■目的研究甲状腺髓样和乳头状癌的临床病理特征。
■我院甲状腺髓样癌(MTC)患者的临床资料(甲状腺外科,中日联合医院,吉林大学)于2009年2月至2023年2月使用分析审查方法进行了评估。根据临床资料是否与MTC相关,将其分为观察组(甲状腺乳头状癌同步MTC)和对照组(单纯MTC)。为了比较临床特征,病理类型,观察两组的阶段性特征和分子生物学特征,并调查两组的随访情况。
■该研究包括122MTC,30与同步MTC/PTC和92简单MTC。当数据比较时,性别比例,术前降钙素水平,术前CEA水平,MTC病变中存在钙化,手术方法,MTC病变的数量,观察组的结节性甲状腺肿和甲状腺炎的发生率高于对照组。当MTC病变直径≤1cm时,术前CEA值组间差异有统计学意义(P<0.05);当MTC病变直径>1cm时,两组术前Ctn值比较差异有统计学意义(P<0.05)。III型与单纯组明显不同,而IV型更类似于简单组。两组患者术前血清Ctn值与肿瘤最大直径呈正相关,尽管在容易组中相关性更强。术前CEA与肿瘤最大直径呈正相关。在组合组中具有更强的相关性。术前Ctn、CEA与单纯组淋巴结转移呈正相关,而联合组与淋巴结转移无明显相关性。单纯组术前血清Ctn对颈淋巴结转移的切断值为39.2pg/ml,对颈外侧淋巴结转移的切断值为195.5pg/ml。联合组术前血清Ctn对颈淋巴结转移的切断值为60.79pg/ml,对颈外侧淋巴结转移的切断值为152.6pg/ml。在简单的群体中,进展组的预后明显较差(P<0.001),缓解组和稳定组之间无统计学差异。在组合组中,进展和稳定组的预后明显差于缓解组(P<0.001),进展组和稳定组之间无统计学差异。
■在甲状腺髓样癌和乳头状癌的患者中,术前Ctn和CEA水平,钙化,孤立性病变,合并甲状腺肿或甲状腺炎与单纯MTC有显著差异.因此,临床管理应重视上述因素,并进行早期风险筛查,以尽可能改善预后。
To
study the clinicopathological characteristics of patients with synchronous medullary and papillary thyroid carcinomas.
The clinical data of patients with medullary thyroid carcinoma (MTC) operated in our hospital (Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University) from February 2009 to February 2023 were evaluated using an analytical review approach. They were divided into an observation group (patients with synchronous MTC and papillary thyroid carcinoma PTC) and a control group (simple MTC) according to whether the clinical data were associated with MTC, in order to compare the clinical features, pathological types, stage characteristics and molecular biology characteristics of the two groups and to investigate the follow-up of the two groups.
The
study included 122 MTC, 30 with synchronous MTC/PTC and 92 simple MTC. When the data were compared, the sex ratio, preoperative calcitonin level, preoperative CEA level, presence of calcifications in the MTC lesions, surgical methods, number of MTC lesions, presence of nodular goitre and presence of thyroiditis were higher in the observation group than in the control group. There was a significant difference between the groups when the MTC lesion diameter was ≤1cm in terms of preoperative CEA value (P<0.05); when the MTC lesion diameter was >1cm, there was a statistical difference between the two groups in terms of preoperative Ctn value (P<0.05). Type III was significantly different from the simple group, while type IV was more similar to the simple group. The preoperative serum Ctn value was positively correlated with maximum tumour diameter in both groups, although the correlation was stronger in the easy group. Preoperative CEA was positively correlated with maximum tumour diameter in both groups, with a stronger correlation in the combination group. Preoperative Ctn and CEA were positively correlated with lymph node metastasis in the simple group, whereas there was no apparent correlation with lymph node metastasis in the combination group. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the simple group was 39.2pg/ml and for lateral cervical lymph node metastases 195.5pg/ml. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the combination group was 60.79pg/ml and for lateral cervical lymph node metastases 152.6pg/ml. In the simple group, prognosis was significantly worse in the progression group (P<0.001), with no statistical difference between the remission and stable groups. In the combination group, the prognosis of the progression and stable groups was significantly worse than that of the remission group (P<0.001), with no statistical difference between the progression and stable groups.
In patients with synchronous medullary and papillary thyroid carcinomas, preoperative Ctn and CEA levels, calcifications, solitary lesions, combined goitre or thyroiditis differ significantly from simple MTC. Therefore, clinical management should pay attention to the above factors and early risk screening should be performed to improve prognosis as much as possible.