Clinical Analysis of Diagnosis and Treatment for 137 Patients with Differentiated Thyroid Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHUANGBu-qiang ,  RENZe-qiang , ZHANGXiu-zhong , ZHANGChong , ZHANGPeng-bo

Department of General Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China;

Corresponding?author：

RENZe-qiang, Email: RZQ0805@189.cn

Keywords：

Differentiated thyroid cancer; Diagnosis; Treatment; Clinical effect

DOI：

10.7507/1007-9424.20140044

Video：

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Objective To analyze the clinical effective of differentiated thyroid cancer and approach the correct treatment methods for it. Method The clinical and postoperative follow-up data of 137 patients with differentiated thy-roid cancer treated in this hospital from 2002 to 2012 were analyzed retrospectively. Results One hundred and thirty-seven patients accepted individualization surgery, conventionalⅥregion lymph node dissection, and postoperative com-prehensive therapy.The rate of lymph node metastasis was 53.28%(73/137).Ⅵregion lymph node was confirmed to be positive by pathology which performedⅡ+Ⅲ+Ⅳregion lymph node dissection, the rate of lymph node metastasis was 41.10%(30/73).Multivariate analysis showed that penetrate capsule, pathologic type, and TNM stage were the independent risk factors for lymph nodes metastasis (P < 0.05).No death occurred perioperative period.The temporary hoarseness was found in 4 cases (2.92%), short-term hypocalcemia in 11 cases (8.03%).During postoperative average 6.5 years of follow-up, there were 5 cases (3.65%) of local recurrence, 11 cases (8.03%) of cervical lymph node meta-stasis, 3 cases (2.19%) of distant metastasis including 1 case of bone metastasis and 2 cases of pulmonary metastasis, and 16 cases (11.68%) of reoperation. Conclusion Individualized surgical options, conventionalⅥregion lymph node dissection, and close follow-up management could reduce the postoperative complications and guarantee the treatment effect of differentiated thyroid cancer.

Citation： ZHUANGBu-qiang, RENZe-qiang, ZHANGXiu-zhong, ZHANGChong, ZHANGPeng-bo. Clinical Analysis of Diagnosis and Treatment for 137 Patients with Differentiated Thyroid Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(2): 192-196. doi: 10.7507/1007-9424.20140044 Copy

1.	Yang GC, Livolsi VA, Baloch ZW.Thyroid microcarcinoma:fine-needle aspiration diagnosis and histologic follow-up[J].Int J Surg Pathol, 2002, 10(2):133-139.
2.	Onitilo AA, Engel JM, Lundgren CI, et al.Simplifying the TNM system for clinical use in differentiated thyroid cancer[J].J Clin Oncol, 2009, 27(11):1872-1878.
3.	楊凡, 樊友本.分化性甲狀腺癌的術式選擇[J].外科理論與實踐, 2009, 14(4):453-457.
4.	Vaisman F, Shaha A, Fish S, et al.Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive Iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer[J].Clin Endocrinol (Oxf), 2011, 75(1):112-119.
5.	Vaiman M, Nagibin A, Hagag P, et al.Subtotal and near total versus total thyroidectomy for the management of multinodular goiter[J].World J Surg, 2008, 32(7):1546-1551.
6.	吳毅.《甲狀腺結節和分化型甲狀腺癌臨床診斷指南》熱點解讀[J].中華內分泌外科雜志, 2012, 6(1):1-2.
7.	Podnos YD, Smith D, Wagman LD, et al.The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J].Am Surg, 2005, 71(9):731-734.
8.	Zaydfudim V, Feurer ID, Griffin MR, et al.The impact of lymph node involvement on survival in patients with papillary and folli-cular thyroid carcinoma[J].Surgery, 2008, 144(6):1070-1078.
9.	Rotstein L.The role of lymphadenectomy in the management of papillary carcinoma of the thyroid[J].J Surg Oncol, 2009, 99(4):186-188.
10.	黃韜.分化型甲狀腺癌的規范治療[J].中國普外基礎與臨床雜志, 2012, 19(8):805-808.
11.	Roy B, Terry T, Carrie A.Cancer of the thyroid gland[A]//In Louis B, Roy B, Waun KH.Head and neck cancer:a multidisciplinary approach[M].Philadelphia:Lippincott-Raven, 1998:807-808.
12.	孫海兵, 崔利昌.甲狀腺乳頭狀癌頸淋巴結轉移途徑[J].中國腫瘤, 2003, 12(9):534-535.
13.	葛明華, 王可敬, 劉愛華, 等.甲狀腺癌頸前區淋巴結術中冷凍切片檢查的價值探討[J].實用腫瘤雜志, 2001, 16(2):137-138.
14.	朱永學, 王弘士, 吳毅, 等.甲狀腺乳頭狀癌Ⅵ區淋巴結的歸屬[J].中華外科雜志, 2004, 42(14):867-869.
15.	劉方舟, 張園, 朱巖.臨床N0期乳頭狀甲狀腺癌中心區淋巴結處理的效果分析[J].東南大學學報:醫學版, 2010, 29(1):85-87.
16.	Palestini N, Borasi A, Cestino L, et al.Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience[J].Langenbecks Arch Surg, 2008, 393(5):693-698.
17.	Moo TA, Mcgill J, Allendorf J, et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J].World J Surg, 2010, 34(6):1187-1191.
18.	Cooper DS, Doherty GM, Haugen BR, et al.Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2009, 19(11):1167-1214.
19.	NCCN Guidelines Version 2.2012 thyroid carcinoma[EB\OL].http://www.nccn.org/professionals/physician_gls/pdf/thyroid.Pdf.
20.	Pacini F, Schlumberger M, Dralle H, et al.European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium[J].Eur J Endocrinol, 2006, 154(6):787-803.
21.	Pacini F, Castagna MG, Brilli L, et al.Thyroid cancer:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J].Ann Oncol, 2010, 21 Suppl 5:v214-v219.
22.	童珍君, 李健君.291例甲狀腺癌的臨床診療分析[J].現代實用醫學, 2013, 25(1):95-97.
23.	Shaha AR, Shah JP, Loree TR.Patterns of failure in differentiated carcinoma of the thyroid based on risk groups[J].Head Neck, 1998, 20(1):26-30.
24.	李潔清, 魏濤, 朱啟波, 等.甲狀腺乳頭狀癌再次手術的原因探討[J].中國普外基礎與臨床雜志, 2012, 19(8):818-822.
25.	Bron LP, Soldati D, Zouhair A, et al.Treatment of early stage squamous-cell carcinoma of the glottic larynx:endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy[J].Head Neck, 2001, 23(10):823-829.
26.	Phan HT, Jager PL, van der Wal JE, et al.The follow-up of patients with differentiated thyroid cancer and undetectable thyrog-lobulin (Tg) and Tg antibodies during ablation[J].Eur J Endocrinol, 2008, 158(1):77-83.
27.	Harmer CL.Thyroid cancer[A]//In Oncology HA.A Multidisci-plinary Textbook[M].London:Chapman and Hall, 1995:565-584.

1. Yang GC, Livolsi VA, Baloch ZW.Thyroid microcarcinoma:fine-needle aspiration diagnosis and histologic follow-up[J].Int J Surg Pathol, 2002, 10(2):133-139.
2. Onitilo AA, Engel JM, Lundgren CI, et al.Simplifying the TNM system for clinical use in differentiated thyroid cancer[J].J Clin Oncol, 2009, 27(11):1872-1878.
3. 楊凡, 樊友本.分化性甲狀腺癌的術式選擇[J].外科理論與實踐, 2009, 14(4):453-457.
4. Vaisman F, Shaha A, Fish S, et al.Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive Iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer[J].Clin Endocrinol (Oxf), 2011, 75(1):112-119.
5. Vaiman M, Nagibin A, Hagag P, et al.Subtotal and near total versus total thyroidectomy for the management of multinodular goiter[J].World J Surg, 2008, 32(7):1546-1551.
6. 吳毅.《甲狀腺結節和分化型甲狀腺癌臨床診斷指南》熱點解讀[J].中華內分泌外科雜志, 2012, 6(1):1-2.
7. Podnos YD, Smith D, Wagman LD, et al.The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J].Am Surg, 2005, 71(9):731-734.
8. Zaydfudim V, Feurer ID, Griffin MR, et al.The impact of lymph node involvement on survival in patients with papillary and folli-cular thyroid carcinoma[J].Surgery, 2008, 144(6):1070-1078.
9. Rotstein L.The role of lymphadenectomy in the management of papillary carcinoma of the thyroid[J].J Surg Oncol, 2009, 99(4):186-188.
10. 黃韜.分化型甲狀腺癌的規范治療[J].中國普外基礎與臨床雜志, 2012, 19(8):805-808.
11. Roy B, Terry T, Carrie A.Cancer of the thyroid gland[A]//In Louis B, Roy B, Waun KH.Head and neck cancer:a multidisciplinary approach[M].Philadelphia:Lippincott-Raven, 1998:807-808.
12. 孫海兵, 崔利昌.甲狀腺乳頭狀癌頸淋巴結轉移途徑[J].中國腫瘤, 2003, 12(9):534-535.
13. 葛明華, 王可敬, 劉愛華, 等.甲狀腺癌頸前區淋巴結術中冷凍切片檢查的價值探討[J].實用腫瘤雜志, 2001, 16(2):137-138.
14. 朱永學, 王弘士, 吳毅, 等.甲狀腺乳頭狀癌Ⅵ區淋巴結的歸屬[J].中華外科雜志, 2004, 42(14):867-869.
15. 劉方舟, 張園, 朱巖.臨床N0期乳頭狀甲狀腺癌中心區淋巴結處理的效果分析[J].東南大學學報:醫學版, 2010, 29(1):85-87.
16. Palestini N, Borasi A, Cestino L, et al.Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience[J].Langenbecks Arch Surg, 2008, 393(5):693-698.
17. Moo TA, Mcgill J, Allendorf J, et al.Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J].World J Surg, 2010, 34(6):1187-1191.
18. Cooper DS, Doherty GM, Haugen BR, et al.Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2009, 19(11):1167-1214.
19. NCCN Guidelines Version 2.2012 thyroid carcinoma[EB\OL].http://www.nccn.org/professionals/physician_gls/pdf/thyroid.Pdf.
20. Pacini F, Schlumberger M, Dralle H, et al.European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium[J].Eur J Endocrinol, 2006, 154(6):787-803.
21. Pacini F, Castagna MG, Brilli L, et al.Thyroid cancer:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J].Ann Oncol, 2010, 21 Suppl 5:v214-v219.
22. 童珍君, 李健君.291例甲狀腺癌的臨床診療分析[J].現代實用醫學, 2013, 25(1):95-97.
23. Shaha AR, Shah JP, Loree TR.Patterns of failure in differentiated carcinoma of the thyroid based on risk groups[J].Head Neck, 1998, 20(1):26-30.
24. 李潔清, 魏濤, 朱啟波, 等.甲狀腺乳頭狀癌再次手術的原因探討[J].中國普外基礎與臨床雜志, 2012, 19(8):818-822.
25. Bron LP, Soldati D, Zouhair A, et al.Treatment of early stage squamous-cell carcinoma of the glottic larynx:endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy[J].Head Neck, 2001, 23(10):823-829.
26. Phan HT, Jager PL, van der Wal JE, et al.The follow-up of patients with differentiated thyroid cancer and undetectable thyrog-lobulin (Tg) and Tg antibodies during ablation[J].Eur J Endocrinol, 2008, 158(1):77-83.
27. Harmer CL.Thyroid cancer[A]//In Oncology HA.A Multidisci-plinary Textbook[M].London:Chapman and Hall, 1995:565-584.

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Clinical Analysis of Diagnosis and Treatment for 137 Patients with Differentiated Thyroid Cancer

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