甲状腺未分化癌的治疗和预后

目的探讨甲状腺未分化癌的治疗方法和影响其预后的因素。方法对1970年5月至2005年5月间在本院治疗的50例甲状腺未分化癌患者的临床资料进行单因素(Kaplan-Meier法)和多因素分析(Cox比例模型)。结果共有50例患者,年龄27~80岁,其总的1、3、5年生存率分别为39·4%、29·6%和20·7%;中位生存时间是6个月;单因素分析显示首次就诊时的年龄<55岁、白细胞计数小于10·0×109个/L、无远处转移、接受放疗且剂量不小于40Gy、接受综合治疗者预后较好;多因素分析显示白细胞计数、是否接受手术加术后放疗是影响甲状腺未分化癌预后的独立因素。结论白细胞计数、是否接受手术加术后放疗是影响甲状腺未分化癌预后的独立因素;甲状腺未分化癌患者的预后极差,对这些患者根据个体情况进行积极的综合治疗特别是手术加术后放疗可能有利于提高其生存率。

Treatment and prognosis of anaplastic thyroid carcinoma

OBJECTIVE: To investigate the treatment model and the factors that influence survival of the patients with anaplastic thyroid carcinoma (ATC). METHODS: The clinical data of all patients with ATC in our hospital from May. 1970 to May. 2005 were analyzed retrospectively with regard to mortality and survival rate (Kaplan-Meier). Multivariate analysis was performed by the Cox proportional hazard model. RESULTS: Fifty cases together were analyzed. The overall 1-year, 3-year, 5-year survival rate were 39.4%, 29.6% and 20.7% respectively. The median survival time was 6 months. Univariate analysis showed the patients with their age < 55 years old, without distant metastasis, white blood cell count < 10.0 x 10(9)/L at presentation, without receiving chemotherapy, receiving radiotherapy with the dose no less than 40 Gy, receiving multiple modality therapy had a better prognosis. White blood cell count at presentation, the model of therapy were the risk factors independently influencing prognosis by multivariate analysis. CONCLUSIONS: White blood cell count at presentation, receiving surgery and postoperative radiotherapy or not were the risk factors independently influencing prognosis. The prognosis of anaplastic thyroid carcinoma was worse; the patients with ATC maybe get a better prognosis by receiving surgery and postoperative radiotherapy.