| Objective:To analyze the clinicopathological features of solitary papillary thyroid isthmus carcinoma and the therapeutic effect and prognosis of different surgical methods.Methods:A total of 161 patients with single isthmic papillary carcinoma of the thyroid who underwent surgical treatment in the Department of Thyroid Surgery,the First Hospital of Jilin University from December 2012 to October 2021 were selected.Gender,age,body mass index,surgical methods,pathology and other information of the patients were collected to analyze the overall clinicopathological characteristics of the patients.The study was further conducted from the following three aspects: 1.Patients were divided into group ≤ 1cm and group >1cm according to the lesion diameter,and the clinical pathological characteristics of the two groups were compared.2.According to the presence or absence of lymph node metastasis,patients were divided into the lymph node metastasis group and the non-metastatic group,and the clinicopathologic characteristics of the two groups were compared.3.According to the different surgical methods,the patients were divided into three groups: Group A received isthmic excision + central lymph node dissection;Group B received isthmic excision + central lymph node dissection;group C received bilateral total thyroidectomy + central lymph node dissection.The clinicopathological characteristics and therapeutic effects of the three groups were compared.The recurrence rate and relapse-free survival rate(RFS)of the three groups were compared after 6-126 months of follow-up.Results:1.Among the 161 patients with single isthmic papillary thyroid carcinoma,132(82.0%)were female,130(80.7%)were younger than 55 years old,with an average BMI25.1±3.6kg/m2,an average tumor diameter of 0.83±0.64 cm,and 124(77.0%)were complicated by tunic invasion.53 cases(32.9%)complicated with central lymph node metastasis;2.The proportion of male patients with tumor diameter >1cm,the proportion of patients with BMI ≥ 26.0 kg/m2,the rate of capsular invasion,extradular invasion and lymph node metastasis were all higher(30.0%vs14.0%,P=0.023;60.0%vs33.9%,P=0.004;97.5%vs70.2%,P<0.001;42.5%vs9.9%,P<0.001;50.0%vs27.3%,P=0.008);3.Male patients with BMI ≥ 26.0 kg/m2 and tumor diameter >1cm had a higher rate of central lymph node metastasis(28.3%vs13.0%,P=0.017;52.8%vs34.3%,P=0.024;37.7%vs18.5%,P=0.008).4.In terms of surgical effect,compared with groups A and B,patients in group C had longer hospitalization days,higher hospitalization costs,longer operation time,more postoperative drainage volume,and higher incidence of postoperative hypoparathyroidism,with statistical significance(all P < 0.05).Group A and Group B were similar in all aspects,with no statistical difference(all P>0.05).During the follow-up,3 patients in each group A and B relapsed,while no patients in group C relapsed.There were no statistical differences in the recurrence rate(P=0.059)and RFS(P=0.082)among the three groups.Conclusions:1.The patients with single isthmic papillary carcinoma have the following characteristics: the proportion of females is high,the proportion of overweight patients is high,and the proportion of age < 55 years old is high;The isthmic papillary carcinoma was mostly microcarcinoma,but the incidence of tumor combined with capsule invasion was high.2.Isthmic papillary carcinoma is more invasive when the focal size exceeds 1cm(the rate of capsular invasion and extrathyroid invasion are both higher).3.Lymph node metastasis was more likely in male patients with BMI≥26.0kg/m2 and tumor diameter >1cm;4.The treatment of single isthmic papillary carcinoma of the thyroid should be as conservative as possible(isthectomy or enlarged isthectomy). |
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