中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (11): 1284-1290.DOI: 10.19538/j.cjps.issn1005-2208.2023.11.18

• 论著 • 上一篇    下一篇

喉返神经受侵的局部进展期甲状腺乳头状癌高危复发因素及预后分析

胡斌涛1，2，徐    楠2，3，陈治宏1，2，王爱连2，3，向玉清1，2，刘    蕾2，4，税春燕2，周雨秋2，蔡永聪2，李    超2，汪    旭2，孙荣昊2   

  1. 1成都医学院临床医学系，四川成都 610041；2四川省肿瘤医院甲状腺-口腔颌面外科   四川省肿瘤临床医学研究中心   四川省肿瘤医院·研究所   四川省癌症防治中心   电子科技大学附属肿瘤医院，四川成都 610041；3西南医科大学附属医院耳鼻咽喉头颈外科，四川泸州 646000）；4电子科技大学临床医学系，四川成都610041
  • 出版日期:2023-11-01 发布日期:2023-11-04

  • Online:2023-11-01 Published:2023-11-04

摘要： 目的    探讨喉返神经受侵的局部进展期甲状腺乳头状癌高危复发因素，以及具备不同高危复发因素时的对应手术处理原则，分析影响其预后的重要因素。方法    回顾性分析2010年1月至2020年12月于四川省肿瘤医院行首次手术治疗中发现喉返神经受侵的274例甲状腺乳头状癌病人资料。采用单因素及多因素Cox回归模型预测喉返神经受侵的局部进展期甲状腺乳头状癌的高危复发因素。采用 Kaplan-Meier法计算无病生存率，评估其预后。结果    274例病人中，女性199例（72.7%），男性75例（27.3%）；年龄≥55岁病人211例（77.0%）。术后随访24～149个月，中位随访时间为62个月。274例病人中，28例（10.2%）发生复发或转移；8例（2.9%）死亡，其中3例（1.1%）死于复发或转移，5例（1.8%）死于其他疾病。单因素分析结果显示发病年龄≥55岁、淋巴结转移数目≥10枚、N分期、术前声带麻痹是喉返神经受侵的甲状腺乳头状癌病人术后复发的危险因素（P均＜0.05）。多因素分析结果显示发病年龄≥55岁（OR=3.087，95%CI 1.525-6.247，P=0.002）、淋巴结转移数目≥10枚（OR=2.777，95%CI 1.289-5.980，P=0.009）是复发的独立危险因素。274例病人5年无病生存率为89.6%，10年无病生存期为75.5%。结论    发病年龄≥55岁、淋巴结转移数目≥10枚是喉返神经受侵的局部进展期甲状腺乳头状癌病人术后复发的危险因素；术前若存在声带麻痹或术中存在喉返神经浸润时，应结合上述高危因素采取不同的手术策略。

关键词: 甲状腺乳头状癌, 局部进展期甲状腺癌, 喉返神经, 危险因素

Abstract: Analysis of high-risk recurrence factors and prognosis of locally advanced papillary thyroid carcinoma with recurrent laryngeal nerve invasion        HU Bin-tao*，XU Nan，CHEN Zhi-hong，et al.*Department of Clinical Medicine, Chengdu Medical College, Chengdu 610041, China；Department of Thyroid-Oral-Maxillofacial Head and Neck Surgery, Sichuan Cancer Hospital,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu 610041, China
Corresponding author:SUN Rong-hao, E-mail:sunronghao@scszlyy.org.cn；WANG Xu,E-mail:wangxu@scszlyy.org.cn
Abstract    Objective    To explore the high-risk recurrence factors of locally advanced papillary thyroid carcinoma with recurrent laryngeal nerve invasion, explore the corresponding surgical management principles with different high-risk recurrence factors, and analyze the important factors affecting their prognosis. Methods    The study retrospectively analyzed the data of patients with papillary thyroid cancer with recurrent laryngeal nerve invasion found in the Sichuan Cancer Hospital during the first operation from January 2010 to December 2020, and collected relevant clinical information including basic patient information, auxiliary examination results, surgical data, pathology data and prognosis data. Univariate and multivariate Cox regression models were used to predict high-risk recurrence factors in locally advanced papillary thyroid carcinoma with recurrent laryngeal nerve invasion. Disease-free survival was calculated by the Kaplan-Meier method. Results    A total of 274 patients were included in the study, including 199 (72.7%) female patients, 75 male patients (27.3%) patients, female: male =2.65:1; 211 (77.0%) patients aged over 55 years.Postoperative follow-up ranged from 24 to 149 months, with a median follow-up time of 62 months.Of the 274 patients, 28 (10.2%) had recurrence or metastasis; 8 (2.9%) died, 3 (1.1%) died of recurrence or metastasis and 5 (1.8%) died of other diseases. Univariate analysis showed that the age of onset ≥ 55 years, the number of lymph node metastases, N stage, and preoperative vocal cord paralysis were the risk factors for postoperative recurrence in patients with recurrent laryngeal nerve invasion (all P <0.05). The multivariate analysis showed that the age of onset ≥55 years (OR=3.087,95%CI 1.525-6.247, P=0.002) and the number of lymph node metastases ≥ 10 (OR=2.777,95%CI 1.289-5.980, P=0.009) were independent risk factors for recurrence. The 274 patients with recurrent laryngeal nerve invasion had 5-year disease-free survival was 89.6% and 10-year disease-free survival was 75.5%.Conclusion    The age of onset ≥55 years and the number of lymph node metastases ≥10 were independent risk factor for postoperative recurrence in locally advanced papillary thyroid carcinoma patients with recurrent laryngeal nerve; if there was vocal cord paralysis before sugery or infiltration during sugery, different surgical strategies should be taken in consideration of the risk factors for recurrence.

Key words: papillary thyroid carcinoma, locally advanced thyroid carcinoma, recurrent laryngeal nerve, risk factors