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미세 유두 갑상선암의 크기에 따른 임상상 및 단기간 치료 결과
이잔디(Jandee Lee),오동규(Dong-Kyu oh),임승수(Seung Soo Lim),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),소의영(Euy Yong Soh),박정수(Cheong Soo Park) 대한두경부종양학회 2008 대한두경부 종양학회지 Vol.24 No.1
Purpose :The incidence of papillary thyroid microcarcinoma(PTMC) has increased due to the widespread use of high resolution ultrasonography and fine-needle aspiration biopsy. However, the clinical and biologic behaviors of PTMC is debatable. The aim of this study was to describe clinicopathologic features of PTMC and to suggest whether tumor size(5mm) might prove the useful parameter for determining the surgical strat-egy in PTMC. Material and Methods :From Jan. 2000 to Dec. 2005, 1355 of 2678 patients with papillary thyroid car-cinoma were identified as having PTMC, based on tumor size≤10mm(50.6%). Among patients with PTMC, we further separated tumors<5mm(minute group:group M) from those 5 to 10mm(tiny group:group T). We compared the clinicopathological characteristics and the TNM stagings between two groups. Results :There were 114(8.4%) men and 1241(91.6%) women with a median age of 47 years(range;13-79). During a mean follow-up of 47.3(range;22-93), 13 patients(1.0%) developed locoregional recur-rences and 3 patients(0.2%) showed distant metastases at initial presentation. Statistical analysis revealed that the presence of extracapsular invasion(p<0.0001), invasion to adjacent structure(p<0.0001), multifocality(p< 0.0001), central lymph node metastasis(p<0.0001), and lateral lymph node metastasis(p<0.0001) were all significantly higher in tiny group(tumor≥5mm). Furthermore, minute group demonstrated a significantly lower tumor stage(AJCC TNM classification) compared with tiny group(p<0.0001). Conclusion :Patients with PTMC have a favorable treatment outcomes, although the distinction needs to be made with reference to the clinicopathologic behaviors. It would be reasonable to consider that tumor size(5mm) would be useful parameter for the treatment strategy of PTMC.
이잔디(Jandee Lee),윤지섭(Ji Sup Yun),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),소의영(Euy-Young Soh),박정수(Cheong Soo Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.4
Purpose: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. Methods: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 ㎝ in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 ㎝ in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). Results: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12∼86). During a mean follow-up of 32.5±18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P<0.001), invasion to adjacent structures (P<0.001), and lateral neck node metastasis (P<0.001) than that of group A. However, there were no significant differences in multifocality (P=0.189), bilaterality (P=0.203), the locoregional recurrence rate (P=0.065) and the distant metastasis rate (P=0.325) between the two groups. On multivariate analysis, locoregional recurrent disease was associated with central lymph node metastases (P=0.033) and lateral neck node metastases (P=0.022). Conclusion: Despite PTMC having less aggressive clinicopathologic parameters as compared with clinical cancer (>1 ㎝), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.
이잔디(Jandee Lee),윤지섭(Ji Sup Yun),정종주(Jong Ju Jeong),남기현(Kee-Hyun Nam),정웅윤(Wong-Youn Chung),소의영(Euy-Young Soh),박정수(Cheong Soo Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1
Purpose: Follicular thyroid carcinoma (FTC) is a relatively rare form of thyroid carcinoma that often presents at a more advanced stage of disease with a higher incidence of distant metastases because of its propensity for vascular invasion. However, FTC and papillary thyroid carcinoma (PTC) have similar prognoses when they are matched for age and stage. Therefore, this study was conducted to evaluate the useful prognostic factors and determine the optimal management of FTC. Methods: This study was conducted on 216 patients with FTC who underwent thyroidectomy at our institutions between April 1986 and August 2006. The patients included 174 women and 42 men with a mean age of 41 (4∼87) years, and patients underwent follow-up evaluation for a mean period of 114 (6∼253) months. The potential risk factors for treatment outcome were calculated using multivariate analysis, and the prognostic accuracy of UICC/AJCC pTNM staging, AMES, AGES, MACIS, and Degroot classification for predicting survival were compared. Results: During the follow-up period, 13 (6.0%) patients developed locoregional recurrences and 8 patients (3.7%) showed distant metastases. In addition, cause specific mortality was seen in 8 patients (3.7%). The overall survival and cause-specific survival (CSS) rates at 10 years were 95.4% and 89.3%, respectively, and these cases were accurately predicted by the AMES and pTNM staging systems. The Cox proportional hazards revealed that gender (P=0.015), angioinvasion (P=0.013), invasion to adjacent structure (P=0.003), widely invasive carcinoma (P=0.028), and distant metastases at the time of presentation (P<0.001) were independent prognostic factors for survival. Conclusion: The extent of surgery in cases of FTC should be individualized based on the clinicopathologic findings; Conservative surgery should be adequate for cases of minimally invasive FTC without angioinvasion, however total or near-total thyroidectomy should be conducted in cases of widely invasive and minimally invasive FTC with angioinvasion.
갑상선 휘틀세포암(Hurthle Cell Carcinoma)의 임상적 특징 및 예후인자
이잔디(Jandee Lee),이승환(Seong Hwan Lee),최수윤(Su-Yun Choi),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),소의영(Eui-Young Soh),박정수(Cheong Soo Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.2
Purpose: Hurthle cell carcinoma (HCC) of the thyroid gland is a rare disease that represents 3% of all thyroid carcinomas. HCC has been known as a more aggressive disease than the usual differentiated thyroid carcinoma. However, the biologic behavior and optimal treatment have come under considerable debate in recent years. This study was performed to evaluate the clinicopathologic features and treatment outcome of HCC. Methods: From April 1986 to August 2006, 18 patients with HCC and 216 patients with pure follicular carcinoma (PFC) underwent thyroidectomy at our institutions with a mean follow-up of 114 (range: 6∼253) months. The clinicopathologic characteristics and treatment outcome of each group were compared, and the prognostic factors for disease-free survival were analyzed. Results: There were 14 women and 4 men with a mean age of 50 (range: 26∼76) years. Compared with PFC patients, all of clinicopathologic features of HCC patients were different (gender, age, tumor size, multifocality, angioinvaion, invasion to adjacent structures, the subclassification and initial distant metastasis), but the high incidence of bilaterality was similar to the PFC patients (P<0.0001). The causespecific survival (CSS) rates at 10 years were 83.4% in the HCC patients and 89.3% in the PFC patients (P=0.702). Older age (greater than 45) (P=0.0125) and initial distant metastasis (P<0.0001) in the HCC patients, and an older age (P<0.0001), male gender (P=0.0039), angioinvasion (P= 0.0122), invasion to adjacent structures (P<0.0001), a widely invasive type (P=0.004) and initial distant metastasis (P<0.0001) in the PCC patients were independent prognostic factors for survival. Conclusion: After accounting for important biologic behaviors, patients with HCC had similar clinicopathologic characteristics and prognosis compared with that of the PFC patients. Therefore, HCC should be managed using the same treatment strategy as PFC.
이잔디(Jandee Lee),홍 협(Hyeop Hong),정종주(Jong Ju Jeong),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),소의영(Euy-Young Soh),박정수(Cheong Soo Park) 대한두경부종양학회 2008 대한두경부 종양학회지 Vol.24 No.1
Purpose :The chronic use of immunosuppressive therapy in transplant recipients can increase the long-term risk of carcinoma. The aim of this study was to determine the incidence, biological behaviors, and treatment outcomes in PTC(papillary thyroid carcinoma) in renal allograft recipients. Material and Methods :The present study examined the incidence and biological behavior of PTCs in RA recipients. A total of 1,739 RA patients treated between January 1986 and December 1999 were followed-up for a median 137(84-238) months. During the follow-up period, 129(7.4%) recipients were identified as having posttransplant malignancies. Of those, 12(0.7%) had PTCs, and these comprised six male and six female patients with a median age of 41(23-57) years. Results :Nine cases(incidentalomas) were diagnosed based on ultrasonography(US) screening. Eight of those nine were TNM stage I, and two of the three clinical carcinomas were TNM stage IVa. During a median follow-up of 94(18-159) months, two(16.7%) PTC patients developed loco-regional recurrence, but no patients showed distant metastasis. Posttransplant PTC showed no gender bias, and was often associated with aggressive lymphatic metastasis. However, most incidentalomas showed a favorable treatment outcome. Conclusion :In conclusion, routine surveillance of the thyroid gland using US screening is recommended to ensure early detection, treatment and favorable prognosis in RA patients with PTC.