| Objective:Differentiated thyroid cancer(DTC)has an excellent prognosis.The presence of extrathyroidal extension(ETE)is one of the main risk factors for developing DTC recurrence and metastasis from DTC.Therefore,an appropriate management approach is needed.The ETE involves several structures such as strap muscles,recurrent laryngeal nerve,trachea,esophagus et al.This study was to analyze the clinical manifestations,reasonable treatment and prognostic factors of papillary thyroid carcinoma(PTC)with ETE in order to provide reference for clinical diagnosis and treatment.Methods:The clinical information and follow-up data of 127 patients with locally advanced PTC treated in Yunnan Cancer Hospital from January 1,2008 to December 31,2018 were reviewed and analyzed by Kaplan-Meier univariate and Cox regression model.Results:A total of 127 patients with ETE PTC were included in this study,including 40 male patients and 87 female patients,the ratio of male to female was 1:2.17;At the time of diagnosis of ETE PTC,the youngest was 15 years old,the oldest was 75 years old,and the average age was 45.70 years old.The 3,5,and 10-year progress-free survival rates(PFSR)were 87.2%,74.4%,and 44.8%,respectively.Univariat’e analysis showed that the age of patients with ETE PTC(5-year PFSR of<55 years old and≥55 years old were 83.0%vs 52.1%,P=0.000),the size of primary tumor(5-year PFSR of ≤4cm group and>4cm group were 78.6%vs 42.1%,respectively,P=0.003),distant metastasis(the 5-year PFSR of non-distant metastasis group and distant metastasis group were 80.1%vs 46.8%,respectively,P=0.000),recurrent laryngeal nerve invasion(the 5-year PFSR of uninvolved and invaded recurrent laryngeal nerve were 80.9%vs 65.5%,respectively,P=0.020),laryngeal airway invasion(the 5-year PFSR of laryngeal airway is 79.6%vs 67.0%,P=0.049),esophageal invasion(the 5-year PFSR of esophageal uninjured group and esophageal invasion group is 83.7%vs 48.7%,respectively,P=0.000),invasion of prevertebral fascia(5-year PFSR of uninvolved and invaded groups were 76.8%vs 20.0%,respectively,P=0.000),whether multiple organs were invaded(5-year PFSR of single organ and multiple organ invaded groups were 88.0%vs 59.4%,respectively,P=0.000),cTNM stage(the 5-year PFSR of stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ were 81.5%vs 52.8%,respectively,P=0.000),and the postoperative margin(the 5-year PFSR of R0,R1 and R2 were 90.9%vs 82.7%vs 33.3%,respectively,p=0.000),Whether the R2 margin(5-year PFSR of two groups is 33.3%vs 86.2%,respectively,P=0.000)affects the prognosis of patients,while the 5-year PFSR of gender were 70.8%vs 76.0%,respectively,P=0.369)and N grade(N0,N1a,N1b),The 5-year PFSR was 75.1%vs 83.2%vs 66.1%,respectively,P=0.358),strap muscle invasion(5-year PFSR were 71.7%vs 79.0%,respectively,P=0.545),major vessel invasion(5-year PFSR were 53.3%vs 77.3%,respectively,P=0.530),postoperative radioiodine(RAI)(the 5-year PFSR were 71.6%vs 79.1%,respectively,P=0.112)and External Beam Radiotherapy(EBRT)(the 5-year PFSR of the treated group and the untreated group were 59.8%vs 76.3%,respectively,P=0.016)had no significant difference in PFSR.Multivariate analysis showed that age>55(P=0.004),primary tumor diameter>4cm(P=0.018),distant metastasis(P=0.022),multiple organs invasion(P=0.037),TNM stages(P=0.007),and postoperative residual lesions(P=0.007)were independent prognostic risk factors for ETE PTC patients.Conclusion:ETE PTC patients with age>55 years old at the time of diagnosis,primary tumor diameter>4cm,distant metastasis,multiple organ invasion,TNM stages,postoperative extrathyroid invasion with macroscopic residual lesions have poor prognosis.Operation is the first choice for PTC patients with extrathyroid invasion,and postoperative RAI and EBRT cannot improve the prognosis of ETE PTC patients.However,because the number of patients receiving EBRT in this study is limited and there are many inherent confounding factors in retrospective study,further prospective study is needed to improve persuasiveness. |
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