原发性甲状腺鳞状细胞癌的临床诊治及生存分析

发布时间：2018-06-26 22:39

本文选题：原发性甲状腺鳞状细胞癌 + 甲状腺超声检查　；参考：《北京协和医学院》2016年硕士论文

【摘要】：研究目的总结原发性甲状腺鳞状细胞癌(PSCCT)临床、B超、病理及免疫组化特点,分析PSCCT的生存状态及影响生存因素。研究方法检索1983年1月至2015年11月近33年期间北京协和医院收治和同期中国知网、万方、维普数据库报道PSCCT病例,就临床诊治、甲状腺超声特点、病理及免疫组化进行回顾性分析。对临床资料完整、有随访结果者采用SPSS 20.0 Kaplan-Meier法及Log-rank检验模型、COX回归模型进行生存分析。结果1、33年协和医院的PSCCT患者8例,占同期甲状腺癌的0.07%。临床分析：男性2例,女性6例。平均年龄52岁。首发症状为颈部肿物增大5例,体检发现甲状腺结节3例。首诊时淋巴结转移7例(87.5%),远处转移2例(25.0%)。治疗方式包括单纯手术4例,手术联合术后放2例,手术联合术后化疗1例,放疗联合化疗1例。1年、2年和5年生存率分别为57.1%,38.1%,38.1%。2、中国大陆地区33例PSCCT甲状腺超声特点分析显示：均表现为甲状腺结节(100%),其中囊实性结节(18.9%)或实性结节(81.1%);回声不均(86.5%)；形态不规则(92.3%)、边界不清(71.9%)；少有钙化(68.8%),靠近或突破被膜；少血供(80.0%)。3、中国大陆地区59例PSCCT病理分析：可合并乳头状癌、脓肿、滤泡癌。41例免疫组化分析：CK, CK10, CK-H, CK5/6, EMA, p63, p53, AE1/AE3多阳性,Ki67指数较高。Tg/TTF-1偶可阳性。3、中国大陆地区66例PSCCT生存分析显示：平均年龄为58.0岁,男：女=21：45；常见首发症状为颈部增粗(84.8%)。首诊86.4%T4,25.7%N1,9.1%M1。1年、2年、5年生存率分别为39.4%,20.9%,10.7%,中位生存期为7个月(95%Cl 2.983-11.017)。手术后局部复发占43.9%。主要死因气道梗阻所致窒息、全身衰竭。经Log-rank单因素分析示预后因素是年龄(P=0.024)、原发灶最大径(P=0.04)、是否放疗(P=0.005)；经COX多因素回归分析,仅放疗(P=0.011,HR=0.441)可改善预后。结论PSCCT虽然是少见的甲状腺恶性肿瘤,但浸润多、进展快,预后差,生存期短,死亡率高,超声少有钙化、血流稀疏,应提高认识,早期诊断,积极治疗,综合治.疗。术后放疗可能改善预后。
[Abstract]:Objective to summarize the clinical, B-ultrasound, pathological and immunohistochemical features of primary thyroid squamous cell carcinoma (PSCCT), and to analyze the survival status and influencing factors of PSCCT. Methods to retrieve PSCCT cases reported from January 1983 to November 2015 in Beijing Union Hospital and the data base of Wanfang and Weipu. The clinical diagnosis and treatment of PSCCT and the characteristics of thyroid ultrasound were analyzed. Pathology and immunohistochemistry were analyzed retrospectively. Patients with complete clinical data were analyzed with SPSS 20.0 Kaplan-Meier method and Cox regression model of Log-rank test. Results eight patients with PSCCT in Union Hospital for 33 years accounted for 0.07% of thyroid carcinoma in the same period. Clinical analysis: male 2 cases, female 6 cases. The average age is 52. The first symptom was cervical tumor enlargement in 5 cases and thyroid nodule in 3 cases by physical examination. Lymph node metastasis was found in 7 cases (87.5%) and distant metastasis in 2 cases (25.0%). The methods of treatment included simple operation in 4 cases, postoperative radiotherapy in 2 cases and postoperative chemotherapy in 1 case. The 1-year, 2-year and 5-year survival rates were 57.1%, 38.1% and 38.1%, respectively. The ultrasonographic features of 33 cases of PSCCT in mainland China were as follows: thyroid nodules (100%), cystic and solid nodules (18.9%), solid nodules (81.1%), uneven echo (86.5%). Irregular shape (92.3%), unclear border (71.9%), rare calcification (68.8%), close to or breaking through the capsule, low blood supply (80.0%) .3.The pathological analysis of 59 cases of PSCCT in mainland China: papillary carcinoma, abscess, Immunohistochemical analysis of 41 cases of follicular carcinoma: 1% CK10, CK-HK, CK5 / 6, EMA, p63, p53, AE1 / AE3 polypositivity. Ki67 index was higher. The survival analysis of 66 PSCCT patients in mainland China showed that the mean age was 58.0 years, male: female: 2145, and the most common symptom was neck thickening (84.8%). The survival rates for the first time were 39.4%, 20.9% and 10.7%, respectively. The median survival time was 7 months (95Cl 2.983-11.017). Local recurrence was 43.9% after operation. The main causes of death were asphyxia and systemic failure caused by airway obstruction. Log-rank univariate analysis showed that the prognostic factors were age (P0. 024), primary tumor maximum diameter (P0. 04) and radiotherapy (P0. 005), and by Cox multivariate regression analysis, only radiotherapy (P0. 011 / HR0. 441) could improve the prognosis. Conclusion although PSCCT is a rare thyroid malignant tumor, it has many infiltrations, rapid progression, poor prognosis, short survival time, high mortality, rare calcification by ultrasound, sparse blood flow, and should be recognized, diagnosed early, treated actively and treated comprehensively. Therapy. Postoperative radiotherapy may improve prognosis.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R736.1

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