甲状腺未分化癌的预后风险指数及治疗抉择

Prognostic risk index and treatment decision for patients with anaplastic thyroid carcinoma

目的探索甲状腺未分化癌(anaplastic thyroid carcinoma,ATC)的预后影响因素,确定ATC预后风险指数以指导治疗决择。方法对60例ATC患者临床及随访资料进行回顾性生存分析,探索预后风险指数及其对治疗抉择的价值。结果单因素分析提示首诊时年龄、远处转移、白细胞计数、血小板计数、cTNM分期以及手术+术后放疗影响预后。多因素分析提示首诊时白细胞计数和手术+术后放疗是影响预后的独立因素。将首诊时年龄、白细胞计数、血小板计数和cTNM分期列为治疗前风险指数并评分及分组,低危组预后显著好于高危组;手术+术后放疗显著改善低危组患者预后,对高危组预后改善有限。结论预后风险指数可用于ATC患者预后判断及指导治疗抉择。

OBJECTIVE Anaplastic thyroid carcinoma（ATC） is a highly aggressive malignancy. The prognosis of patients with ATC is poor and its treatment is debated. The objective of this study was to investigate the prognostic factors in patients with ATC and explore the risk index in order to guide the treatment decision. METHODS Clinical data from all 60 patients with ATC were analyzed retrospectively. Multivariate analysis was performed using a Cox proportional hazards model. Then risk index and its clinical value on treatment decision for the ATC patients were explored. RESULTS Univariate analysis showed that age, distant metastasis, white blood cell（WBC） count, blood platelet（PLT） count, cTNM stage at presentation and receiving surgery plus postoperative radiotherapy were associated with prognosis for the patients with ATC. WBC count at presentation and receiving surgery plus postoperative radiotherapy independently influenced survival according to multivariate analysis. Following factors were graded according to their inf luence on the prognosis： age, WBC count, PLT count and cTNM stage. Patients with total score no more than 1 were regarded as low risk group, ≥2 score as high risk group. Overall survival rate of low risk group was significantly better than that of high risk group. Surgery plus postoperative radiotherapy benefited the patients with low risk index, but not benefited the patients with high risk index. CONCLUSION The prognosis for ATC is dismal. The risk index was very helpful to evaluate the prognosis and to guide treatment decision of the ATC patients. Aggressive treatment combining surgery with postoperative radiotherapy is actively recommended to the patients with low risk disease, but giving aggressive treatment or palliative treatment to the patients with high risk index should be carefully balanced.