| Objective:More than 90%of thyroid cancers are differentiated thyroid cancers,and the degree of malignancy is low.The prognosis after surgery is generally good,but 15%to 20%will still have postoperative recurrence or metastasis.Once thyroid cancer patients have recurrence or metastasis after surgery.No matter what the patient's physiology or psychology will have a greater impact.This article retrospectively analyzed the clinical data of patients with differentiated thyroid cancer who had undergone surgical treatment and long-term follow-up in our hospital to discuss the clinical factors that affect the recurrence or metastasis of differentiated thyroid cancer,which helps to identify possible recurrence or metastasis.High-risk patients provide clinical guidance for the development of treatment plans for such patients.Methods:A total of 219 patients with differentiated thyroid cancer who underwent surgery and long-term postoperative follow-up were selected from January 2009 to December 2015 in our hospital.The follow-up time was from the time of surgery to July 31,2017.During the follow-up period,recurrence or metastasis and pathologically confirmed recurrence and metastasis were found.A total of 76 cases were diagnosed;In the group without recurrence,a total of 143 cases were found.The clinical data and follow-up data of all patients were retrospectively analyzed to analyze the factors affecting recurrence or metastasis.Results:1.Of the 76 patients with recurrence and metastasis,24(31.6%)had intrathyroidal recurrences,47(61.8%)had cervical lymph node metastases,12(15.8%)had cervical lymph node metastases,and 32(neck cervical lymph node metastases).42.1%),lymph node metastasis in the central region of the neck and lateral cervical lymph node metastasis in 3 cases(3.9%);intrarectal recurrence was accompanied by cervical lymph node metastasis in 4 cases(5.3%);distant metastasis(lung metastasis)occurred in 1 case(1.3%).2.In the different treatment methods,the recurrence rate of surgery alone accounted for 44.7%(34/76);the recurrence rate of surgery and postoperative TSH suppression treatment accounted for 35.3%(27/76);the recurrence rate of surgery and postoperative 1311 treatment accounted for 11.8%(9/76);Surgery +postoperative TSH suppression +1311 postoperative recurrence rate was only 8%(6/76).3.The recurrence rate was 39.5%(30/76)in the first year after the first surgical treatment,27.6%(21/76)in the second year,and 7.9%(6/76)in the third year;after the sixth year Only 2.6%(2/76).4.Comparison of the two groups of patients,in a univariate analysis,whether the recurrence or metastasis of differentiated thyroid cancer after operation and the gender,the size of the lesion,whether the capsule invasion,the number of cervical lymph node metastasis and the largest diameter,lateral neck The number and maximum diameter of regional lymph node metastases,whether postoperative TSH suppression therapy,postoperative follow-up according to doctor's orders,and postoperative Tg levels were closely related(P<0.05),and age,whether combined with nodular goiter,Whether or not the patients were combined with Hashimoto,histological type,location of lesions,number of lesions,operation method,postoperative 1311 treatment,preoperative Tg,TgAb levels,and postoperative TgAb levels were not significantly related(P>0.05).5.In the multivariate analysis results,independent risk factors for recurrence and metastasis of patients with differentiated thyroid cancer were associated with envelopment of the capsule,lymph node metastasis in the central region of the neck,and follow-up without doctor's orders;With the continuous increase of the maximum diameter of lymph nodes and the continuous increase of postoperative Tg levels,the risk of recurrence and metastasis of differentiated thyroid cancer patients is also increasing.The maximum diameter of metastatic lymph nodes in the central region of the neck and the increase of postoperative Tg levels are Independent risk factors for recurrence and metastasis in patients with differentiated thyroid cancer.Conclusions:1.The most common site of recurrence and metastasis of differentiated thyroid cancer is cervical lymph node.The recurrence and metastasis rate is the highest within 3 years after the first operation,and the recurrence and metastasis rate is significantly reduced after 6 years,suggesting that we should treat postoperative patients with differentiated thyroid cancer.Pay attention to the monitoring and follow-up of cervical lymph nodes,especially the first 3 years after surgery,it is best to follow up for more than 6 years.2.The recurrence and metastasis of male patients,lesions>1cm,envelops invasion,cervical lymph node metastasis before surgery were common,and attention should be paid to the treatment and follow-up of these patients.3.After the addition of TSH suppression therapy and 1311 treatment,can effectively reduce the risk of postoperative recurrence and metastasis.4.Tg can effectively monitor the recurrence and metastasis after operation in patients with differentiated thyroid cancer.It can be used as an indicator to monitor the recurrence and metastasis of differentiated thyroid cancer after operation. |
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