Abstract: Analysis of clinical prognostic factors and recurrence-free survival in 137 patients with medullary thyroid carcinoma        MO Cong-hui,LU Xiu-bo. Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China 
Corresponding author：LU Xiu-bo, E-mail:doctorluxiubo@126.com
Abstract    Objective    To investigate the related factors affecting the prognosis and recurrence-free survival of patients with medullary thyroid carcinoma (MTC). Methods    The data of 137 patients who underwent thyroid surgery for the first time in the First Affiliated Hospital of Zhengzhou University from 2012-05-01 to 2021-03-31 and were routinely diagnosed as medullary thyroid carcinoma(MTC) by the pathology department after the operation were retrospectively analyzed. The COX risk regression model was used to screen out the relevant risk factors that affect the recurrence of MTC patients. The Kaplan-Meier method was used to estimate the recurrence-free survival rate of the relevant risk factors, and the recurrence-free survival curve was drawn. The log-rank method was used to compare the recurrence-free survival curve. Results    In 137 patients, the median follow-up time was 29 (1-108) months, and the 5-year recurrence-free survival rate was 80.6%. The results of multivariate analysis suggested that the presence or absence of distant metastasis (P=0.049) and the status of lateral lymph node metastasis (P=0.002) were independent related risk factors affecting postoperative recurrence of MTC patients. Comparing the recurrence-free survival curves of related risk factors, the differences were statistically significant: whether there is distant metastasis (χ2=15.59, P<0.0001, HR=4.662, 95%CI 1.049-20.73), and the status of lateral lymph node metastasis (χ2=16.96, P<0.0001, HR=4.775, 95%CI 2.269-10.05). Conclusion    The status of lateral lymph node metastasis and the presence or absence of distant metastasis are independent risk factors affecting postoperative recurrence of MTC patients. The occurrence of lateral lymph node metastasis and distant metastasis has clinical significance in predicting postoperative recurrence of MTC patients.

Key words: medullary thyroid carcinoma, lateral lymph node metastasis, distant metastasis, recurrence-free survival, prognosis

摘要： 目的    探讨影响甲状腺髓样癌（MTC）病人的预后和无复发生存期的相关影响因素。方法    回顾性分析2012-05-01—2021-03-31郑州大学第一附属医院137例首次行甲状腺手术治疗且术后常规经病理科诊断为MTC的病人资料。采用COX风险回归模型筛选出影响MTC病人复发的相关危险因素，Kaplan-Meier法对相关危险因素的无复发生存率进行估计，绘制无复发生存曲线，使用Log-rank法对无复发生存曲线进行比较。结果   137例病人，中位随访时间29（1~108）个月，5年无复发生存率为80.6%。多因素分析结果提示有无远处转移（P=0.049）、侧区淋巴结转移状态（P=0.002）为影响MTC病人术后复发的独立相关危险因素。对相关危险因素进行无复发生存曲线的比较，差异均有统计学意义：有无远处转移（χ2=15.59，P<0.0001，HR=4.662，95%CI 1.049-20.73），侧区淋巴结转移状态（χ2=16.96，P<0.0001，HR=4.775，95%CI 2.269-10.05）。结论    侧区淋巴结转移状态和有无远处转移为影响MTC病人术后复发的独立相关危险因素，发生侧区淋巴结转移和远处转移对预测MTC病人术后复发具有临床意义。

关键词: 甲状腺髓样癌, 侧区淋巴结转移, 远处转移, 无复发生存期, 预后