수술 후 재발한 유두상 갑상선 암의 경부 재발 위험인자에 대한 연구
A Study on the Risk Factors for Recurrence of Recurrent Papillary Thyroid Cancer after Surgery
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence. Methods: We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed. Results: Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis. Conclusion: The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence. (Korean J Endocrine Surg 2010;10:261-265)
Abstract
Purpose: Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence. Methods: We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed. Results: Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis. Conclusion: The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence. (Korean J Endocrine Surg 2010;10:261-265)
참고문헌 (22)
- Oritiz S, "Recurrent papillary thyroid cancer: Analysis of prognostic factors including the histological variant", Eur J Surg, 17, pp.406~412 (2001)
- Micheal C, "Recurrent thyroid cancer. Role of surgery versus radioactive iodine", Ann Surg, 219, pp.588~595 (1994)
- Cady B, "An expanded view of risk-group definition in differentiated thyroid carcinoma", Surgery, 104, pp.947~953 (1998)
- Hay ID, "Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a prognostic scoring system", Surgery, 102, pp.1088~1095 (1987)
- Harach HR, "Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study", Cancer, 56, pp.531~538 (1985)
- Chow SM, "Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality", Cancer, 98, pp.31~40 (2003)
- Wada N, "Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection", Ann Surg, 237, pp.399~407 (2003)
- Martin JS, "Papillary and follicular thyroid carcinoma", N Engl J Med, 338, pp.297~306 (1998)
- Grant CS, "Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important?", Surgery, 104, pp.954~962 (1988)
- Clark JR, "Variables predicting distant metastasis in thyroid cancer", Laryngoscope, 115, pp.661~667 (2005)
- Jemal A, "Cancer statistics", CA Cancer J Clin, 57, pp.43~66 (2007)
- Shah JP, "Prognostic factors in differentiated carcinoma of the thyroid gland", Am J Surg, 164, pp.658~661 (1992)
- Scheumann GF, "Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer", World J Surg, 18, pp.559~567 (1994)
- Shvili Y, "Conservative surgical management of invasive differentiated thyroid cancer", J Laryngol Otol, 99, pp.1255~1260 (1985)
- McCaffrey TV, "Locally invasive thyroid carcinoma", Head Neck, 16, pp.165~172 (1994)
- 박해린, "잠재성 유두상 갑상선암에서 원발종양의 크기에 따른 공격성 정도 분석", 대한외과학회지, 73(6), pp.470~475 (2007), 대한외과학회
- DeGroot LJ, "Natural history, treatment, and course of papillary thyroid carcinoma", J Clin Endocrinol Metab, 71, pp.414~424 (1990)
- Haigh PI, "Extent of thyroidectomy is not a major determinant of survival in low-or high-risk papillary thyroid cancer", Ann Surg Oncol, 12, pp.81~89 (2005)
- Sosa JA, "Total thyroidectomy for differentiated thyroid cancer", J Surg Oncol, 94, pp.701~707 (2006)
- Mirallie E, "Localization of cervical node metastasis of papillary thyroid carcinoma", World J Surg, 23, pp.970~973 (1999)
- Watkinson JC, "Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer", Thyroid, 16, pp.187~194 (2006)
- Marshall CL, "Routine pre-operative Ultrasonography for papillary thyroid cancer: effects on cervical recurrence", Surgery, 146, pp.1063~1072 (2009)