Clinical Analysis Of Multifocal Papillary Thyroid Carcinoma

Objective To investigate the clinical biological characteristics and treat surgical management of multifocal papillary thyroid carcinoma.Methods Clinical data of 253 patients who underwent thyroidectomy and were pathologically diagnosed as progressive papillary thyroid carcinoma from January 2003 to December 2005 in The Dalian Medical University Attached First Hospital were retrospectively analyzed, and 81 patients were multifocal papillary thyroid carcinoma.Results There were 81 cases of multifocal papillary thyroid carcinoma, accounting for 32.0% of all papillary thyroid carcinoma of the same period. In the 81 cases of multifocal papillary thyroid carcinoma, there was unilateral in 28 cases and bilateral in 53 cases; cervical lymph node metastasis in 52 cases ( 64.2% ); combined microcarcinoma of 57 cases (70.3% );Hashimoto's thyroiditis was concomitant in 22 cases (27.2%);nodular goiter was concomitant in 35 cases (43.2%%); local invasion was found in 26 cases (32.1% ); distant metastasis occurred in 8 case ( 9.8% ); 5-year survival rate was 93.8%. American Joint Committee on Cancer ( AJCC ) stage was associated with prognosis significantly ( X~2 =49.061 , P =0.000).Conclusions Frequently-occurring focus is one clinical characteristics of papillary thyroid carcinoma, its biology malignancy is higher. Multifocal papillary thyroid carcinoma often occurs bilaterally, concomitant nodular goiter, microcarcinoma and Hashimoto's thyroiditis is common with a comparatively favorable prognosis. The technique type choice should select nimbly by the clinical actual need, take realizes the curative effect best as the goal. Excessively excise will the reduce thyroid gland organ's physiological function, and will affect patient's quality of life, too few will excise the thyroid gland easily to recur, must be the surgery once more, increase patient's pain and the economic burden . The lymph node cleaning should be prudent, to the patient, who already discovered neck lymph metastasis adopts the neck dissection, suggested that neck midcontinental region lymph node dissectionmay to the MPTC patient who undiscovered lymph node metastasis. Order to avoid the complication occurrence and the serious influence to the patient prognosis, like the non-lymph node metastasis, does not sweep clear as far as possible. The minimal invasive surgery of thyroid gland will create the present's surgery development direction, whether to be suitable in treatment of MPTC to wait for further studying. After the surgery, the patient should take the thyroxine for a long time, regular reexamine the thyroxine level in the blood ,adjusts the dosage of thyroxine, by against recrudescence and metastasis; Radioactive iodine treatment should be selectively applicative; The papillary thyroid carcinoma lacks the sensitivity to the radiotherapy and the chemotherapy, is not suitable; Thyroid cancer's molecular foundation will also be expounded, the gene therapy will certainly to become an effective measure which the thyroid cancer treatment. AJCC stage is still the best prognostic factor.