Tiroid kanserinde prognoza etkili faktörler
Prognostic factors in thyroid cancer
- Tez No: 310241
- Danışmanlar: PROF. DR. MAHİR AKYILDIZ
- Tez Türü: Tıpta Uzmanlık
- Konular: Endokrinoloji ve Metabolizma Hastalıkları, Genel Cerrahi, Endocrinology and Metabolic Diseases, General Surgery
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2012
- Dil: Türkçe
- Üniversite: Ege Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Genel Cerrahi Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 92
Özet
Amaç: Tiroid kanserinde morbidite ve mortaliteyi etkileyen risk faktörlerini ve bunların birbirleriyle ilişkilerini belirlemek, tedavi ve prognozu etkileyen faktörleri saptamak.Gereç ve yöntem: Aralık 1995 ile Aralık 2007 yılları arasında opere edilen ve tiroid kanseri tanısı alan ve takipte verilerine tam olarak ulaşılabilen 186 hasta retrospektif olarak irdelendi.Bulgular ve sonuç: Toplam 186 hastadan 42'sinde (%22.6) lokorejyonel nüks ve 5 (%2.7) hastada eksitus tespit edildi. Çalışma sonucunda istatistiksel olarak anlamlı tespit edilen prognoza etkili parametreler;1) En iyi hastalıksız sağkalım oranları papiller mikrokarsinomlu hastalarda tespit edilmiş olup bunu sırasıyla papiller kanser, medüller kanser ve folliküler kanserin takip ettiği belirlendi.2)Tümör çapının prognoza etkisine bakıldığında; en uzun hastalıksız sağkalım oranları 3cm %20) iken, 5 yıllık ortalama hastalıksız sağkalım oranlarının da en kötü bu grupta olduğu belirlendi On yıllık ortalama hastalıksız sağkalımın ise en kötü nodül >3cm olan hastalarda olduğu belirlendi.9)Preoperatif uygulanan medikal tedavi türüne göre; radyoaktif iyot alan hastalardaki nüks oranı en fazla (%50-medikal tedavi almamış hastalarda %18.8- hormonoterapi %27.3- antitiroid tedavi %16.7- hormonoterapi ve antitiroid tedavi %100) ve ortalama hastalıksız sağkalım oranlarının da en kötü bu grupta olduğu belirlendi.10)De Groot evreleme sistemine göre 4 gruba ayrılan hastalardan en iyi hastalıksız sağkalım oranlarının evre 1 hastalarda, en kötü oranların ise evre 4 hastalarda olduğu belirlendi.11)MACIS evreleme sistemine göre 4 gruba ayrılan hastalardan en iyi hastalıksız sağkalım oranlarının evre 1 hastalarda, en kötü oranların ise evre 4 hastalarda olduğu belirlendi.12)EORTC evreleme sistemine göre en iyi 5 yıllık ortalama hastalıksız sağkalım oranlarının evre 2 hastalarda, en iyi 10 yıllık ortalama hastalıksız sağkalım oranlarının evre 1 hastalarda, en kötü 5 yıllık ortalama hastalıksız sağkalım oranlarının evre 3 hastalarda, en kötü 10 yıllık ortalama hastalıksız sağkalım oranlarının ise evre 4 hastalarda olduğu belirlendi.
Özet (Çeviri)
Aim: To determine the factors that affect mortality and morbidity in thyroid cancers, and they relative impacts on the treatment and prognosis of each type of thyroid cancer Material and methods: Between December 1995 and April 2007 a retrospective study were made on the patiens operated for thyroid cancer. Among the patients present in the hospital database, only 186 were reached .Results: Among 186 patients included in the study, 42 patients developped a locoregional recurrence, 5 patients deceaded from the primary desease. Statistically significant prognostic factors on the survey and morbidity are mentioned above:1. The papillary microcarcinoma histologic type were found to have the best disease-free survival rate of the overall patients incoming the study, followed respectivelly by the papillary, medullary and folliculary thyroid carcinoma.2. Patients with small tumor (less than 1 cm of tumor size) had a better disease-free survival rate whereas patients whose tumor size was between 4.1-5 cm had a worse disease-free survival rate.3. The relation between the tumor invasion status and the locoregional recurrence was as follows: the recurrence rate in patients without invasion was 19.7%, 50% in patients with invasion of surrounding tissue, 50% in patients with vascular invasion. And the related disease-free survival rate average was better in patients with vascular invasion than with those in whom vascular invasion was not found.4. According to the number of lymph nodes metastasis, the presence of at least 2 metastatic lymph nodes was associated with a higher locoregional recurrence rate (66%) whereas the abesence of metastatic lymph nodes was associated with a lower locoregional recurrence rate (15%). The disease-free survival rate average was better in patients without lymph node metastatic disease than in those with at least 2 lymph nodes metastasis disease.5. According to the surgical procedure, the patients who underwent near total thyroidectomy had the lowest local reccurence rate (14%), and those who underwent completion thyroidectomy had the highest locat recurrence rate (44%). The 5 years disease-free survival rate was better in the bilateral total thyroidectomy group whereas the 10 years disease-free survival rate was better in the near total thyroidectomy group.6. Patients who presented with local compression related symptoms had the lowest recurrence rate (11.5%) but the bone metastasis and the related pathologic bone fracture group of patients presented the worst disease-free survival rate (100%).7. According to the frozen biopsy results, recurrence rate was found to be lower in patients whom frozen biopsy was not performed during the operation (21.7% of recurrence rate for patients without frozen biopsy, 36.4% for benign result of frozen biopsy, 25% for malignant result of frozen biopsy), whereas the 5 and 10 years disease-free survival rate was better in the patient group with malignant frozen biopsy result.8. According to tumor size as determined by ultrasonography, patients with nodules sized less than 1 cm had a higher local recurrence rate. Also this group of patients had the worst 5 years disease-free survival rate. But the 10 years disease?free survival rate was higher in the group with tumor size bigger than 3 cm.9. According to the type of preoperative medical treatment recieved, postoperative iodine ablation therapy group had a higher recurrence rate (50 % of recurrence for this group, 18.8% the patients without preoperative medication, 27.3% for the hormonotherapy group, 16.7% for the antithyroid medication group, 100% for the hormonotherapy-antithyroid medication group) and the average disease-free survival rates were determined to be the worst in this group.10. According to the De Groot staging system, the stage I group of patients presented with the best disease-free survival rate whereas the stage IV patients group had the worst disease-free survival rate.11. According to the MACIS staging system, the stage I group of patients presented with the best disease-free survival rate whereas the stage IV patients group had the worst disease-free survival rate.12. According to the EORTC staging system, the stage II group of patients presented the best 5 years disease-free survival rate whereas the stage III group of patients presented the worst 5 years disease-free survival rate, the stage I group of patients presented the best 10 years survival rate whereas the the stage IV group of patients presented the worst 10 years disease-free survival rate.
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