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DOI: 10.1055/s-2002-36062
Bedeutung der Lymphknoten- und Fernmetastasen für das Ausmaß der chirurgischen Therapie von papillären und follikulären Schilddrüsenkarzinomen
Significance of Lymph Node and Distant Metastases with Respect to Surgical Treatment for Papillary and Follicular Thyroid CarcinomaPublikationsverlauf
Publikationsdatum:
11. Dezember 2002 (online)
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Zusammenfassung
Einleitung: In Bezug auf die Rezidivhäufigkeit und die Mortalität wird die Bedeutung der Lymphknoten- und Fernmetastasen als Prognosefaktoren kontrovers diskutiert. Patienten und Methode: In einer Nachbeobachtungsstudie von 346 Patienten mit einem papillären und 105 Patienten mit einem follikulären Schilddrüsenkarzinom, die zwischen 1986 und 1998 in der Chirurgischen Universitätsklinik Düsseldorf operiert worden waren, wurden univariate (Kaplan-Meier-Log-Rank- oder Breslow-Test) und multivariate (Cox Regression-Test) Risikoanalysen durchgeführt. Ergebnisse: Multivariat zeigten sich die Lymphknotenmetastasen als bedeutende Risikofaktoren für das Rezidiv und die Fernmetastasen als bedeutende Risikofaktoren für die Mortalität bei papillären und follikulären Schilddrüsenkarzinomen. Schlussfolgerung: Aufgrund der Bedeutung der Lymphknotenmetastasen für das Rezidiv empfehlen wir bei papillären und follikulären Schilddrüsenkarzinomen im Tumorstadium T3 und T4 sowie bei makroskopisch vorhandenen Lymphknoten die Erweiterung der Thyreoidektomie mit einer ein- oder beidseitigen modifizierten, systematischen Lymphknotendissektion. Wegen der guten Prognose insbesondere der follikulären Schilddrüsenkarzinome erfolgt bei langen Krankheitsverläufen die Behandlung der Fernmetastasen operativ oder mittels Radiojodtherapie zur Verbesserung der Lebensqualität.
Abstract
Introduction: The significance of lymph node and distant metastases in papillary and follicular thyroid carcinoma is still discussed controversially. Patients and methods: A retrospective survey was carried out on 346 patients with papillary and 105 patients with follicular thyroid cancer operated in the Department of surgery at the University hospital of Düsseldorf from 1986 to 1998. Univariate analysis was done by Kaplan Meier test and multivariate analysis by Cox Regression test. Results: Multivariate analysis with Cox Regression test demonstrated a high significance of lymph node metastases for recurrence and a high significance of distant metastases for mortality. Summary: With respect to the significance of lymph node metastases for recurrence we advocate thyroidectomy plus uni - or bilateral modified neck dissection in T3 and T4 thyroid carcinoma as well as in all cases with visible lymph node enlargement. Treatment of distant metastases by operation or radioiodine is recommended with respect to increased quality of life because of the favourable long term survival especially in follicular thyroid cancer.
Schlüsselwörter
Papilläre und follikuläre Schilddrüsenkarzinome - Lymphknoten- und Fernmetastasen - chirurgische Therapie
Key words
Papillary and follicular thyroid carcinoma - lymph node and distant metastases - surgical treatment
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Dr. Jürgen Witte
Klinik für Allgemeine und Unfallchirurgie, Universität Düsseldorf
Moorenstraße. 5
40225 Düsseldorf