甲状腺未分化癌的处理及影响预后因素的探讨

Discussion on Treatment and Prognostic Factors for Anaplastic Thyroi d Carcinoma

目的:探讨甲状腺未分化癌的治疗及影响预后的因素。方法:回顾性分析1959年至1996年本院收治的11例甲状腺未分化癌,其中4例行颈淋巴结清扫,4例患侧甲状腺全切除,3例仅作甲状腺活检(1例活检后放疗)。结果:行甲状腺全切除或仅作活检的7例均有腺体外侵犯,且年龄偏大,病程长。除1例术后放疗生存2.5年外,其余均于术后1至6个月内死亡。颈淋巴结清扫术4例,其中1例有腺体外侵犯,术后仅生存1年;其余3例肿块均局限于腺体内,分别生存7年(仍生存)、12年(后失访)、18年(仍生存);皆为女性,病程较短。结论:肿瘤局限于腺体内可能是甲状腺未分化癌预后较好的因素。对肿瘤局限于腺体内的患者,应扩大手术范围。已有腺体外侵犯者,预后较差,辅助放疗有助于延长生存期。

Objective:Discu ss ion on treatment of anaplastic thyroid carcinoma(ATC)and its prognostic facto rs.Methods:Data of11patients with ATC hospitalized during1959to1996w ere retrospectively analyzed.Of all of them,4patients had radical neck disse ction,.4patients had subtotal thyroidectomy,the other3patients only had bio psy(one had radiotherapy after biop-sy).Results:Seven patients who underwen t subtotal thyroidectomy or just had biopsy were found local invasion outside the gland,and these patients were all elderly aged with long disease history.S ix patients died in1to6months after operation,one patient who had biopsy fol lowed by radiotherapy survived for2.5years.Among the4patients who had radic al neck dissection,just one patient with extrathyroid invasion died one year a fter operation and the other three pa-tients whose tumors were limited inside t he gland survived7years(still alive),12years(lost fol-low-up then),an d18years(still alive)respectively.All these patients were female and had sh ort disease history.Conclusion:The tumors limited in the gland usually have a better prognosis in patients with ATC,and extended surgery should be performed in these patients.Patients with extrathyroid invasion usually have poor prognos is.Adjuvant therapy might be helpful to improve the survival of these patien ts.