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ࡢࣜࣥࣃ⾜ᛶ㌿⛣ࡀࡳࡽࢀࡿ⒴࡛࠶ࡿࡶࢃࡽࡎࠊ ࡚ࡢ⒴ࡢ୰࡛᭱ࡶணᚋࡢⰋ࠸⒴ࡢ࠺ࡕࡢࡦࡘ࡛࠶ࡿࠋ ࡉࡽࠊ⏥≧⭢ࡀࢇࡢணᚋ㛵ࡋ࡚ࣜࣥࣃ⠇㌿⛣ࡣணᚋࡢ༴㝤ᅉᏊࡋ࡚ከࡃࡢศ㢮 ࡣྵࡲࢀ࡚࠸࡞࠸ࠋ ┠ⓗ㸸⚾㐩ࡣ࡞ࡐ⏥≧⭢ங㢌⒴ࡣࣜࣥࣃ⠇㌿⛣ࡀ࠶ࡿࡶ㛵ࢃࡽࡎணᚋࡀ࠸࠸ࡢ࠸࠺ࡇ ၥࢆឤࡌࠊᩥ⊩ⓗ⪃ᐹࢆຍ࠼ࠊ┿ഇࢆ☜ࡵࡿࡇࡋࡓࠋ ࣜࣥࣃ⠇ࡣᕥᅗࡢࡼ࠺እഃ༊ᇦࣜࣥࣃ⠇ࠊ୰ኸ༊ᇦࣜࣥࣃ⠇ ศࡅࡽࢀࡿࠋ 㸸እഃ༊ᇦࣜࣥࣃ⠇ 㸸୰ኸ༊ᇦࣜࣥࣃ⠇ ࡞࠾ࠊ⏥≧⭢ங㢌⒴࡛ࡣࢇࡢ୰ኸ༊ᇦࣜࣥࣃ⠇㌿⛣ࡀぢࡽࢀࡿࡓࡵ᭷ពᕪࡀ ⏕ࡌ࡞࠸ࠋࡼࡗ࡚ୖグ♧ࡋࡓእഃ༊ᇦࣜࣥࣃ⠇ࡘ࠸᳨࡚ドࡍࡿࠋ 46 ⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ ᪉ἲ㸸௨ୗࡘ࠸࡚ᩥ⊩ⓗ⪃ᐹ ձ⭘⒆ᚄูࡢእഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ᭷↓ࢆ⏥≧⭢ங㢌⒴ᝈ⪅ 1231 ࡢࢹ࣮ࢱࢆඖࠊ ࢢࣛࣇࢆసᡂࡋࠊ⪃ᐹࡍࡿࠋ ղ⭘⒆ࡢࡁࡉணᚋࡘ࠸࡚⏥≧⭢ங㢌⒴ᝈ⪅ 5917 ࡢࢹ࣮ࢱࢆඖࠊࢢࣛࣇࢆసᡂࡋࠊ ⪃ᐹࡍࡿࠋ ࡞࠾ࠊ⚾ࡓࡕࡢᣦࡍணᚋࡣ Ⓨணᚋ㸸disease-free survival㸦DFS㸧 㸸⾡ᚋࠊ⒴ࡀⓎࡏࡎ↓࡛࠶ࡗࡓྜࢆ♧ࡍ ⏕ணᚋ㸸cause-specific survival㸦CSS㸧 㸸⾡ᚋࡢ⏕Ꮡࡋ࡚࠸ࡿྜࢆ♧ࡍ ࡍࡿࠋ ⤖ᯝ㸸ձ⭘⒆ᚄูࡢእഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡢ᭷↓ ࣜࣥࣃ⠇㌿⛣ࡢ᭷ࡿࡣࠊ⭘⒆ᚄ㸯cm ௨ୗ࡛ࡣయࡢ 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 ௨ୖࡽࠊ⭘⒆ᚄࡀࡁ࠸እഃ༊ᇦࣜࣥࣃ⠇ࡢ㌿⛣ࡢྜࡀቑຍࡋ࡚࠸ࡿࡇࡀࢃࡿࠋ ղ⭘⒆ᚄࡢࡁࡉணᚋ እഃ༊ᇦࣜࣥࣃ⠇ࡶ㌿⛣ࡢ᭷ࡿࡣࠊ⭘⒆ᚄ㸯cm ௨ୗ࡛ࡣయࡢ 12%ࠊ1.1㹼2.0cm ࡛ࡣ 15%ࠊ2.1㹼3.0cm ࡛ࡣ 20%ࠊ3.1cm ௨ୖ࡛ࡣ 27%࡛࠶ࡾࠊࡇࡕࡽࡢࢹ࣮ࢱࡶ๓㏙ձྠᵝ⭘⒆ ᚄࡀࡁ࠸እഃ༊ᇦࣜࣥࣃ⠇ࡢ㌿⛣ࡢྜࡀቑຍࡋ࡚࠸ࡿࡇࡀࢃࡿࠋ 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ࡽࢀࡿࠊእഃ༊ᇦ ࣜࣥࣃ⠇㌿⛣ࡶ㌿⛣ࡢࡳࡽࢀࡿࢆẚ㍑ࡍࡿࠊእഃ༊ᇦࣜࣥࣃ⠇ࡶ㌿⛣ࡢぢࡽࢀࡿ ࡢ᪉ࡀࠊⓎ⋡ࡀ㧗ࡃࠊ⭘⒆ᚄࡀࡁࡃ࡞ࡿ᭷ពᕪࡣࡁࡃ࡞ࡿࡇࡀࢃࡿࠋ 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࠶ࡿ࡛ࡣ 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 ྠᵝࣜࣥࣃ⠇㌿⛣ࡢぢࡽࢀ࡞࠸ࠊࡶࡋࡃࡣ୰ኸ༊ᇦࣜࣥࣃ⠇ ㌿⛣ࡢぢࡽࢀࡿࠊእഃ༊ᇦࣜࣥࣃ⠇㌿⛣ࡶ㌿⛣ࡢࡳࡽࢀࡿࢆẚ㍑ࡍࡿࠊእഃ༊ ᇦࣜࣥࣃ⠇ࡶ㌿⛣ࡢぢࡽࢀࡿࡢ᪉ࡀࠊṚஸ⋡ࡀ㧗ࡃࠊ⭘⒆ᚄࡀࡁࡃ࡞ࡿ᭷ពᕪࡣࡁ ࡃ࡞ࡿࡇࡀࢃࡿࠋ 49 ⏥≧⭢ங㢌⒴ࣜࣥࣃ⠇㌿⛣ࡢணᚋ ⪃ᐹ㸸ࣜࣥࣃ⠇㌿⛣ࡀ࠶ࡗ࡚ࡶணᚋࡀ࠸࠸ࡢ⤖ㄽࡣ㛫㐪࠸࡛࠶ࡾࠊ⭘⒆ࡀࡁࡃ࡞ࡿእഃ༊ᇦ ࣜࣥࣃ⠇㌿⛣ࡣቑຍࡋࠊ⭘⒆Ⓨ⋡ࡶቑຍࠊ⏕ணᚋࡶᝏࡍࡿࠋࡼࡗ࡚⚾ࡓࡕࡣ⏥≧⭢ங 㢌⒴࠾࠸࡚ࠊࣜࣥࣃ⠇㌿⛣ࡣணᚋࡢ༴㝤ᅉᏊ࡞ࡿ⪃࠼ࡿࠋ ௨ୖࡼࡾࠊ⏥≧⭢ங㢌⒴ࡣࡢ⭘⒆ྠᵝ࡛ࡁࡿࡔࡅ᪩ᮇデ᩿⒪ࡍࡿࡇࡀᮃࡲࡋ࠸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
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