分化型甲状腺癌三个危险组的划分及其与治疗和预后的关系_李树春

outcome of patients with metastasis of head and neck cancer to the parotid lymph nodes．Methods：We retrospectively reviewed patients who had been treated for metastatic disease to the parotid lymph nodes．From January 2001 to January 2010，17 patients met study criteria．Age，gender，histopathology，clinical findings，treatment and outcome were analyzed．Results：Parotid metastasis represented the initial disease manifestation in 3 cases．While in the other 14 cases，parotid metastasis represented recurrent disease．Primary subsites included nasopharynx (n = 4)，eyelid (n = 4)，forehead (n = 2)，paranasal sinus (n = 2)，cheek (n = 2)，tongue (n = 1)，submandibular gland (n = 1)，and unknown (n = 1)．The histological diagnosis of the primary tumors were squamous cell carcinoma in 9 patients，malignant melanoma in 3 patients，adenocarcinoma in 3 patients，olfactory neuroblastoma in 1 patients，and alveolar rhabdomyosarcoma in 1 patients．Pathologic findings showed grade 3 or 4 in most of the patients，and patients generally have substantial associated cervical metastases．Of the 17 cases with follow-up information from range 7 to 120 months after treatment of metastatic disease，the mean and median survival time was 45 months and 34 months respectively．And the overall 5-year cumulative survival was 22.5%．Conclusions：Metastasis to the parotid lymph nodes should be considered in patients with head and neck cancer．Despite combined treatment modalities，long-term survival remains poor．Resection of the inferior parotid lymph nodes is warranted during the neck dissection when treating patients with substantial cervical metastasis．When intraparotid lymph node metastasis is detected，total parotidectomy and multidisciplinary adjuvant therapy should be conducted．

分化型甲状腺癌三个危险组的划分及其与治疗

分化型甲状腺癌三个危险组的划分及其与治疗

和预后的关系

和预后的关系

李树春 董慧蕾 李振东

辽宁省肿瘤医院头颈外科，沈阳，110042

目的 探讨分化型甲状腺癌各危险组的划分及其与治疗和预后的关摘要]] 目的

[摘要

目的

方法 回顾分析514例分化型甲状腺癌患者，借助于单和多变量分析确定有意系。方法

方法

义的预后因素，再根据这些因素将患者分成低、中和高三个危险组。应用Kaplan-Meier方法计算出各危险组患者以及各预后因素所表现出来的生存曲线。结果 长期生存率在低、中和高危组分别为98.3%、83.6%和42.9%。在低危组和部分选择出来的中危组病人仅做腺叶及峡部切除，而在高危组及部分选择的中危组病人

则做较广范围切除，术后再辅以内或外放射治疗。结论

结论 将分化型甲状腺癌分成三

结论

个危险组并借以制定治疗措施和判断预后是十分正确的。

关键词]] 甲状腺癌； 甲状腺手术；预后；危险因素

[关键词

The relationship between three risk groups and management and prognosis in differentiated thyruid cancer

Li Shuchun, Dong Huilei, Li Zhendong

Liaoning Tumor Hospital,Shenyang China 110042 [Abstract] Objectives: To study the retationship between three groups [Abstract] Objectives

Method: In and management and prognosis in differentiated thyroid cancer. Method

a retrospective review of 514 patients with differentiated thyroid carcinoma, various prognostic factors were studied by univariate and multivariate analysis.The significant prognostic factors were studied in detail and, based on these prognostic factors, the patients were divided into low-,intermediate- and high-risk groups.The survival curves were plotted

Results: The long term survivals in by Kaplan-Meier method. Results

low-,intermediate- and high-risk groups were 98.3%, 83.6%, and 42.9% respectively. In the low-risk grup and selected patients in the intermediate-risk group, one lobe with isthmus resection appears to be satisfactory with excellent long-term outcome. In the high-risk group and selected patients in the intermediate-risk group, aggressive surgery including removal of all gross disease and extrathyroidal extension with

Conclusion: The post-operative internal or external radiation therapy. Conclusion: decision to divide three groups for differentiated thyroid cancer and to judge the treatment and prognosis based on these groups are correct .

[Key words] Thyroid Carcinoma ; Thyroidectomy ; Prognosis ;Risk factor.

words]

分化型甲状腺癌约占全部甲状腺恶性肿瘤的90%，其全部生存率和结果是令人满意的。然而，高危险组病人的表现要比低危险组差很多。人们常以45岁为界分成高低两个危险组。无论是国际抗癌联盟（UICC）抑或是美国癌症联盟（AJCC）均限定45岁以下的年青甲状腺癌患者没有III和IV期病例，这是唯一一个将年龄包括在分期系统的人类癌症。也就是说年龄仍然是分化型甲状腺癌主要的预后因素，在制定治疗计划之前必须考虑到这一因素。分化型甲状腺癌有着独特的生物学行为，一方面它生长缓慢是一种十分懒惰的肿瘤对周围组织也没有明显的侵犯，预后良好。而另一方面，随着年龄的增长逐渐变得更具侵袭性，向甲状腺外扩展向周围