Objective: To investigate the clinicopathological characteristics and the survival of re-operated patients for persistent/recurrent papillary thyroid carcinoma (PTC) and risk factors for re-recurrence after the second operation. Method: A retrospective analysis of 69 cases underwent re-operation for persistent/recurrent PTC in Sichuan Cancer Hospital from January 2010 to December 2016 was performed. There were 21 males and 48 females, aged 14-85 (44.8) years old. According to the imaging after initial treatment, they were divided into a recurrence group (42 cases) and a persistent disease/residual group (27 cases). The positive rates of ipsilateral paratracheal lymph node metastases at re-operation were calculated and compared by chi-square test. Patients were divided into different subgroups according to potential risk factors for re-recurrence. Kaplan-Meier (K-M) method was used for survival analysis. Results: The positive rate of ipsilateral paratracheal lymph node metastasis in recurrence group (15/42, 35.7%) was significantly lower than that in the persistent disease/residual group (17/27, 63.0%) (χ2=4.91, P<0.05). The follow-up period after re-operation was 60-104 months, with a median of 66 months, and 8 patients were lost to follow-up. Permanent hypoparathyroidism occurred in 2 cases (2.9%) and permanent recurrent laryngeal nerve palsy in 1 case (1.4%). Twenty patients had structural recurrences and/or distant metastases. The 5-year disease-specific survival rate was 92.8% and the 5-year recurrence-free survival rate was 68.1%. Survival analysis was performed on risk factors such as age≥55 years old, recurrent tumor diameter ≥4 cm, number of positive lymph nodes ≥ 10, and obvious extracapsular invasion (ENE). Among them, age and diameter of recurrent tumor had significant influences on recurrence-free survival rate (χ2 was 6.36, 8.17, respectively, both P values<0.05). There was a statistically significant difference in recurrence-free survival rates between ENE(+) group and ENE(-) group (χ2=5.52, P<0.05). Conclusion: For the re-operated patients due to persistence/ recurrence PTC, attention should be paid to protecting the parathyroid gland and recurrent laryngeal nerve during re-operation. Timely and effective postoperative follow-up for patients aged ≥ 55 years, with recurrent tumor diameter ≥ 4 cm and ENE(+), can significantly improve their prognoses.
目的： 探讨持续/复发甲状腺乳头状癌（PTC）再手术患者的临床病理特征与不同再复发风险因素下的生存状况。 方法： 回顾性分析2010年1月至2016年12月，四川省肿瘤医院收治的69例行再次甲状腺手术且两次手术术后病理诊断均为PTC患者的临床资料，其中男性21例，女性48例，年龄14~85岁。根据初治术后影像学状态分为复发组（42例）和疾病持续状态/残留组（简称残留组，27例），计算再手术时同侧气管旁淋巴结转移阳性率，结果采用卡方检验比较。针对不同复发危险因素分组，采用Kaplan-Meier法进行生存分析。 结果： 复发组的同侧气管旁淋巴结转移阳性率（35.7%，15/42）与残留组（63.0%，17/27）比较，差异有统计学意义（χ2=4.91，P<0.05）。再手术术后随访60~104个月，中位随访时间66个月，8例患者失访；发生永久性甲状旁腺功能减退2例（2.9%），永久性喉返神经麻痹1例（1.4%）；20例患者出现结构性复发和/或远处转移。5年疾病特异性生存率为92.8%，5年无复发生存率为68.1%。对相关危险因素（年龄≥55岁、复发肿瘤直径≥4 cm、阳性淋巴结数目≥10个、明显包膜外侵犯）进行生存分析，其中年龄、复发肿瘤直径对于无复发生存率差异有统计学意义（χ2值分别为6.36、8.17，P值均<0.05）。对于是否存在淋巴结结外侵犯（extranodal extension，ENE），将ENE（+）组与ENE（-）组无复发生存率进行比较，差异有统计学意义（χ2=5.52，P<0.05）。 结论： 针对持续/复发PTC患者，再手术术中注意保护甲状旁腺及喉返神经，对年龄≥55岁、复发肿瘤直径≥4 cm以及ENE（+）患者及时有效地进行术后随访可以改善其预后。.