甲状腺乳头状癌134例临床研究

目的探讨甲状腺乳头状癌（PTC）的术式选择及p53基因表达对患者预后的影响．方法回顾分析134例PTC患者临床资料,根据危险因素、术前和术中病理结果将患者分为两组：低危组102例,行功能性根治术;高危组32例,行扩大根治术联合核素辅助治疗．对照术后标本的免疫组化结果,判断术前分组的可行性;结合术后随访情况进行生存分析．结果术后免疫组化结果：102例低危组中,p53基因的表达呈强阳性者14例（13．7％）;32例高危组中,强阳性者28例（87．5％）,两组比较具有统计学意义（P〈0．01）．随访5a,低危组出现转移者11例（10．7％）,高危组淋巴结转移4例（12．5％）,淋巴结转移率两组比较无统计学意义（P〉0．05）,但高危组有严重并发症出现,两组无死亡病例．结论甲状腺乳头状癌的术前分组对治疗方案的选择具有指导意义,p53基因表达与危险评估相一致,可作为判断PTC恶性程度的参考指标,具有重要临床参考价值．

Clinical Study of 134 Cases with Thyroid Papillary Carcinoma

Objective To discuss the selection of of p53 expression on the prognoses. Method retrospectively. Based on the risk factors and the operation for thyroid papillary carcinoma （FFC） and the effect Clinical data from 134 cases with PTC were analyzed pathological results before and after the operation, they were divided into two groups ,low-risk group and high-risk group. 102 patients in the low-risk group were treated with the functional radical operation and 32 patients in the high-risk group were treated with extended radical operation in combination with the adjuvant radionuclide therapy. The feasibility of preoperative group was judged by comparing the postoperative immunohistochemical results and the survival analysis was performed based on the postoperative follow-up information. Results Postoperative immunohistochemical resuhs：p53 gene expression of 14 cases in the low-risk group was positive （ 13.7% ） ; that of 28 cases in high-risk groups was highly positive （87.5%）. The difference between two groups was significant （P 〈0.01 ）. 134 Patients were followed up for 5 years. The results showed that there were 11 cases with the metastasis in the low-risk group （10.7%） and 4 cases with the lymph node metastasis in the high-risk group （12.5）, suggesting that there was no significant difference in the lymph node metastasis between the two groups （ P 〉 0.05 ）, but some serious complications appeared in the high-risk group. There were no death in both groups. Conclusion The preoperative group with papillary thyroid carcinoma should have a guiding significance for the choice of treatment. The expression of p53 gene is consistent with the risk assessment and can be taken as an indicator to judge the malignant degree of PTC,indicating that it has an important clinical reference value in the treatment of PTC.