甲状腺髓样癌的诊断、治疗和预后：219例患者的回顾性分析

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【中图分类号】R581

【文献标志码】A

【Abstract]Objective：Tosummarizethediagnostic，therapeutic，andprognosticcharacteristicsofmedularythyroidcarcnoma （MTC），toanalzetheimpactof imingofdagnosisontreatmentandprognosis，andtoidentifyriskfactorsfostructuralcuece. Methods：Thisretrospectivecohortstudyincluded219patients withMTCfromPekingUnionMedicalCollgeHospital.Diagnostico dalities，pathologicalfeatures，reatmentapproaches，ndprognosticoutcoeswereaalyzed.Patientserestratifiedintoprprativeandpostoperatiediagosisgroupsacodingtothetimngofdiagnosis.Clincopatholgicalharacteristicsandprogosticout comeswerecomparedbetweengroups.Univariateandmultivariatelgisticregresionanalyseswereperformedtoidentifyindependent riskfactors for structural recurrence.Results：The median ageof these MTC patients was 47 years，and female patients accounted for 54.3% .Asfor thepreoperativediagnostic methods forMTC，serum calcitonin had the highest sensitivity of 98.1% ，followed by serum carcinoembryonic antigen （ 79.8% ），fine-needle aspiration cytology （ 62.4% ），and somatostatin receptor imaging（35.3 % ）. Of all patients， 47.9% werediagnosedwith MTCbeforesurgery，and 34.7% were diagnosed with MTC after surgery.At initial surgery， 65.9% of the patients were found to have lymph node metastasis，and the patients with stage IV MTC accounted for 42.9% .After a median follow-up time of 40 months（range：3-372 months）， 42.9% of the patientsachieved biochemical cure， 21.4% achieved anatomical cure，and 33.3% experienced structural recurrence.Compared with the preoperativediagnosis group，thepostoperativediagnosis grouphadasignficantlysmalermeantumordiameter（1.39cmvs.1.89cm， P=0.004），a significantly lower proportion of patients with multiple lesions（ 18.2% vs.34.0%，P=0.036），a significantly lower proportion of patients undergoing total thyroidectomy（ 43.4% vs.99.0%，P1 cm，and lymph node metastasiswereindependentrisfctorsforstrcturalrecuence.Conclusion：MCisiglyaggresseandisoftennegectedbefore surgeryandouoidsovedteialgeryelydatepropatigosisll ment standardized surgical treatment，thereby reducing disease recurrence.

【Keywords】medullary thyroid carcinoma;diagnosis;structural recurrence;treatment

甲状腺髓样癌（medullarythyroid carcinoma，MTC）起源于甲状腺滤泡旁C细胞，是一种可分泌降钙素（calcitonin， Ctn ）的恶性神经内分泌肿瘤（neuroendocrinetumor，NET）。（剩余15507字）