다발성 유두상 갑상선암의 임상병리학적 특성 분석
Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. Methods: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. Results: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15∼77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P＜0.001), ETE (P＜0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. Conclusion: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with post operative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC. (Korean J Endocrine Surg 2010;10:24-28)
Abstract
Purpose: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. Methods: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. Results: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15∼77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P＜0.001), ETE (P＜0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. Conclusion: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with post operative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC. (Korean J Endocrine Surg 2010;10:24-28)
참고문헌 (26)
- Sosa J, "Total thyroidectomy for differentiated thyroid cancer", J Surg Oncol, 94, pp.701~707 (2006)
- Grebe SK, "Follicular cell-derived thyroid Carcinomas", Cancer Treat Res, 89, pp.91~140 (1997)
- Gulcelik MA, "Prognostic factors determining survival in differentiated thyroid cancer", J Surg Oncol, 96, pp.598~604 (2007)
- Katoh R, "Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients", Cancer, 70, pp.1585~1590 (1992)
- Schlumberger MJ, "Papillary and follicular thyroid carcinoma", N Engl J Med, 338, pp.297~306 (1998)
- Pellegriti G, "Clinical behavior and outcome of papillany thyroid cancers smaller than 1.5 cm in diameter: Study of 299 cancer", J Clin Endocrinol Metab, 89, pp.3713~3720 (2004)
- Lin JD, "High recurrent rate of multicentric papillary thyroid carcinoma", Ann Surg Oncol, 16, pp.2609~2616 (2009)
- Mazzaferri EL, "Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer", Am J Med, 97, pp.418~428 (1994)
- Loh KC, "Pathological tumor node metastasis (pTNM) staging of papillary and follicular thyroid carcinomas: Retrospective analysis of 700 patients", J Clin Endocrinol Metab, 82, pp.3553~3562 (1997)
- Chow M, "Papillry microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality", Cancer, 98, pp.31~40 (2003)
- Park SY, "Analysis of differential BRAF V600E mutational status in multifocal papillary thyroid carcinoma", Cancer, 107, pp.1831~1838 (2006)
- Giannini R, "The heterogeneous distribution of BRAF mutation supports the independent clonal origin of distinct tumor foci in multifocal papillary thyroid carcinoma", J Clin Endocrinol Metab, 92, pp.3511~3516 (2007)
- Shattuck TM, "Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma", N Engl J Med, 352, pp.2406~2412 (2005)
- Sugg SL, "Distinct multiple RET", PTC gene rearrangement in multifocal papillary thyroid neoplasia, 1998, pp.83, 4116~4122
- McCarthy RP, "Molecular evidence for the same clonal origin of multifocal papillary thyroid carcinomas", Clin Cancer Res, 12, pp.2412~2418 (2006)
- Hay ID, "Papillary thyroid microcarcinoma: A study of 535 canes observed in a 50-year period", Surgery, 112, pp.1139~1146 (1992)
- Pasieka JL, "The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy", World J Surg, 16, pp.711~716 (1992)
- DeGroot LJ, "Second operations for ‘completion' of thyroidectomy in treatment of differentiated thyroid cancer", Surgery, 10, pp.936~940 (1991)
- Pacini F, "Contralateral papillary thyroid cancer is freguent at completion thyroidectomy with no difference in low- and high-risk patiens", Thyroid, 11, pp.877~881 (2001)
- Hundahl SA, "A national cancer data base report on 53.856 cases thyroid carcinoma treated in the LIS,1985-1995", Cancer, 83, pp.2638~2648 (1998)
- Kasai N, "New subgrouping of small thyroid carcinomas", Cancer, 60, pp.1767~1770 (1987)
- 박해린, "잠재성 유두상 갑상선암에서 원발종양의 크기에 따른 공격성 정도 분석", 대한외과학회지, 73(6), pp.470~475 (2007), 대한외과학회
- Appetecchia M, "Outcome after treatment of papillary thyroid microcarcinoma", J Exp Clin Cancer Res, 21, pp.159~164 (2002)
- Cooper DS, "Management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 16, pp.109~142 (2006)
- Bierley JD, "A comparison of different staging system predictability of patient outcome: Thyroid carcinoma as an examle", Cancer, 79, pp.2414~2423 (1997)
- Passler C, "Application of staging system for differentiated thyroid carcinoma in an endemic goiter region with iodine substitution", Ann Surg, 237, pp.227~34 (2003)