【摘要】：目的:分析病理中同時(shí)存在分化型甲狀腺癌(Differentiated Thyroid Carcinoma,DTC)和未分化型甲狀腺癌(Anaplastic Thyroid Cancer,ATC)的患者,研究其臨床表現(xiàn)、預(yù)后轉(zhuǎn)歸。并對(duì)未分化甲狀腺癌的可能病因及預(yù)后的影響因素進(jìn)行探討。方法:回顧性分析從2006-10-01至2016-10-01中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院頭頸外科收治并完成手術(shù)治療,術(shù)后病理存在ATC者且有完整就診病歷資料的共33例。按術(shù)后病理中是否共存DTC成分分為兩組,即共存組和單純未分化組。其中共存組17例,單純未分化組16例,比較兩組患者就診首發(fā)癥狀、腫瘤特征、手術(shù)切除范圍及徹底性、綜合治療情況、預(yù)后等因素差異,并分析各因素對(duì)所有甲狀腺未分化癌預(yù)后的影響。結(jié)果:單純未分化組中位生存期3月,共存組中位生存期6個(gè)月,但差異無(wú)統(tǒng)計(jì)學(xué)意義。單純未分化組就診首發(fā)癥狀存在頸部腫塊者11例,從出現(xiàn)癥狀到就診的中位時(shí)間為2.5個(gè)月,術(shù)前7例患者出現(xiàn)聲帶單側(cè)固定,7例出現(xiàn)肺轉(zhuǎn)移,根治性切除者9例,姑息性切除7例,單純手術(shù)者7例,采用綜合治療者9例。共存組就診首發(fā)癥狀存在頸部腫塊者12例,從出現(xiàn)癥狀到就診的中位時(shí)間為2.0個(gè)月,術(shù)前7例患者出現(xiàn)聲帶單純固定,5例出現(xiàn)肺轉(zhuǎn)移,根治性切除者8例,姑息性切除9例,單純手術(shù)者10例,采用綜合治療者7例。對(duì)所有33例未分化癌進(jìn)行單因素分析,首發(fā)癥狀包括頸部腫物、原發(fā)灶最大徑大于5cm、未采用綜合治療方案的病人預(yù)后差。多因素分析發(fā)現(xiàn)首發(fā)癥狀包括頸部腫物是影響ATC預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:伴分化型病理表現(xiàn)的未分化甲狀腺癌臨床表現(xiàn)與單純未分化甲狀腺癌相仿,預(yù)后差異無(wú)統(tǒng)計(jì)學(xué)意義。對(duì)于甲狀腺未分化癌,首發(fā)癥狀包括頸部腫物、腫物直徑大于5cm、未采用綜合治療是影響預(yù)后的重要因素,其中首發(fā)癥狀包括頸部腫物是影響甲狀腺未分化癌預(yù)后的獨(dú)立危險(xiǎn)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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R736.1

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