Kliniğimizde izlenen iyi differansiye tiroid karsinomu olgularının retrospektif analizi ve prognostik faktörlerin değerlendirilmesi
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Date
2012
Authors
Alkış, Nihan
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmadaki amacımız; iyi differansiye tiroid karsinomlarında prognoz ve tedaviye yanıtı etkileyen faktörler ile mortalite ve morbiditeye etkili risk faktörlerini değerlendirmektir.2000-2011 yılları arasında UÜTF Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı Polikliniğine başvuran iyi differansiye tiroid karsinomu tanılı 140 hastanın demografik bilgileri, preoperatif değerlendirmeleri, tümör özellikleri, tedavi ve takip süreçleri retrospektif olarak incelenmiştir.Çalışmaya ortanca yaşları 49 (20-74) yıl olan, 129 (%92,1) PTK ve 11 (%7,9) FTK tanısı alan 140 hasta dahil edilmiştir. Kadın cinsiyetin (%79,8) hakim olduğu ortanca izlem süresi 23 (5-140) ay olan hastalarımızın tanı öncesi çoğunlukla (%73,6) ötiroidik durumda oldukları görülmüştür. Preoperatif USG incelemelerinde tümöre eşdeğer gelen nodüllerin daha çok solid ya da mikst yapıda ve hipoekoik olduğu saptanmıştır. En sık uygulanan cerrahi yöntem TT/TYT (%80) şeklinde olup ortanca tümör çapı 14 (1-70) mm bulunmuştur. Tümör çapı (≥14mm), multisentrisite, lenf nodu metastazı varlığı, hastalık evresi, RAİ ablasyon tedavisi uygulanmaması ve postoperatif dönem takipte serum Tg ≥2 ng/ml olması hastalıksız sağ kalım süresini olumsuz etkileyen faktörler olarak saptanmıştır.Tiroid bezinde, USG görünümü olarak riskli ve tüm ≥1 cm nodüllerin İİAB ile değerlendirilmesi gerektiği, tümör saptandıktan sonra tanı anındaki yaş, cinsiyet, tümörün histopatolojisi, çapı, invazyon durumu ve multisentrisitesi, lenf nodu metastazı varlığının, tanı anındaki prognostik faktörler olduğu sonucuna varılmıştır. İyi differansiye tiroid kanserlerinin tedavi seçeneklerinin cerrahi ve RAİ ablasyon tedavisi olduğu, temel tedavi sonrası tiroid hormon replasman tedavisi verilmesi ve tedavi sonrası serum Tg, anti-Tg düzeyleri, TVT sintigrafisi ve USG ile hastaların düzenli aralıklarla izlenmesinin, ileride oluşabilecek nüks ve metastazları önleme açısından çok önemli olduğu düşüncesindeyiz.
Aim in this study evaluation of prognosis, risk factors for morbidity and mortality and factors affects the response to the treatment in well differentiated thyroid carcinoma.Demographics, preoperative evaluations, tumors specifications, treatments and follow-up processes of 140 well-differentiated thyroid carcinoma patients who admitted to the Uludağ University Medical Faculty, Endocrinology and Metabolism Disease department between 2000 and 2011 were investigated retrospectively.Totally, 140 patients mean age 49 (20-74) years were included in the study. 129 of them (92,1%) were papillary thyroid carcinoma and 11 of them (7,9%) were follicular thyroid carcinoma. Mean follow-up period was 23 months (5 to 140 months) and there was a significant female predominance (79,8%). Most of the patients (73,6%) were euthyroid before the diagnosis. Preoperative ultrasound shows that malignant nodules were mostly solid or mixt structure and hypo echoic. Total thyroidectomy was performed in 80% of patient and mean tumor diameter was 14 mm (1 to 70 mm). Tumor diameter (≥14 mm), multicentricity, lymph node metastasis, stage of disease, unperformed radioactive iodine ablation therapy and follow up thyroglobulin levels ≥2 ng/ml were identified as negative prognostic factors. All ≥1 cm diameter thyroid nodules with malignant ultrasound specifications should be evaluated with fine needle aspiration. Patients age, sex, tumor histopathology, diameter, tumors invasion, multicentricity, lymph node metastasis and stage of disease at the time of diagnosis was identified as prognostic factors. The most accepted treatment of well differentiated thyroid cancer is surgery and consecutive radioactive iodine ablation therapy. We think that, it is more important to follow-up patients with hormone replacement, serum thyroglobulin and anti-thyroglobulin levels, thyroid-neck ultrasound and whole body scintigrapyh after primary ablative therapy in regular visits.
Aim in this study evaluation of prognosis, risk factors for morbidity and mortality and factors affects the response to the treatment in well differentiated thyroid carcinoma.Demographics, preoperative evaluations, tumors specifications, treatments and follow-up processes of 140 well-differentiated thyroid carcinoma patients who admitted to the Uludağ University Medical Faculty, Endocrinology and Metabolism Disease department between 2000 and 2011 were investigated retrospectively.Totally, 140 patients mean age 49 (20-74) years were included in the study. 129 of them (92,1%) were papillary thyroid carcinoma and 11 of them (7,9%) were follicular thyroid carcinoma. Mean follow-up period was 23 months (5 to 140 months) and there was a significant female predominance (79,8%). Most of the patients (73,6%) were euthyroid before the diagnosis. Preoperative ultrasound shows that malignant nodules were mostly solid or mixt structure and hypo echoic. Total thyroidectomy was performed in 80% of patient and mean tumor diameter was 14 mm (1 to 70 mm). Tumor diameter (≥14 mm), multicentricity, lymph node metastasis, stage of disease, unperformed radioactive iodine ablation therapy and follow up thyroglobulin levels ≥2 ng/ml were identified as negative prognostic factors. All ≥1 cm diameter thyroid nodules with malignant ultrasound specifications should be evaluated with fine needle aspiration. Patients age, sex, tumor histopathology, diameter, tumors invasion, multicentricity, lymph node metastasis and stage of disease at the time of diagnosis was identified as prognostic factors. The most accepted treatment of well differentiated thyroid cancer is surgery and consecutive radioactive iodine ablation therapy. We think that, it is more important to follow-up patients with hormone replacement, serum thyroglobulin and anti-thyroglobulin levels, thyroid-neck ultrasound and whole body scintigrapyh after primary ablative therapy in regular visits.
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Keywords
Malign tiroid nodülü, İyi differansiye tiroid karsinomu, Cerrahi, Radyoaktif iyot ablasyon tedavisi, Prognostik faktörler, Malignant thyroid nodule, Well-differentiated thyroid carcinoma, Surgery, Radioactive iodine ablation therapy, Prognostic factors
Citation
Alkış, N. (2012). Kliniğimizde izlenen iyi differansiye tiroid karsinomu olgularının retrospektif analizi ve prognostik faktörlerin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.