甲状腺髓样癌预后影响因素分析

目的 探讨影响甲状腺髓样癌预后的因素.方法 本研究采用统计学多因素分析方法,回顾性分析1980年1月至2000年12月中山大学肿瘤防治中心同期收治的102例甲状腺髓样癌预后影响因素.结果 根据Kaplan-Meier法统计生存率,102例患者5年、10年、15年累积生存率分别为87.4%、74.6%和54.2%.单因素分析示:性别、年龄、原发灶累及双侧、原发灶最大直径＞4 cm、甲状腺包膜外侵犯、远处转移、手术彻底程度(以距肿瘤2 em肉眼切除干净为手术彻底的标准)均影响预后.多因素分析发现,影响甲状腺髓样癌生存率的独立因素有原发灶最大直径＞4 cm(X2=7.43,P=0.0035),远处转移(X2=23.50,P=0.0000)和手术彻底程度(X2=25.90,P=0.0000).结论 当原发灶过大、行姑息性手术及出现远处转移时,甲状腺髓样癌患者的生存率显著下降;选择合理的外科手术治疗可取得较满意的疗效,减少并发症.早期诊断和早期治疗能显著改善甲状腺髓样癌患者的预后.

Prognostic factors of medullary thyroid carcinoma

Objective To investigate prognostic factors of medullary thyroid carcinoma.Methods By using univariate analysis and multivariate analysis,the prognostic factors were investigated in 102 patients with medullary thyroid carcinoma treated at this hospital.Results Overall survival rates of 5-year,10-year and 15-year were 87.4%,74.6%and 54.2%respectively by Kaplan-Meier method analysis.In univariate analysis,gender,age,bilateral thyroid lobe tumors,tumor size＞4 cm,invasion of thyroid capsule,distant metastasis,and non-radical tumor resection were significant poor prognostic factors.In multivariate analysis,tumor size＞4 cm(X2=7.43,P=0.0035),distant metastasis(X2=23.50,P=0.0000),and non-radical tumor resection(X2=25.90,P=0.0000)remained as independent pmgnostic factors.Conclusions Tumor size＞4 cm,distant metastasis,and non-radical tumor resection are the independent predictors of patients survival.Early diagnosis and early therapy can improve significantly the prognosis of medullary thyroid carcinoma.