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浙江大学学报（医学版）
浙江大学学报（医学版）  2021, Vol. 50 Issue (6): 707-715    DOI: 10.3724/zdxbyxb-2021-0222
专题报道     
持续/复发性分化型甲状腺癌综合治疗相关预后因素分析
王健行,姚瑶,钱亦淳,姚卫萍,程帅,袁欣越,张园()
南京医科大学附属肿瘤医院 江苏省肿瘤医院 江苏省肿瘤防治研究所头颈外科，江苏 南京 210009
Prognostic factors in patients with persistent/recurrent differentiated thyroid carcinoma after comprehensive treatment
WANG Jianxing,YAO Yao,QIAN Yichun,YAO Weiping,CHENG Shuai,YUAN Xinyue,ZHANG Yuan()
Department of Head and Neck Surgery, the Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing 210009, China
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摘要：

目的：分析持续/复发性分化型甲状腺癌（DTC）尤其是外侵型持续/复发性DTC患者综合治疗后的相关预后因素。方法：回顾性分析2011年8月至2021年6月于江苏省肿瘤医院头颈外科进行再次手术的525例DTC患者的临床资料，分析影响持续/复发性DTC尤其是外侵型持续/复发性DTC综合治疗后总生存时间和无复发生存时间的相关预后因素。结果： 525例患者中，行甲状腺区手术318例，行颈部中央淋巴结清扫359例，行颈外侧淋巴结清扫409例。493例随访患者的5年总存活率和无复发存活率分别为95.10%和89.60%，8年总存活率和无复发存活率分别为91.80%和81.30%。回归分析结果显示，复发后再次手术时55岁及以上、男性和远处转移是影响持续/复发性DTC患者综合治疗后总生存时间的独立危险因素（均P<0.05），甲状腺和淋巴结同时外侵、多器官外侵和既往手术次数2次及以上是影响持续/复发性DTC患者综合治疗后无复发生存时间的独立危险因素（均P<0.05）；复发后再次手术时55岁及以上和男性是影响外侵型持续/复发性DTC患者总生存时间的独立危险因素（均P<0.05），多器官外侵和既往手术次数2次及以上是影响外侵型持续/复发性DTC患者无复发生存时间的独立危险因素（均P<0.05）。结论：复发后再次手术时55岁及以上、男性和远处转移的持续/复发性DTC患者死亡风险较高，甲状腺和淋巴结同时外侵、多器官外侵以及既往手术次数2次及以上的患者更易复发。复发后再次手术时55岁及以上和男性外侵型持续/复发性DTC患者死亡风险较高，多器官外侵和既往手术次数2次及以上的外侵型持续/复发性DTC患者更易复发。
关键词： 分化型甲状腺癌;  持续/复发;  局部晚期;  多学科综合治疗;  预后;  回顾性研究    
Abstract:

Objective: To investigate the prognostic factors of patients with persistent/recurrent differentiated thyroid carcinoma (DTC) especially with external invasive persistent recurrent DTC after comprehensive treatment. Methods: The clinical data of 525 patients with persistent/recurrent DTC who underwent surgical treatment from August 2011 to June 2021 in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital were retrospectively analyzed. The prognostic factors affecting overall survival (OS) and relapse-free survival (RFS) of persistent/recurrent DTC, especially external invasive persistent/recurrent DTC were analyzed. Results: Among 525 patients, 318 patients underwent thyroidectomy, 359 patients underwent central lymph node dissection, and 409 patients underwent lateral cervical lymph node dissection. Among 493 followed-up patients, 5-year OS and RFS were 95.10% and 89.60%, 8-year OS and RFS were 91.80% and 81.30%. Cox regression analysis showed that in patients with persistent/recurrent DTC after comprehensive treatment, age ≥55?years at reoperation after recurrence, male gender and distant metastasis were independent risk factors of OS (all P<0.05); while the simultaneous invasion of thyroid and lymph nodes, multiple organ invasion and the number of previous operations ≥2 were independent risk factors of RFS (allP<0.05). In patients with external invasive persistent/recurrent DTC after comprehensive treatment, age ≥55?years at reoperation after recurrence and male gender were independent risk factors of OS (bothP<0.05); while multiple organ invasion and the number of previous operations ≥2 were independent risk factors of RFS (bothP<0.05).Conclusions: Male patients aged 55?years old and above, with distant metastasis have a higher risk of poorer prognosis in persistent/recurrent DTC; while patients with simultaneous external invasion of thyroid and lymph nodes, multiple organ invasion and the number of previous operations ≥2 are more likely to relapse. For external invasive persistent/recurrent DTC, male patients aged 55?years old and above have a higher risk of poorer prognosis; while patients with multiple organ invasion and the number of previous operations ≥2 are more likely to have recurrence.
Key words: Differentiated thyroid carcinoma    Persistent/recurrent    Locally advanced    Multidisciplinary comprehensive treatment    Prognosis    Retrospective studies
收稿日期: 2021-08-06 出版日期: 2022-03-22
CLC:  R736.1  
基金资助: 江苏省社会发展重点研发计划（BE2016796）
通讯作者: 张园     E-mail: yzhang1963@163.com
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王健行
姚瑶
钱亦淳
姚卫萍
程帅
袁欣越
张园

引用本文:

王健行,姚瑶,钱亦淳,姚卫萍,程帅,袁欣越,张园. 持续/复发性分化型甲状腺癌综合治疗相关预后因素分析[J]. 浙江大学学报（医学版）, 2021, 50(6): 707-715.

WANG Jianxing,YAO Yao,QIAN Yichun,YAO Weiping,CHENG Shuai,YUAN Xinyue,ZHANG Yuan. Prognostic factors in patients with persistent/recurrent differentiated thyroid carcinoma after comprehensive treatment. J Zhejiang Univ (Med Sci), 2021, 50(6): 707-715.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0222    或    https://www.zjujournals.com/med/CN/Y2021/V50/I6/707

图 1  持续/复发性分化型甲状腺癌（DTC）患者的治疗流程
图 2  持续/复发性分化型甲状腺癌患者综合治疗后的生存曲线

临床特征

单因素分析

多因素分析

HR

95%CI

P值

HR

95%CI

P值

复发后再次手术时55岁及以上

14.152

4.120~48.612

<0.01

13.595

3.816~48.432

<0.01

男性

5.687

2.047~15.798

<0.01

4.187

1.423~12.322

<0.01

不同组织外侵无

1.000

—

—

—

—

—

甲状腺外侵

1.931

0.581 ~ 6.419

>0.05

—

—

—

淋巴结外侵

1.417

0.414 ~ 4.848

>0.05

—

—

—

同时外侵

—

—

>0.05

—

—

—

器官外侵程度无

1.000

—

—

—

—

—

单器官外侵

2.024

0.643 ~ 6.368

>0.05

—

—

—

多器官外侵

1.007

0.252 ~ 4.032

>0.05

—

—

—

远处转移

6.154

2.500~15.151

<0.01

3.526

1.265~9.833

<0.05

再次术后碘治疗

2.765

1.123~6.810

<0.05

—

—

—

既往手术次数2次及以上

0.330

0.044~2.473

>0.05

—

—

—
表 1  持续/复发性分化型甲状腺癌患者综合治疗后总生存时间影响因素的回归分析结果

临床特征

单因素分析

多因素分析

HR

95%CI

P值

HR

95%CI

P值

复发后再次手术时55岁及以上

1.004

0.516~1.951

>0.05

—

—

—

男性

1.431

0.784~2.610

>0.05

—

—

—

不同组织外侵无

1.000

—

—

1.000

—

—

甲状腺外侵

1.755

0.767~4.012

>0.05

3.288

1.424~7.588

>0.05

淋巴结外侵

1.459

0.638~3.336

>0.05

3.350

1.397~8.037

>0.05

同时外侵

13.638

5.056~36.784

<0.01

12.270

4.406~34.174

<0.01

器官外侵程度无

1.000

—

—

1.000

—

—

单器官外侵

0.340

0.105~1.103

>0.05

1.304

0.301~5.646

>0.05

多器官外侵

4.346

2.079~9.089

<0.01

11.924

4.285~33.185

<0.01

远处转移

2.783

1.432~5.411

<0.01

1.039

0.431~2.504

>0.05

再次术后碘治疗

1.661

0.890~3.101

>0.05

—

—

—

既往手术次数2次及以上

13.853

7.401~25.927

<0.01

11.716

6.012~22.830

<0.01
表 2  持续/复发性分化型甲状腺癌患者综合治疗后无复发生存时间影响因素的回归分析结果
图 3  外侵型持续/复发性分化型甲状腺癌患者综合治疗后的生存曲线

临床特征

单因素分析

多因素分析

HR

95%CI

P值

HR

95%CI

P值

复发后再次手术时55岁及以上

36.209

4.761~275.402

<0.01

31.288

4.029~242.990

<0.01

男性

6.754

1.906~23.935

<0.01

4.592

1.239~17.021

<0.05

不同组织外侵 甲状腺外侵

1.000

—

—

—

—

—

淋巴结外侵

0.733

0.266~2.023

>0.05

—

—

—

同时外侵

—

—

>0.05

—

—

—

器官外侵程度单器官外侵

1.000

—

—

—

—

—

多器官外侵

0.571

0.165~1.624

>0.05

—

—

—

远处转移

6.377

2.312~17.587

<0.01

2.946

0.934~9.287

>0.05

再次术后碘治疗

3.045

1.104~8.397

<0.05

1.655

0.549~4.988

>0.05

既往手术次数2次及以上

0.387

0.051~2.946

>0.05

—

—

—
表 3  外侵型持续/复发性分化型甲状腺癌患者综合治疗后总生存时间影响因素的回归分析结果

临床特征

单因素分析

多因素分析

HR

95%CI

P值

HR

95%CI

P值

复发后再次手术时55岁及以上

1.076

0.515~2.244

>0.05

—

—

—

男性

1.290

0.660~2.519

>0.05

—

—

—

不同组织外侵甲状腺外侵

1.000

—

—

1.000

—

—

淋巴结外侵

0.822

0.402~1.682

>0.05

0.966

0.456~2.047

>0.05

同时外侵

7.844

3.186~19.315

<0.01

2.458

0.830~7.277

>0.05

器官外侵程度单器官外侵

1.000

—

—

1.000

—

—

多器官外侵

12.031

4.246~34.088

<0.01

8.934

3.072~26.865

<0.01

远处转移

2.981

1.456~6.103

<0.01

1.161

0.435~3.096

>0.05

再次术后碘治疗

1.737

0.874~3.454

>0.05

—

—

—

既往手术次数2次及以上

17.982

8.588~37.652

<0.01

16.156

7.035~37.107

<0.01
表 4  外侵型持续/复发性分化型甲状腺癌患者综合治疗后无复发生存时间的回归分析结果
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