伴分化型病理表现的未分化型甲状腺癌临床分析

发布时间：2018-09-01 18:15

【摘要】：目的:分析病理中同时存在分化型甲状腺癌(Differentiated Thyroid Carcinoma,DTC)和未分化型甲状腺癌(Anaplastic Thyroid Cancer,ATC)的患者,研究其临床表现、预后转归。并对未分化甲状腺癌的可能病因及预后的影响因素进行探讨。方法:回顾性分析从2006-10-01至2016-10-01中国医学科学院肿瘤医院头颈外科收治并完成手术治疗,术后病理存在ATC者且有完整就诊病历资料的共33例。按术后病理中是否共存DTC成分分为两组,即共存组和单纯未分化组。其中共存组17例,单纯未分化组16例,比较两组患者就诊首发症状、肿瘤特征、手术切除范围及彻底性、综合治疗情况、预后等因素差异,并分析各因素对所有甲状腺未分化癌预后的影响。结果:单纯未分化组中位生存期3月,共存组中位生存期6个月,但差异无统计学意义。单纯未分化组就诊首发症状存在颈部肿块者11例,从出现症状到就诊的中位时间为2.5个月,术前7例患者出现声带单侧固定,7例出现肺转移,根治性切除者9例,姑息性切除7例,单纯手术者7例,采用综合治疗者9例。共存组就诊首发症状存在颈部肿块者12例,从出现症状到就诊的中位时间为2.0个月,术前7例患者出现声带单纯固定,5例出现肺转移,根治性切除者8例,姑息性切除9例,单纯手术者10例,采用综合治疗者7例。对所有33例未分化癌进行单因素分析,首发症状包括颈部肿物、原发灶最大径大于5cm、未采用综合治疗方案的病人预后差。多因素分析发现首发症状包括颈部肿物是影响ATC预后的独立危险因素。结论:伴分化型病理表现的未分化甲状腺癌临床表现与单纯未分化甲状腺癌相仿,预后差异无统计学意义。对于甲状腺未分化癌,首发症状包括颈部肿物、肿物直径大于5cm、未采用综合治疗是影响预后的重要因素,其中首发症状包括颈部肿物是影响甲状腺未分化癌预后的独立危险因素
[Abstract]:Objective: to analyze the clinical manifestations and prognosis of patients with differentiated thyroid carcinoma (Differentiated Thyroid Carcinoma,DTC) and undifferentiated thyroid carcinoma (Anaplastic Thyroid Cancer,ATC). The possible etiology and prognostic factors of undifferentiated thyroid carcinoma were discussed. Methods: from January 2006 to January 10-2016, 33 patients with ATC and complete medical records were analyzed retrospectively. The patients were divided into two groups according to the coexistence of DTC in postoperative pathology: coexistence group and simple undifferentiated group. There were 17 cases in coexisting group and 16 cases in simple undifferentiated group. The difference of initial symptoms, tumor features, resection scope and thoroughness, comprehensive treatment and prognosis between the two groups were compared. The influence of various factors on the prognosis of all undifferentiated thyroid carcinoma was analyzed. Results: the median survival time was 3 months in the undifferentiated group and 6 months in the coexistence group, but the difference was not statistically significant. In the undifferentiated group, the initial symptom of cervical mass was found in 11 cases, the median time from symptom to visit was 2.5 months, 7 cases had unilateral fixation of vocal cord and 7 cases had lung metastasis before operation, 9 cases had radical resection. Palliative resection in 7 cases, simple operation in 7 cases, combined therapy in 9 cases. In the co-existing group, the first symptom of cervical mass was found in 12 cases, and the median time from symptom to visit was 2.0 months. Before operation, 7 cases had vocal cord fixation and 5 cases had pulmonary metastasis, 8 cases had radical resection, 9 cases had palliative resection. There were 10 cases of simple operation and 7 cases of comprehensive treatment. All 33 cases of undifferentiated carcinoma were analyzed by univariate analysis. The initial symptoms included cervical tumor, the maximum diameter of the primary tumor was more than 5 cm, and the prognosis of the patients without comprehensive treatment was poor. Multivariate analysis showed that initial symptoms, including cervical neoplasms, were independent risk factors for the prognosis of ATC. Conclusion: the clinical manifestations of undifferentiated thyroid carcinoma with differentiated pathological features are similar to those of simple undifferentiated thyroid carcinoma, and there is no significant difference in prognosis between undifferentiated thyroid carcinoma and undifferentiated thyroid carcinoma. In the case of undifferentiated thyroid carcinoma, the initial symptoms include the cervical tumor, the diameter of which is more than 5 cm. The failure of comprehensive treatment is an important factor affecting the prognosis. The initial symptom including the cervical tumor is an independent risk factor for the prognosis of undifferentiated thyroid carcinoma.
【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】：2017
【分类号】：R736.1

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