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目的探讨影响甲状腺髓样癌(medullary thyroid carcinoma,MTC)预后的因素。方法回顾性分析中山大学肿瘤防治中心2000年1月至2014年11月间收治的118例MTC的临床资料,并进行随访,采用单因素、多因素分析统计影响其预后的相关因素。结果 118例MTC病人无疾病存活率(disease free survival,DFS)为73%。1年、3年、5年、10年的总存活率(overall survival,OS)分别是97%、95%、94%、89%;单因素分析显示原发灶大小、顽固性腹泻、包膜外侵犯(extra thyroid extension,ETE)、上纵隔淋巴结转移、远处转移及复发影响预后;多因素分析显示顽固性腹泻、上纵隔淋巴结转移及远处转移是影响患者生存的独立预后因素。研究中虽然血清降钙素(ct)值在单、多因素分析均无统计学意义,但其动态变化有预测复发的趋势。结论存在顽固性腹泻、上纵隔淋巴结转移及远处转移的MTC病人的预后差,需进行密切随访和相应处理。另外,术前行血清ct值测量和术后长期随访血清ct值动态变化对MTC预后的评估有一定的价值。
Objective To investigate the prognostic factors of medullary thyroid carcinoma (MTC). Methods The clinical data of 118 patients with MTC admitted to Cancer Center of Sun Yat-sen University from January 2000 to November 2014 were retrospectively analyzed and followed up. The related factors influencing their prognosis were analyzed by univariate and multivariate analysis. Results 118 cases of MTC patients with disease free survival (disease free survival, DFS) was 73%. The overall survival rates at 1 year, 3 years, 5 years and 10 years were 97%, 95%, 94% and 89% respectively. Univariate analysis showed that the size of primary tumor, intractable diarrhea, Extra thyroid extension (ETE), lymph node metastasis of the mediastinum, distant metastasis and recurrence affected the prognosis. Multivariate analysis showed that refractory diarrhea, supratentorial mediastinal lymph node metastasis and distant metastasis were the independent prognostic factors affecting the survival of patients. Although the serum calcitonin (ct) values in the study in single and multivariate analysis were not statistically significant, but its dynamic changes have a trend of predicting recurrence. Conclusions The prognosis of MTC patients with intractable diarrhea, supratentorial mediastinal lymph node metastasis and distant metastasis is poor, which needs close follow-up and corresponding treatment. In addition, preoperative serum ct measurement and long-term follow-up serum ct dynamic changes in the evaluation of the prognosis of MTC has a certain value.