目的:尽管甲状腺微小癌(TMC)通常预后良好,一些患者出现疾病复发或持续的风险较高.因此,我们旨在确定与TMC治疗反应不完全相关的可能危险因素.
方法:这是一项对517例TMC患者行全甲状腺切除术的回顾性研究,有或没有放射性碘(RAI)治疗,在1.1±0.4年后,根据对治疗的反应重新分类为“有利”(优异/不确定)或“不利”(生化/结构不完全)。我们评估了参与者的年龄,性别,肿瘤大小,组织学变异,多焦点,血管/淋巴/神经周浸润的存在,甲状腺外延伸,转移性淋巴结(LN),和远处转移。在给定亚组中分析RAI治疗对反应范围的影响。
结果:观察到的平均年龄为46.4±12.0岁,女性占89.7%。我们注意到97.5%患有乳头状癌,多病灶为27.8%,LN转移为11.2%。尽管大多数患者的复发/持续风险较低(78%),75%接受RAI治疗。不完全反应(20.7%)与多灶性(p=0.041;OR=1.619)和转移性LN(p=0.041;OR=1.868)相关。这些变量密切相关(p=0.000;OR=3.283)。通过接受者工作曲线分析,没有将肿瘤大小的截止值确定为不完全反应的预测因子。RAI治疗不影响多灶性或LN转移患者的反应。
结论:多灶性和LN转移是TMC患者反应不完全的独立危险因素,并且具有很强的相关性。在这些亚组中,额外的RAI治疗与更有利的反应无关。
OBJECTIVE: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC.
METHODS: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into \"favourable\" (excellent/indeterminate) or \"unfavorable\" (biochemical/structural incomplete) responses. We evaluated participants\' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup.
RESULTS: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis.
CONCLUSIONS: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.