12例甲状腺髓样癌合并乳头状癌患者的临床病理特征分析

Analysis of the clinicopathological characteristics of 12 patients with medullary thyroid cancer coexistent with papillary thyroid cancer

摘要:

目的 本研究旨在分析甲状腺髓样癌合并乳头状癌（MTC-PTC）患者的临床病理特征与预后，并与单纯甲状腺髓样癌（MTC）患者进行比较。方法 本研究采用回顾性分析，收集2003年1月—2025年10月辽宁省肿瘤医院头颈外科收治的12例MTC-PTC患者（设为MTC-PTC组）及89例单纯MTC患者（设为MTC组）的临床病理资料，比较两组的临床病理特征与预后差异。结果 MTC-PTC占本中心同期收治MTC总病例数的 11.9%(12/101)，该病好发于中老年女性人群，平均发病年龄为54岁。本研究纳入的病例中，MTC病灶与PTC病灶多共存于同侧甲状腺腺叶（占比58.3%），MTC病灶平均直径为1.1 cm，PTC病灶平均直径为0.8 cm，微小癌占比偏高（MTC微小癌占比58.3%，PTC微小癌占比75.0%）。与单纯MTC组比较，MTC-PTC组的肿瘤最大径更小（P= 0.010），双侧腺体受累比例更高（P=0.003），甲状腺被膜侵犯发生率更高（P=0.046），颈侧区淋巴结转移率（P=0.029）更低，颈侧区阳性转移淋巴结数目（P=0.039）更少；淋巴结转移灶的病理成分与原发灶最大肿瘤的病理类型高度一致。微小癌患者中，MTC-PTC组与MTC组比较，各项临床病理学特征差异均无统计学意义（P>0.05）。随访结果提示，MTC-PTC组仅 1例出现肿瘤复发，其余患者均未观察到复发及死亡事件发生。结论 MTC-PTC患者的治疗原则需遵循MTC的诊治规范，患者术后应定期监测血清降钙素和甲状腺球蛋白水平。由于本病临床发病率较低，本研究所得结论仍有待多中心、大样本量研究进一步验证。

Abstract:

Objective To analyze the clinicopathological characteristics and prognosis of patients with medullary thyroid cancer coexistent with papillary thyroid cancer (MTC-PTC), and to conduct a comparison between patients with MTC-PTC and those with pure medullary thyroid cancer (MTC). Methods A retrospective analysis was conducted on clinical data of 12 patients with MTC-PTC (MTC-PTC group) and 89 patients with MTC (MTC group) admitted to the Department of Head and Neck Surgery, Liaoning Cancer Hospital from January 2003 to October 2025. The clinicopathological features and prognosis were compared between the two groups. Results MTC-PTC accounted for 11.9% (12/101) of the total MTC patients treated in our center during the study period. MTC-PTC occurred predominantly in middle-aged and elderly female populations, with a mean age of onset of 54 years. Among the cases included in this study, the MTC lesions and PTC lesions were often found to coexist in the same thyroid lobe (accounting for 58.3%). The average diameters of the MTC lesion and the PTC lesion were 1.1 cm and 0.8 cm, respectively. And the proportion of microcarcinomas was relatively high (58.3% for MTC and 75.0% for PTC). Compared with the MTC group, the MTC-PTC group showed smaller maximum diameter of the tumor (P=0.010), more frequent bilaterality (P=0.003), higher rates of thyroid capsular invasion (P=0.046), but lower rates of lateral lymph node metastasis (P=0.029) and fewer metastatic lymph nodes (P=0.039). The histological type of lymph node metastasis was highly consistent with the dominant tumor component. No significant differences were observed between the micro-MTC-PTC and micro-MTC groups in the clinicopathological features (all P>0.05). During follow-up, only one patient in the MTC-PTC group experienced recurrence, but no deaths occurred. Conclusions The therapeutic strategy for MTC-PTC should follow the principles established for MTC, and regular postoperative monitoring of serum calcitonin and thyroglobulin levels is recommended. Due to the rarity of this entity, the conclusions obtained from this study still need to be further verified by multi-center large-sample studies.