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目的阐明甲状腺乳头状癌(papillary thyroid carcinoma,PTC)组织学变型的临床生物学特点。方法选取我院自1974至1994年间收治的具有完整病历记录和随访观察的PTC病例505例,按国际最新甲状腺肿瘤的组织学分类标准重新分型,总结并分析各组织学变型的临床生物学特性。结果所有变型中,弥漫硬化型发生率最高,达20．0％;弥漫滤泡型、柱状细胞型及大滤泡型发生率最低。高细胞型、弥漫滤泡型、柱状细胞型和弥漫硬化型颈部淋巴结转移率和侵出腺外发生率较高,预后差;乳头状微癌和大滤泡型颈部淋巴结转移率和侵出率则较低,预后好。按照颈淋巴结转移发生率的高低差异可将所有变型分为高转移变型组(高细胞型、弥漫滤泡型、柱状细胞型、弥漫硬化型)、中转移变型组(滤泡型、嗜酸性细胞型、实体状变型、间质高度增生呈结节状筋膜炎样型、透明细胞型、典型PTC)和低转移变型组(大滤泡型、乳头状微癌),颈淋巴结转移率分别为83．0％,55．5％及34．1％(P<0．05)。结论PTC各组织学变型的临床生物学特性存在一定差异。应细化外科处理原则,以使患者得到更加恰当的治疗。
Objective To elucidate the clinical biological characteristics of histological variants of papillary thyroid carcinoma (PTC). Methods A total of 505 cases of PTC with complete history record and follow-up were selected from 1974 to 1994 in our hospital. According to the histological classification criteria of the latest thyroid tumor, the clinical biological characteristics of each group were summarized and analyzed. . Results In all the variants, the incidence of diffuse sclerosis was the highest, reaching 20.0%. The incidence of diffuse follicular type, columnar cell type and large follicular type was the lowest. High cell type, diffuse follicular type, columnar cell type and diffuse sclerosis type of cervical lymph node metastasis rate and the incidence of extravasated extravasular high, poor prognosis; papillary microcarcinoma and large follicular lymph node metastasis rate and invasion The rate is lower, the prognosis is good. According to the difference of the incidence of neck lymph node metastasis, all the variants could be divided into high metastatic variant group (high cell type, diffuse follicular type, columnar cell type, diffuse sclerosis type), middle transfer type group (follicular type, eosinophilic cell Type, entity-like variants, interstitial hyperplastic nodular fasciitis type, clear cell type, typical PTC) and low metastasis variant group (large follicular type, papillary microcarcinoma), cervical lymph node metastasis rates were 83.0%, 55.5% and 34.1%, respectively (P <0.05). Conclusion There are some differences in the clinical biological characteristics of PTC histological changes. The principle of surgical treatment should be refined to allow patients to be more appropriately treated.