甲状腺低分化滤泡状癌30例临床分析

Poorly Differentiated Thyroid Follicular Carcinoma——A Clinical Analysis of 30 Cases

背景与目的:甲状腺低分化滤泡状癌较少见,但有其一定的临床特征和发展规律。本研究探讨其临床特征、治疗效果及预后,旨在提高对本病的认识。方法:回顾分析30例低分化滤泡状癌的临床资料。用Kaplan-Meier法统计生存率,用log-rank检验模型对患者年龄、性别、肿瘤大小、外侵程度、治疗方式和手术切除程度等可能的预后因素进行分析,用t检验分析两组数据之间是否有显著性差异。结果:3、5和10年的总生存率分别为32.2%、25.1%和12.5%;3、5年累积肿瘤复发率分别为37.6%和48.0%。3、5年颈淋巴结转移率为57.6%、68.2%,3、5年远处转移率为82.5%和86.9%。根治性切除原发灶及颈部转移灶可显著降低肿瘤复发(χ2=6.59,P=0.01),改善生存率(χ2=12.40,P=0.00)。伴有静脉瘤栓的肿瘤复发率明显高于其他患者(χ2=4.62,P=0.03)。接受131I治疗的远处转移患者的生存时间显著长于未行131I治疗的患者(χ2=12.25,P=0.00)。结论:甲状腺低分化滤泡状癌的远处转移率高,预后差,远处转移是影响预后的主要原因。手术切除是提高局部控制和改善预后的关键,131I治疗远处转移有效,可延长生存时间。

BACKGROUND &OBJECTIVE: Poorly differentiated thyroid follicular c ar cinoma is rare, and there were few reports on it. This study was designed to det ermine clinical characteristics, treatment, and prognosis of poorly differentiat ed thyroid follicular carcinoma. METHODS: Thirty patients with poorly differenti ated thyroid follicular carcinoma were investigated retrospectively for their ge neral clinical manifestation, process of treatment,and prognosis. Duration of su rvival from operation to various endpoints, including local recurrence, distant metastasis, and death from cancer or any causes, was estimated by Kaplan-Meier method. Factors that might be related to prognosis, including age, gender, tumor size, extrathyroidal extension, treatment, and operation status, were analyzed by log-rank test. The difference of data between 2 groups was estimated by t te st. RESULTS: The 3-, 5-, 10-year overall survival rates of 30 patients with p oorly differentiated thyroid follicular carcinoma were 32.2%, 25.1%, and 12.5 %, respectively. The cumulative recurrence rate, regional lymph node metastasis rate, and distant metastasis rate were 37.6%, 57.6%, and 82.5%at 3 years, an d 48.0%, 68.2%, and 86.9%at 5 years, respectively. The local recurrence rate decreased significantly (÷2=6.59,P=0.01), and the survival rate increased signi ficantly (÷2=12.40,P=0.00) for patients who had complete removal of the primary lesion and neck metastasis. The recurrence rate of patients with venous tumorou s emboli was remarkably higher than that of other patients,(÷2=4.62,P=0.03). Th e survival time of patients with distant metastases, who had undergone 131I ther apy, was significantly longer than that of other patients, who had not undergone 131I therapy (÷2=12.25,P=0.00). CONCLUSION: Patients with poorly differentiate d thyroid follicular carcinoma had high distant metastasis rate, and poor progno sis. Distant metastasis is an important factor that affects the survival rate. R adical resection is important for control primary tumor, and improve survival ra te. 131I therapy is an effective treatment and could prolong the survival time o f patients with distant metastases.