甲状腺未分化癌临床特征及预后分析:单中心20年回顾性研究

Clinical characteristics and prognosis of anaplastic thyroid carcinoma:a 20-year single-center retrospective study

目的探究甲状腺未分化癌(anaplastic thyroid carcinoma,ATC)患者临床特征和预后,探索综合治疗对ATC患者预后的价值。方法回顾性分析2001—2020年中国医学科学院肿瘤医院确诊为ATC患者的临床病理资料,并根据治疗方式分为单纯手术组和综合治疗组。生存分析采用Kaplan-Meier法,多因素分析采用Cox风险回归模型。结果共纳入47例患者,男性24例,女性23例,中位年龄63岁。中位随访3.37个月,其中42例患者死亡,均因肿瘤复发进展死亡,全组中位生存时间4.33个月。单因素分析显示,治疗前出现喉返神经受累症状、远处转移、白细胞升高以及单纯手术治疗等因素与预后不良有关(P值均<0.05)。多因素分析显示,治疗前出现喉返神经受累症状(HR=2.49,95%CI:1.16~5.32,P=0.019)、远处转移(HR=2.33,95%CI:1.06~5.16,P=0.036)和白细胞升高(HR=2.50,95%CI:1.16~5.40,P=0.020)是预后不良的独立危险因素,综合治疗较单纯手术可显著改善总生存期(HR=0.22,95%CI:0.10~0.47,P<0.001)。结论ATC患者中,初诊无喉返神经受累症状、白细胞正常、无远处转移的患者预后相对好,综合治疗有助于改善患者预后。

Objectives To investigate the clinical characteristics and prognoses of patients with anaplastic thyroid carcinoma(ATC),and to explore the value of multi-modality treatment in improving overall survival(OS)of ATC patients.Methods Medical records including clinicopathological data of patients diagnosed with ATC at Cancer Hospital,Chinese Academy of Medical Sciences between 2001 and 2020 were retrospectively analyzed.The cohort were divided into surgery-only and multi-modality subgroups,and the latter included patients treated with surgery plus radiotherapy and/or medical therapy(including chemotherapy,target therapy and immunotherapy).Univariate survival analysis was conducted through Kaplan-Meier method,and multivariate survival analysis was performed using Cox proportional hazard model.Results A total of 47 patients were included in the study,including 24 males and 23 females,with a median age of 63 years.After a median follow-up duration of 3.37 months,42 patients died due to tumor recurrence or progression.The median OS of the cohort was 4.33 months.Univariate survival analysis demonstrated that symptoms of recurrent laryngeal nerve(RLN)involvement,distant metastasis,leukocyte elevation,and treatment modality were significantly associated with OS(P values all<0.05).Multivariate analysis showed that symptoms of RLN involvement(HR=2.49,95%CI:1.16-5.32,P=0.019),distant metastasis(HR=2.33,95%CI:1.06-5.16,P=0.036),and leukocyte elevation(HR=2.50,95%CI:1.16-5.40,P=0.020)were all independent risk factors for OS,while multi-modality therapy significantly prolonged OS compared with surgery alone(HR=0.22,95%CI:0.10-0.47,P<0.001).Conclusions Among ATC patients,absence of symptoms of RLN invasion,normal leukocyte level and absence of distant metastasis at initial diagnosis are all independent protective factors for OS and multi-modality treatment can help to improve the prognosis.