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目的探讨甲状腺癌的临床生物学特性、预后总生存(OS)期及影响预后的主要因素。方法对1997—2007年上海长征医院首次行手术治疗的860例甲状腺癌患者临床资料进行双向性队列研究分析预后及影响因素。结果(1)860例甲状腺癌患者平均年龄(47.01±13.36)岁,女性占78.1%。96.0%为分化型甲状腺癌,82.0%为Ⅰ~Ⅱ期。(2)甲状腺癌的肿瘤相关致死率为2.40%(21例),OS期为(91.23±29.10)个月。(3)多因素分析结果显示,甲状腺癌分类为甲状腺髓样癌或未分化癌、有腺外侵犯(包括远处转移、血管侵犯、甲状腺被膜侵犯)、病理Ki67比值>1.0%、血清CEA>0.41μg/L是甲状腺癌OS期的主要影响因素(P<0.05)。结论甲状腺癌患者多数分化程度高,肿瘤分期早。整体预后较佳,致死率低,平均生存时间较长,以女性多发,男性预后差于女性。术前检查如血清CEA、有无腺外侵犯(包括远处转移、血管侵犯、甲状腺被膜侵犯)以及病理免疫Ki67比值对甲状腺癌患者的预后预测及评估有一定提示作用。
Objective To investigate the clinical biological characteristics of thyroid cancer, the prognosis of the total survival (OS) and prognosis of the main factors. Methods The clinical data of 860 thyroid cancer patients who underwent surgery for the first time in Shanghai Changzheng Hospital from 1997 to 2007 were analyzed by two-way cohort to analyze prognosis and influencing factors. Results (1) The mean age of 860 thyroid cancer patients (47.01 ± 13.36) years and 78.1% women. 96.0% were differentiated thyroid cancer and 82.0% were stage Ⅰ ~ Ⅱ. (2) The tumor-related lethal rate of thyroid cancer was 2.40% (21 cases), OS was (91.23 ± 29.10) months. (3) Multivariate analysis showed that thyroid cancer was classified as medullary thyroid carcinoma or undifferentiated carcinoma with extragon gland invasion (including distant metastasis, vascular invasion, invasion of thyroid capsule), pathological Ki67 ratio> 1.0%, serum CEA> 0.41μg / L is the main influencing factor of OS in OS (P <0.05). Conclusion Most patients with thyroid cancer have a high degree of differentiation and early tumor staging. The overall prognosis is better, the mortality rate is low, the average survival time is longer, with multiple women, men have worse prognosis than women. Preoperative examination such as serum CEA, with or without extrahepatic invasion (including distant metastasis, vascular invasion, thyroid capsule invasion) and Ki67 ratio of pathological prognosis and evaluation of thyroid cancer patients have some tips.