ANALYSIS OF CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF PATIENTS AND THE PROGNOSIS OF COMPLEX TREATMENT OF LOCALLY ADVANCED T3B-4A MALIGNANT TUMORS OF THE THYROID GLAND WITH INVASION IN THE PRETHYROID MUSCLES, SUBCUTANEOUS TISSUE AND SKIN
DOI:
https://doi.org/10.21856/j-PEP.2025.1.01Keywords:
malignant tumors of the thyroid gland, invasion of the prethyroid muscles, spread of the tumor into the subcutaneous tissue and skin, treatmentAbstract
Local spread of a thyroid tumor into the prethyroid muscles is the most common type of invasion among malignant thyroid tumors (52-66%). Such patients require a detailed analysis, taking into account the morphological differentiation of the tumor and the extent of its spread to optimize complex treatment and surgical tactics.
The aim. Analysis of the general characteristics of patients with locally disseminated malignant tumors of the thyroid gland T3b with initial invasion of the tumor into the prethyroid muscles and T4a with a more widespread spread of the tumor into the subcutaneous fascia and tissue and layers of the skin, in comparison with the control group, taking into account the morphological structures and the degree of spread tumors.
Materials and methods. During 2004-2021, 2110 patients with malignant tumors of the thyroid gland were treated: 1786 patients without invasion (T1-3a); 160 patients with invasion of the prethyroid muscles (T3b); 19 patients with invasion of the subcutaneous fascia, tissue and skin (T4a) and 145 had other invasions that did not involve the skin and subcutaneous tissue, but affected other organs of the neck (T4a-b), which was not the subject of our study in this work. All patients underwent clinical, biochemical, hormonal and instrumental research methods, as well as molecular-genetics of cytological material, and, if necessary, immunohistochemical examination. Data were presented as n (%) with Pearson's. The critical significance level is p<0.05.
The results. It was found that the patients of the groups of invasive tumors had an older average age, there was a predominance of men, and a higher percentage of regional and distant metastasis and low morphological differentiation of tumors was observed.
Conclusions. The listed factors significantly worsen the prognosis of the treatment of patients, which indicates the need for "aggressive", maximally radical surgical interventions as part of the complex treatment of patients with extrathyroidal spread of the tumor, even with minimal invasion of the prethyroid muscles.
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