甲状腺乳頭癌リンパ節転移の予後

45
⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ
཭ᯇ భድࠊ㛗㇂ᕝ ᪩⣖ࠊ᫂฼ ⨾㔛
㸦⑓⌮ᙧែ⣔◊✲ࢢ࣮ࣝࣉࠊᣦᑟᩍဨ㸸ぬ㐨 ೺୍㸧
ࡣࡌࡵ࡟㸸⏥≧⭢ங㢌⒴ࡣ㏻ᖖ 60㸣ࡢ⑕౛࡟ࣜࣥࣃ⾜ᛶ㌿⛣ࡀࡳࡽࢀࡿ⒴࡛࠶ࡿ࡟ࡶ࠿࠿ࢃࡽࡎࠊ
඲࡚ࡢ⒴ࡢ୰࡛᭱ࡶணᚋࡢⰋ࠸⒴ࡢ࠺ࡕࡢࡦ࡜ࡘ࡛࠶ࡿࠋ
ࡉࡽ࡟ࠊ⏥≧⭢ࡀࢇࡢணᚋ࡟㛵ࡋ࡚ࣜࣥࣃ⠇㌿⛣ࡣணᚋ࡬ࡢ༴㝤ᅉᏊ࡜ࡋ࡚ከࡃࡢศ㢮࡟
ࡣྵࡲࢀ࡚࠸࡞࠸ࠋ
┠ⓗ㸸⚾㐩ࡣ࡞ࡐ⏥≧⭢ங㢌⒴ࡣࣜࣥࣃ⠇㌿⛣ࡀ࠶ࡿ࡟ࡶ㛵ࢃࡽࡎணᚋࡀ࠸࠸ࡢ࠿࡜࠸࠺ࡇ࡜࡟␲
ၥࢆឤࡌࠊᩥ⊩ⓗ⪃ᐹࢆຍ࠼ࠊ┿ഇࢆ☜࠿ࡵࡿࡇ࡜࡜ࡋࡓࠋ
ࣜࣥࣃ⠇ࡣᕥᅗࡢࡼ࠺࡟እഃ༊ᇦࣜࣥࣃ⠇ࠊ୰ኸ༊ᇦࣜࣥࣃ⠇
࡟ศࡅࡽࢀࡿࠋ
㸸እഃ༊ᇦࣜࣥࣃ⠇
㸸୰ኸ༊ᇦࣜࣥࣃ⠇ ࡞࠾ࠊ⏥≧⭢ங㢌⒴࡛ࡣ࡯࡜ࢇ࡝ࡢ⑕౛࡟୰ኸ༊ᇦࣜࣥࣃ⠇࡟㌿⛣ࡀぢࡽࢀࡿࡓࡵ᭷ពᕪࡀ
⏕ࡌ࡞࠸ࠋࡼࡗ࡚ୖグ࡟♧ࡋࡓእഃ༊ᇦࣜࣥࣃ⠇࡟ࡘ࠸᳨࡚ドࡍࡿࠋ
46 ⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ
᪉ἲ㸸௨ୗ࡟ࡘ࠸࡚ᩥ⊩ⓗ⪃ᐹ
ձ⭘⒆ᚄูࡢእഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ᭷↓ࢆ⏥≧⭢ங㢌⒴ᝈ⪅ 1231 ⑕౛ࡢࢹ࣮ࢱࢆඖ࡟ࠊ
ࢢࣛࣇࢆసᡂࡋࠊ⪃ᐹࡍࡿࠋ
ղ⭘⒆ࡢ኱ࡁࡉ࡜ணᚋ࡟ࡘ࠸࡚⏥≧⭢ங㢌⒴ᝈ⪅ 5917 ⑕౛ࡢࢹ࣮ࢱࢆඖ࡟ࠊࢢࣛࣇࢆసᡂࡋࠊ
⪃ᐹࡍࡿࠋ
࡞࠾ࠊ⚾ࡓࡕࡢᣦࡍணᚋ࡜ࡣ
෌Ⓨணᚋ㸸disease-free survival㸦DFS㸧
㸸⾡ᚋࠊ⒴ࡀ෌Ⓨࡏࡎ࡟↓⑓࡛࠶ࡗࡓ๭ྜࢆ♧ࡍ
⏕࿨ணᚋ㸸cause-specific survival㸦CSS㸧
㸸⾡ᚋࡢ⏕Ꮡࡋ࡚࠸ࡿ๭ྜࢆ♧ࡍ
࡜ࡍࡿࠋ
⤖ᯝ㸸ձ⭘⒆ᚄูࡢእഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ᭷↓
ࣜࣥࣃ⠇㌿⛣ࡢ᭷ࡿ⑕౛ࡣࠊ⭘⒆ᚄ㸯cm ௨ୗ࡛ࡣ඲యࡢ 40%ࠊ1.1㹼2.0cm ࡛ࡣ 52%ࠊ2.1㹼
3.0cm ࡛ࡣ 70%ࠊ3.1㹼4.0cm ࡛ࡣ 78%ࠊ4.0cm ௨ୖ࡛ࡣ 86%࡛࠶ࡗࡓࠋ
௨ୖ࠿ࡽࠊ⭘⒆ᚄࡀ኱ࡁ࠸࡯࡝እഃ༊ᇦࣜࣥࣃ⠇࡬ࡢ㌿⛣ࡢ๭ྜࡀቑຍࡋ࡚࠸ࡿࡇ࡜ࡀࢃ࠿ࡿࠋ
ղ⭘⒆ᚄࡢ኱ࡁࡉ࡜ணᚋ
እഃ༊ᇦࣜࣥࣃ⠇࡟ࡶ㌿⛣ࡢ᭷ࡿ⑕౛ࡣࠊ⭘⒆ᚄ㸯cm ௨ୗ࡛ࡣ඲యࡢ 12%ࠊ1.1㹼2.0cm ࡛ࡣ
15%ࠊ2.1㹼3.0cm ࡛ࡣ 20%ࠊ3.1cm ௨ୖ࡛ࡣ 27%࡛࠶ࡾࠊࡇࡕࡽࡢࢹ࣮ࢱࡶ๓㏙ձྠᵝ࡟⭘⒆
ᚄࡀ኱ࡁ࠸࡯࡝እഃ༊ᇦࣜࣥࣃ⠇࡬ࡢ㌿⛣ࡢ๭ྜࡀቑຍࡋ࡚࠸ࡿࡇ࡜ࡀࢃ࠿ࡿࠋ
47 ⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ
Kaplan-Meier curves for disease-free survival of N1b and N0 or N1a patients
with carcinoma ≦1.0cm,1.1-2.0cm,2.1-3.0cm,and>3.0cm
እഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ᭷ࡿᝈ⪅㸦Ⅼ⥺㸧࡛ࡣ 15 ᖺ෌Ⓨணᚋࡀࠊ⭘⒆ᚄ㸯cm ௨ୗ࡛ࡣ⣙ 80%ࠊ1.1
㹼2.0cm ࡛ࡣ⣙ 72%ࠊ2.1㹼3.0cm ࡛ࡣ⣙ 68%ࠊ3.0cm ௨ୖ࡛ࡣ⣙ 50㸣࡛࠶ࡗࡓࠋ
ࣜࣥࣃ⠇㌿⛣ࡢ࡞࠸ࠊࡶࡋࡃࡣ୰ኸ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ࠶ࡿ⑕౛㸦ᐇ⥺㸧࡛ࡣ 15 ᖺ෌Ⓨணᚋࡀࠊ⭘
⒆ᚄ㸯cm ௨ୗ࡛ࡣ⣙ 95%ࠊ1.1㹼2.0cm ࡛ࡣ⣙ 92%ࠊ2.1㹼3.0cm ࡛ࡣ⣙ 84%ࠊ3.0cm ௨ୖ࡛ࡣ⣙
78%࡛࠶ࡗࡓࠋ
ࡼࡗ࡚ࣜࣥࣃ⠇㌿⛣ࡢぢࡽࢀ࡞࠸ࠊࡶࡋࡃࡣ୰ኸ༊ᇦࣜࣥࣃ⠇࡟㌿⛣ࡢぢࡽࢀࡿ⑕౛࡜ࠊእഃ༊ᇦ
ࣜࣥࣃ⠇㌿⛣࡟ࡶ㌿⛣ࡢࡳࡽࢀࡿ⑕౛࡜ࢆẚ㍑ࡍࡿ࡜ࠊእഃ༊ᇦࣜࣥࣃ⠇࡟ࡶ㌿⛣ࡢぢࡽࢀࡿ⑕౛
ࡢ᪉ࡀࠊ෌Ⓨ⋡ࡀ㧗ࡃࠊ⭘⒆ᚄࡀ኱ࡁࡃ࡞ࡿ࡯࡝᭷ពᕪࡣ኱ࡁࡃ࡞ࡿࡇ࡜ࡀࢃ࠿ࡿࠋ
48 ⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ
ӌ
Kaplan-Meier curves for cause-specific survival of N1b and N0 or N1a patients
with carcinoma ≦1.0cm,1.1-2.0cm,2.1-3.0cm,and>3.0cm
እഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ᭷ࡿᝈ⪅࡛ࡣ 15 ᖺ⏕࿨ணᚋࡀࠊ⭘⒆ᚄ㸯cm ௨ୗ࡛ࡣ⣙ 100%ࠊ1.1㹼2.0cm
࡛ࡣ⣙ 100%ࠊ2.1㹼3.0cm ࡛ࡣ⣙ 98%ࠊ3.0cm ௨ୖ࡛ࡣ⣙ 95㸣࡛࠶ࡗࡓࠋ
ࣜࣥࣃ⠇㌿⛣ࡢ࡞࠸ࠊࡶࡋࡃࡣ୰ኸ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ࠶ࡿ⑕౛࡛ࡣ 15 ᖺ෌Ⓨணᚋࡀࠊ⭘⒆ᚄ㸯cm
௨ୗ࡛ࡣ⣙ 98%ࠊ1.1㹼2.0cm ࡛ࡣ⣙ 90%ࠊ2.1㹼3.0cm ࡛ࡣ⣙ 90%ࠊ3.0cm ௨ୖ࡛ࡣ⣙ 90%࡛࠶
ࡗࡓࠋ
ࡇࡕࡽࡢ CSS ࡟࠾࠸࡚ࡶࠊDFS ࡜ྠᵝ࡟ࣜࣥࣃ⠇㌿⛣ࡢぢࡽࢀ࡞࠸ࠊࡶࡋࡃࡣ୰ኸ༊ᇦࣜࣥࣃ⠇
࡟㌿⛣ࡢぢࡽࢀࡿ⑕౛࡜ࠊእഃ༊ᇦࣜࣥࣃ⠇㌿⛣࡟ࡶ㌿⛣ࡢࡳࡽࢀࡿ⑕౛࡜ࢆẚ㍑ࡍࡿ࡜ࠊእഃ༊
ᇦࣜࣥࣃ⠇࡟ࡶ㌿⛣ࡢぢࡽࢀࡿ⑕౛ࡢ᪉ࡀࠊṚஸ⋡ࡀ㧗ࡃࠊ⭘⒆ᚄࡀ኱ࡁࡃ࡞ࡿ࡯࡝᭷ពᕪࡣ኱ࡁ
ࡃ࡞ࡿࡇ࡜ࡀࢃ࠿ࡿࠋ
49 ⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ
⪃ᐹ㸸ࣜࣥࣃ⠇㌿⛣ࡀ࠶ࡗ࡚ࡶணᚋࡀ࠸࠸࡜ࡢ⤖ㄽࡣ㛫㐪࠸࡛࠶ࡾࠊ⭘⒆ࡀ኱ࡁࡃ࡞ࡿ࡜እഃ༊ᇦ
ࣜࣥࣃ⠇㌿⛣ࡣቑຍࡋࠊ⭘⒆෌Ⓨ⋡ࡶቑຍࠊ⏕࿨ணᚋࡶᝏ໬ࡍࡿࠋࡼࡗ࡚⚾ࡓࡕࡣ⏥≧⭢ங
㢌⒴࡟࠾࠸࡚ࠊࣜࣥࣃ⠇㌿⛣ࡣணᚋ࡬ࡢ༴㝤ᅉᏊ࡟࡞ࡿ࡜⪃࠼ࡿࠋ
௨ୖࡼࡾࠊ⏥≧⭢ங㢌⒴ࡣ௚ࡢ⭘⒆࡜ྠᵝ࡟࡛ࡁࡿࡔࡅ᪩ᮇ࡟デ᩿἞⒪ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋ
ཧ⪃ᩥ⊩㸸
࣭ Fukushima M, ௚ :Prognostic impact of extrathyroid extension and clinical lymph node
metastasis in papillary thyroid carcinoma depend on carcinoma size㸸World J Surg 2010
࣭Kim TY,௚:Prognostic parameters for recurrence of papillary thyroid microcarcinoma㸸BMC
Cancer 2008
࣭⏥≧⭢እ⛉◊✲఍㸸⏥≧⭢⒴ྲྀᢅ࠸つ⣙ ➨㸴∧㸸㔠ཎฟ∧ᰴᘧ఍♫
࣭᪥ᮏෆศἪ࣭⏥≧⭢እ⛉Ꮫ఍㞧ㄅ June2012 Vol.29 ,No.2 p123-125
࣭ᆏᮏ ✕ᙪ,௚㸸ᶆ‽⑓⌮Ꮫ ➨㸲∧㸸་Ꮫ᭩㝔