DataSheet_1_Surgical resection of recurrent differentiated thyroid cancer: patterns, detection, staging, and treatment of 683 patients.pdf

BackgroundDespite improvements in overall survival, the recurrence of differentiated thyroid cancer (DTC) is becoming more common and remains a challenge necessitating accurate reappraisal of the patient. This study aimed to describe the characteristics, reasons, morbidity, and strategies of second operations for DTC.
MethodsThis was a retrospective observational study of patients with DTC who underwent a second surgery between June 2008 and June 2021 in the Department of Thyroid Surgery at China–Japanese Union Hospital, Jilin University, P.R. China. All clinical characteristics were recorded, and the analysis was estimated using SPSS.
ResultsSecond surgeries were detected in 683 patients. The proportion of second operations changed with the update of international guidelines from 2015 (P < 0.001). The true recurrence rate progressively increased from 21.3% to 61.5%. The rate of an “absence of preoperative FNA” or an “absence of intraoperative pathology at first surgery” decreased from 49.8% to 12.7%, while that of a “misdiagnosis of preoperative FNA at second surgery” decreased from 10% to 1.8%. The most common tumor location during the second surgery was the lateral lymph nodes (n = 104, 36.5%), with a median time to relapse of 36 months. Completion of thyroidectomy and lymph node dissection correlated with the second operation.
ConclusionAfter 2015, second surgeries were more standardized, the incidence of complications decreased, and real recurrence became the most common reason for a second DTC surgery.

背景 尽管分化型甲状腺癌（differentiated thyroid cancer, DTC）患者的总生存期已有所改善，但其复发率却逐年升高，仍是亟待解决的临床难题，亟需对患者开展精准的重新评估。本研究旨在阐述分化型甲状腺癌二次手术的特征、诱因、发病情况及应对策略。
方法 本研究为回顾性观察研究，纳入了2008年6月至2021年6月期间，于中国吉林大学中日联谊医院甲状腺外科接受二次手术的分化型甲状腺癌患者。研究收集了所有患者的临床特征数据，并采用SPSS统计软件进行数据分析。
结果 本研究共纳入683例接受二次手术的患者。随着2015版国际诊疗指南的更新，二次手术的占比发生了显著变化（P < 0.001）。真实复发率从21.3%逐步升高至61.5%。"术前未行细针穿刺活检（fine-needle aspiration, FNA）"或"首次手术未行术中病理检查"的占比从49.8%降至12.7%，而"二次手术时发现术前FNA诊断失误"的占比从10%降至1.8%。二次手术中最常见的肿瘤累及部位为侧颈淋巴结（n=104，36.5%），患者复发中位时间为36个月。二次手术与甲状腺全切术及淋巴结清扫术存在相关性。
结论 2015年之后，分化型甲状腺癌二次手术的操作更趋规范，并发症发生率降低，且真实复发成为二次手术的最主要诱因。