甲状腺转移癌临床诊治分析

Clinical analysis of metastatic carcinoma in thyroid

目的探讨甲状腺转移癌的临床发病特点、诊断、治疗及预后分析。方法回顾性分析83例甲状腺转移癌病例。结果83例患者中，男性39例，女性39例，性别不明5例；年龄16-78岁，中位年龄52岁；原发癌依次为食管癌31例、肺癌12例、喉咽部癌8例、肾透明细胞癌7例、直肠癌6例、黑色素瘤6例、乳腺癌3例、肌肉瘤3例、胃癌2例、肝癌、宫颈癌、非嗜铬性副神经节瘤、卵巢癌、唇鳞癌各1例。64例经过治疗（手术或放疗或化疗），原发癌转移至甲状腺时间间隔为1个月至26年，中位时间2．5年；79例以发现颈部肿物入院；80例行甲状腺转移癌切除术或放疗、化疗；83例中，生存期1个月至12年，中位生存期32个月。死亡原因为重要脏器的广泛癌转移。结论甲状腺转移癌临床不常见，对既往有恶性肿瘤史近期发现甲状腺包块的患者应考虑转移癌可能，治疗以手术切除为主，辅以放疗、化疗可延长生存期。

Objective To explore the clinical manifestations, diagnosis, treatment and prognosis of secondary thyroid neoplasms. Methods To retrospectively analyse clinical manifestations, examinations and treatment of 83 cases of secondary thyroid cancer, which were retrieved from CNKI （ 1994 - 2008）. Results In all cases, 39 were male, 39 were female and 5 were unknow, aged from 16 to 78 years old, median age was 52. The primary cancers included 31 esophageal carcinomas, 12 lung cancers, 8 laryngopharynx cancers, 7 clear cell re- nal carcinomas, 6 rectal carcinomas, 6 melanomas, 3 breast cancers, 3 rhabdomyosarcoma, 2 gatric cancers, 1 liver cancer, 1 cervical cancer, 1 nonchromaffin paraganglioma,1 ovary cancer, 1 lip squamous cell carcinomac. 64 patients had undergone chemotherapy or surgery or radiotherapy. The intervals between finding of primary carcinoma and secondary thyroid carcinoma ranged from 1 month to 26 years with a median time of 2.5 years. Patients died of widespread metastases from 1 month to 12 years following the diagnosis of secondary carcinoma in thyroid, with a median time of 32 months. Conclusions Metastasis in the thyroid gland is uncommon and may cause a diagnostic problem. Metastatic cancer to the thyroid should be considered when a patient with histoy of malignant tumor has a recent found thyroid lesions. With the combination of Surgery, chemotherapy and radiotherapy, the survival of patients can be significantly prolonged.