摘要
目的:研究甲状腺乳头状微小癌的临床生物学特性,探讨更加合理的微小癌外科处理原则。方法:选取天津医科大学附属肿瘤医院自2003年1月至2006年12月间收治的具有完整病历记录的甲状腺乳头状癌383例,按国际最新甲状腺肿瘤的组织学分类标准分型,统计分析其中微小癌的发生率、性别比例、好发年龄、颈淋巴结转移程度、区域淋巴结转移规律等临床生物学特性。结果:所有病例中甲状腺乳头状微小癌110例,发生率为28.7%。微小癌可同时合并其他组织学变型,其中硬化型最常见,发生率为20.9%;侵袭转移能力较高的高细胞型占3.6%。微小癌在性别及年龄分布上与总体甲状腺乳头状癌相比无明显差异(P>0.05)。383例甲状腺乳头状癌颈淋巴结转移率为74.7%,而微小癌颈淋巴结转移率为20.0%,低于总体淋巴结转移率(P<0.05)。在所有转移性甲状腺乳头状微小癌中,90.9%的病例出现Ⅵ区淋巴结转移,仅2例为跨越Ⅵ区直接转移至其它区域。此外所有病例中远处转移(肺)1例,微小癌未见远处转移。结论:甲状腺乳头状微小癌较乳头状癌总体淋巴结转移率低,但亦可合并有高侵袭性组织学变型,可在早期发生颈淋巴结转移,因此不可全部按照Ⅰ期甲状腺癌处理。90.9%微小癌的淋巴结转移是以Ⅵ区为第一站。此区淋巴结阳性,具有指导术式选择的作用。
Objective： To investigate the clinical and biological features of papillary thyroid microcarcinoma. Methods： Data from 383 patients with papillary thyroid carcinoma seen in our hospital between January 2003 and December 2006 were retrospectively reviewed. WHO guidelines for papillary thyroid microcarcinoma were employed. Results： Of these 383 patients, 110 （28.7%） cases were identified as microcarcinoma. Other histological variants were also observed in those cases classified as microcarcinoma. The rates of diffuse sclerosing variant and tall cell variant were 20.9% and 3.6%, respectively. No significant difference was found in age or gender between microcarinoma and conventional papillary thyroid carcinoma （P〉0.05）. The rate of cervical lymph node metastasis in patients with microcarcinoma was 20.0%, lower than that in patients with conven- tional papillary thyroid carcinoma （P〈0.05）. The rate of metastasis to section VI was 90.9%. No distant metastasis was found in patients with microcarcinoma. Conclusion： Although the rate of cervical lymph node metastasis from papillary thyroid microcarcinoma is low, careful monitoring should be upheld because aggressive variants exist. All cases of microcarcinoma cannot be considered and treated as stage Ⅰ carcinoma. Individualization is critical in the treatment of papillary thyroid microcarcinoma.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2008年第23期1325-1327,共3页
Chinese Journal of Clinical Oncology
关键词
甲状腺乳头状微小癌
组织学变型
生物学特性
Papillary thyroid microcarcinoma
Histological variant
Biological characteristics
