中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

多灶性甲状腺乳头状癌克隆起源分析

李    卫1， Linwah Yip2， 周剑宇1，李小荣1   

  1. 1 中南大学湘雅三医院普外科，湖南长沙410000；2 Surgery，University of Pittsburgh, Pittsburgh，USA
  • 出版日期:2017-09-01 发布日期:2017-09-05

  • Online:2017-09-01 Published:2017-09-05

摘要：

目的    探讨多灶性甲状腺乳头状癌（MPTC）的生物学特性及起源。方法    回顾性分析2007年1月至2013年7月间美国匹兹堡大学医学中心收治的1510例甲状腺乳头状癌病人的临床资料，采用7基因面板测序对甲状腺癌样本进行分子学检测，比较突变相同与否的MPTC病人的临床和病理学特征。结果    776（51.4%）例为MPTC病人，且其与单灶性甲状腺乳头状癌（SPTC）病人相比，具有更高的恶性程度。MPTC病人中检测到突变相同病人（SAME）78例（41%），突变不同病人（DIFF）113例（59%）。SAME组病人中央区淋巴结转移发生率和中央区淋巴结转移百分数均显著高于DIFF组（P＜0.05）。结论    41%的MPTC病人具有相同的克隆起源，且其可能具有更高的恶性程度，强烈推荐行预防性中央区淋巴结清扫。

关键词: 甲状腺乳头状癌, 克隆起源, 中央区淋巴结转移

Abstract:

Analysis of clonal origin of multifocal papillary thyroid carcinoma     LI Wei*， Linwah Yip，ZHOU Jian-yu, et al. *Department of General Surgery, the Third Xiangya Hospital of Central South University，Changsha 410000，China
Corresponding author：LI Xiao-rong，E-mail：lixiaorong@medmail.com.cn；Linwah Yip， E-mail： yipl@upmc.edu
Abstract    Objective To investigate the histologic variability of multifocal papillary thyroid carcinoma （MPTC）， to determine the clonal origin of MPTC. Methods    The clinical data of 1510 papillary thyroid carcinoma patients admitted from January 2007 to July 2013 in Medical Center ,University of Pittsburgh were reviewed.Seven-gene panel molecular test was detected in thyroid specimens. Clinical and pathological characteristics were compared between patients with same or different gene mutations.Results    A total of 776 patients （51.4%） were MPTC. When compared to the solitary papillary thyroid (SPTC), MPTC comprise a more aggressive form of PTC. Identical “matching” mutations （SAME） were identified in 78 patients （41%） and differing mutations （DIFF） were detected in MPTC of 113 patients （59%）. Compared to DIFF patients， SAME patients had a higher rate of central compartment lymph node metastasis and a higher percentage of positive central compartment lymph nodes （P＜0.05）. Conclusion    A total of 41% of MPTC may have the same clonal origin and may manifest a more aggressive disease pattern. Thus central lymph node dissection should be strongly considered at the initial operation.

Key words: papillary thyroid carcinoma, clonal origin, central lymph node metastasis