymph node could improve the survival rate. |
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