| Objective: 1.To investigate the value of preoperative routine high-frequency ultrasonography in improving the staging of thyroid cancer and predicting the risk of postoperative recurrence.2.To analyze the follow-up results of postoperative patients with thyroid cancer,and to explore the effects of operation-related complications and special clinical symptoms on the quality of life of patients with thyroid cancer.Methods: A retrospective study was used to analyze the medical records of patients who underwent surgery for thyroid cancer in Fujian Medical University Union Hospital from January 2013 to December 2015.In order to understand the recurrence after operation and the influence of postoperative complications and special clinical symptoms on patients’ quality of life,outpatient follow-up or telephone inquiry were used.Results:(1)A total of 1969 patients with thyroid cancer were collected,including 103 incidental carcinoma,3 occult carcinoma,10 without high quality preoperative ultrasound image and 468 loss of follow-up,with a follow-up rate of 74.7%.Among the other 1385 patients,tumor persistence / recurrence occurred in 143 patients.The 1-,3-and 5-year cumulative tumor persistence / recurrence rates were 3.2%,8.2%and 13.5%,respectively.(2)In univariate analysis,age and sex of patients,preoperative ultrasound showed that the number,location,maximum diameter,relationship with capsule,shape,blood supply,lymph node metastasis and mode of operation were all risk factors for postoperative tumor persistence /recurrence.(3)In multivariate Cox proportional hazards regression,age ≥ 55 years old,preoperative ultrasound findings such as large number,located in the isthmus or showed diffuse distribution,large diameter,breakthrough of thyroid capsule and cervical lymph node metastasis were risk factors for postoperative tumor persistence / recurrence.(4)The evaluation of the risk factors of postoperative tumor persistence / recurrence by preoperative ultrasound was confirmed by postoperative pathology.The kappa coefficients of the number,location,maximum diameter and relationship between the focus and the capsule were 0.884,0.871,0.688 and 0.876,respectively,indicating that the preoperative ultrasound was in good agreement with the postoperative pathological gold standard.(5)The sensitivity of preoperative ultrasonography in the diagnosis of central lymph node metastasis was lower,but compared with microscopic lymph node involvement,preoperative ultrasonographic diagnosis of central lymph node metastasis was more likely to predict postoperative tumor persistence / recurrence(P < 0.001).(6)The incidence of postoperative complications and special clinical symptoms of thyroid cancer was high,including 0.6% of permanent recurrent laryngeal nerve injury,1.7% of permanent hypoparathyroidism,1.7% of postoperative bleeding,3.4% of chyle leakage,3.0% of transient recurrent laryngeal nerve injury,6.6% of transient hypoparathyroidism,23.0% of cervical scar distress,and 32.1% of neck stiffness(traction sensation).Coupled with patients’ worries or fears about the future,the quality of life of patients was affected to a certain extent.Conclusion:(1)The risk factors of postoperative tumor persistence / recurrence were age ≥ 55 years old,preoperative US findings of large number,located in the isthmus or showed diffuse distribution,larger diameter,breakthrough of thyroid capsule and metastasis of cervical lymph nodes.;(2)The preoperative ultrasound wad highly consistent with the postoperative pathological results in the judgment of the number,location,maximum diameter and relationship with the capsule;(3)Preoperative ultrasonographically visible central lymph node metastases predict postoperative tumor persistence/recurrence compared with microscopic central lymph node involvement;(4)Postoperative complications,special clinical symptoms and worries or fears about the future of thyroid cancer affect the quality of life of the patients to a certain extent. |
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