56例甲状腺未分化癌的临床特点和预后分析

Clinical characteristics and prognosis of anaplastic thyroid carcinoma

目的分析并探讨甲状腺未分化癌的临床特点、治疗方式以及预后影响因素。方法回顾性分析浙江省肿瘤医院2006年1月至2016年6月收治的56例甲状腺未分化癌患者的临床病理资料。结果56例甲状腺未分化癌患者中，男24例，女32例；中位年龄65岁。10例患者就诊时有不同程度的呼吸困难，8例患者有不同程度的吞咽困难，12例患者伴声音嘶哑。首诊发现远处转移者23例。ⅣA期19例，ⅣB期14例，ⅣC期23例。未放疗38例，放疗18例，其中精确放疗6例。未经综合治疗27例，接受综合治疗29例。56例甲状腺未分化癌患者的中位生存时间为4.5个月，1年生存率为5.4%。单因素分析显示，甲状腺未分化癌患者的1年生存率与是否放疗和是否行综合治疗有关（均P〈0.05），其中采用精确放疗患者的1年生存率为16.7%，明显高于采用其他方式放疗的患者（4.0%，P＝0.040）；采用手术＋放疗患者的1年生存率为12.5%，明显高于其他治疗方式患者（4.2%，P＝0.040）。多因素分析显示，接受放疗是影响甲状腺未分化癌患者预后的独立因素（P＝0.020）。结论对于甲状腺未分化癌患者，建议采用手术联合放疗的综合治疗方式。放疗是影响甲状腺未分化癌患者预后的独立因素，其中采用精确放疗患者的预后更好。

ObjectiveTo investigate the clinical characteristics, treatment outcomes and prognostic factors in patients with anaplastic thyroid cancer.MethodsClinical data of 56 patients with anaplastic thyroid cancer at Zhejiang Cancer Hospital from January 2006 to June 2016 were retrospectively reviewed and followed up. ResultsOf the 56 patients, there were 24 male and 32 female. The median age was 65 years old. At diagnosis, 10 patients have different degrees of breathing difficulty; 8 patients have varying degrees of dysphagia, and 12 patients have hoarseness. Distant metastases were found in 23 patients at presentation. Patient staging was performed in accordance with the tumor-node-metastasis system as follows： stage ⅣA （n=19）, stage ⅣB （n=14） and stage ⅣC （n=23）. The median survival time of 56 patients was 4.5 months.The overall 1-year survival rate was 5.4%. Univariate analysis showed that radiotherapy and multimodality therapy were prognostic factors for 1-year overall survival （both of P〈0.05）. The overall 1-year survival rate of the patients who received precision radiotherapy was 16.7%, which was higher than who received the other radiation therapy （4.0%, P=0.040）. Furthermore, the overall 1-year survival rate of the patients who received surgery combined with radiotherapy was 12.5%, which was higher than who received the other treatments（4.2%, P=0.040）. Multivariate analysis indicated that radiotherapy was independently associated with improved survival （P=0.020）.ConclusionsPatients with anaplastic thyroid cancer should receive multimodality therapies combining surgery with radiotherapy. Radiotherapy is independently associated with improved overall survival. Notably, the precision radiotherapy that based on image guidance has a significantly beneficial impact on the prognosis of patients.