甲状腺未分化癌88例治疗及预后分析

 目的 探讨甲状腺未分化癌患者的生存状况及预后因素。方法 回顾性分析天津市肿瘤医院2003年1月—2016年5月收治的88例甲状腺未分化癌患者的临床及随访资料，采用Kaplan-Meier法及Cox多因素回归分析预后因素。结果 88例甲状腺未分化癌患者的中位生存时间为3.5月；6月生存率30.7%，1年生存率为22.7%，2年生存率为11.4%。单因素分析显示，肿物最大径、年龄、远处转移、淋巴结转移、分期、白细胞数、放疗、化疗、甲状腺结节、不同手术方式、综合治疗是影响甲状腺未分化癌患者预后的因素。多因素分析显示，影响预后的独立因素为年龄、分期、白细胞数、综合治疗。结论 甲状腺未分化癌预后极差，对于ⅣA、ⅣB期患者手术切除联合术后放化疗的综合治疗方案可延长其生存期，即使丧失手术机会的患者仍能从放疗和（或）化疗中获益。     

甲状腺未分化癌的治疗进展

甲状腺未分化癌是恶性程度最高的甲状腺肿瘤,其发病率低、病死率高。根治性手术有利于提高局部控制率和生存率。适形放疗优于常规放疗,可改善患者的生存质量。有效的化疗药物较少,单用疗效有限,放化疗同步应用于一部分患者可延长生存。而靶向治疗为难治性患者带来新的希望。多个肿瘤中心在探索手术、放疗、化疗、靶向及其他生物治疗的综合应用,以期提高疗效。现就甲状腺未分化癌的治疗方法作一综述。     

甲状腺未分化癌的处理及影响预后因素的探讨

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例颈淋巴颈淋巴结清扫，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，对肿瘤避限于腺体内的患者，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。     

甲状腺未分化癌13例分析

甲状腺未分化癌１３例分析山东德州肿瘤医院张玉华甲状腺未分化癌恶性程度高，进展迅速，预后不良。多数患者初诊时，因病期太晚失去手术机会，从而难以获得组织学诊断。我院自１９７９年以来共收治甲状腺癌１３２例，其中获手术病理证实的１３例为未分化癌。现分析讨论如...     

胸骨后甲状腺未分化癌1例报告并文献复习

目的:探讨胸骨后甲状腺未分化癌的临床特征和预后。方法:结合文献对1例胸骨后甲状腺未分化癌进行分析。结果:胸骨后甲状腺未分化癌,术前确诊较难,手术可解除压迫症状,但难以完整切除,预后差。结论:胸骨后甲状腺未分化癌应及时行影像学检查,尽早手术切除,并辅以放射等综合治疗。     

少见食管恶性肿瘤的诊断及治疗体会

对1973年-2001年间共收治46例均经手术证实少见的食管贲门部恶性肿瘤患者进行临床分析，其中食管小细胞未分化癌34例；癌肉瘤6例；恶性黑色素瘤1例；平滑肌肉瘤4例；恶性纤维组织细胞瘤1例，这几种肿瘤除癌肉瘤外，病程发展快，易早期转移，故应早期诊断，早期行手术根治为主的，放化疗为辅的综合治疗。     

青少年分化型甲状腺癌60例临床分析

目的探讨青少年分化型甲状腺癌的临床表现、诊断、治疗及预后。方法回顾性分析60例青少年分化型甲状腺癌的临床资料。结果60例中甲状腺乳头状癌51例,滤泡状癌9例。所有患者均接受手术治疗,术后辅以内分泌治疗。其中颈淋巴结转移17例,双侧甲状腺癌并双侧颈淋巴结转移2例（占3．3％）。随访2～17年,其中25例获得10年以上随访,5年及10年生存率均为100％。结论青少年分化型甲状腺癌多为甲状腺乳头状癌,生物学行为较好,癌细胞生长缓慢,愈后较好;彩超为首选辅助检查;细针穿刺细胞学检查可获得较高确诊率。治疗关键在于手术方式的合理选择。     

代谢综合征与分化型甲状腺癌的发生及严重程度的相关性

目的:分析代谢综合征及其组分与分化型甲状腺癌的发生及严重程度的相关性。方法:收集自2020年06月至2022年06月在我院因甲状腺结节行手术治疗，术后病理确诊为分化型甲状腺癌的285例患者以及病理确诊为良性甲状腺结节的138例患者的临床资料，根据病理结果，分为良性组138例和恶性组285例；根据是否合并代谢综合征，将恶性组患者分为甲癌组156例和甲癌合并代谢综合征组129例。结果:恶性组患者BMI平均数及代谢综合征占比明显高于良性组，恶性组年龄平均数低于良性组，且存在显著性差异（P＜0.05）；甲癌合并代谢综合征组患者较甲癌组体质量指数、血压、空腹血糖、甘油三酯、肿瘤直径≥1、肿瘤位于双侧甲状腺、肿瘤多灶均高（P＜0.05），高密度脂蛋白胆固醇水平低（P＜0.05）。结论:合并代谢综合征的甲状腺结节患者恶性可能性更高，且在肿瘤直径、肿瘤位置、癌灶数量方面较未合并代谢综合征者表现出更严重的倾向，提示代谢综合征可能是影响甲状腺恶性肿瘤严重程度的危险因素。     

眼睑基底细胞癌25例综合性治疗疗效观察

为了观察25例眼睑基底细胞癌的综合治疗的疗效，对25例眼睑基底细胞癌进行组织学分型及临床分型，根据不同的分型，进行手术、化疗和放疗。结果25例患者中，术后复发2例（8％），5年内死亡2例（8％），5年生存率为92％。初步研究结果提示，早期诊断和以手术为主、放化疗为辅的综合治疗是提高基底细胞癌患者术后生存率的关键。     

甲状腺未分化癌的治疗

甲状腺未分化癌预后险恶,平均生存期不足六个月,属最恶性肿瘤。本文分析癌研头颈科1951～1970年收治的甲状腺未分化癌患者53例。病理证实小细胞癌7例,大细胞癌46例。手术时平均年龄男性为65.9岁,女性     

Poorly differentiated and anaplastic thyroid cancer.

BACKGROUND: Poorly differentiated thyroid carcinoma (PDTC) and anaplastic (undifferentiated) thyroid carcinoma (ATC) comprise a small subset of thyroid tumors that are associated with a poor prognosis and account for a significant portion of the morbidity and mortality related to thyroid cancer. Since management strategies vary between these two entities, it is important for clinicians to be able to differentiate PDTC from ATC. METHODS: We reviewed the literature on PDTC and ATC and compared clinical and histopathologic features important in defining the disease process. RESULTS: Both PDTC and ATC display aggressive behavior with increased locoregional and distant disease. In most cases, patients are older and have large, locally advanced tumors. PDTC may represent an intermediate entity in the progression of well-differentiated thyroid carcinoma to ATC. The use of surgical management may be curative or palliative and differs between PDTC and ATC. The roles of radiotherapy and chemotherapy have not been well described. CONCLUSIONS: PDTC and ATC are rare diseases that carry a poor prognosis. Recognition of their different clinicopathologic features is important to the optimal management of these tumors.     

External radiotherapy of thyroid cancer.

Differentiated thyroid cancer comprises papillary, mixed papillary-follicular and follicular adenocarcinomas. They are mostly hormone-sensitive and respond to thyroid-stimulating hormone (TSH) suppression. The standard treatment is total thyroidectomy, (131)I therapy and thyroid hormone suppression therapy. Adjuvant external radiotherapy is discussed controversially. Most authors recommend adjuvant external radiotherapy for extra-capsular tumor extension. Decision on an individual basis should be made for patients with lymph node involvement. In the case of incomplete surgical resection, external radiotherapy should be applied if second surgery is not possible. For medullary thyroid cancer, external beam radiotherapy seems to be beneficial for patients with surgically inaccessible disease, with microscopic residual or gross tumor after surgery, with recurrent locoregional disease, or with surgically unmanageable metastases. Patients suffering from anaplastic thyroid cancer should receive combined treatment consisting of extensive surgery, external irradiation with total doses up to 60 Gy, and chemotherapy. The combined treatment modality leads to higher local control rates and prolongs survival.     

Anaplastic thyroid cancer

Anaplastic thyroid carcinoma is one of the most aggressive malignancies, with a poor prognosis. Although rare, representing only 2% of clinically recognized thyroid cancers, the overall median survival is limited to months. Most patients are elderly and seek treatment with a rapidly growing mass. Almost half the patients seek treatment with distant metastases, with as many as 75% developing distant disease during their illness. In most the patients, complete surgical resection is not possible. There are, however, a few patients with resectable disease reported in the literature who have demonstrated long-term survival with aggressive multimodal therapy that included surgery, radiation, and chemotherapy. Preclinical studies in human anaplastic thyroid carcinoma cell lines show promise that new approaches to the management of this disease will be found in the future. Until such time when an effective regimen is found, all patients with anaplastic thyroid carcinoma should be evaluated for multimodal therapy in the setting of a clinical trial.     

精确放疗治疗甲状腺癌的研究进展

甲状腺癌是最常见的内分泌系统恶性肿瘤,按组织病理类型可以分为乳头状甲状腺癌、滤泡状甲状腺癌、髓样甲状腺癌和未分化型甲状腺癌。前两者因分化水平较高统称为分化型甲状腺癌。分化型甲状腺癌首选手术治疗,其次针对术中未能切除的残余病灶进行放射碘治疗。外照射放疗在分化型甲状腺癌及甲状腺髓样癌中的作用仅局限于手术治疗失败、肿瘤不能切除或者有肉眼可见远处转移灶残留的患者。精确放疗可增加肿瘤的局部控制率,减少正常组织的放射损伤。而甲状腺未分化癌大多数不能完全手术切除,外照射放疗联合化疗具有重要作用。放疗作为术前、术后综合治疗的一部分发挥作用,也可以采用单纯放疗的形式缓解症状、控制病变生长,从而延长生存期,起到姑息治疗的目的。     

Treatment of rectal cancer metastases to the thyroid gland: report of two cases

Rectal cancer rarely metastasizes to the thyroid gland. When it does, however, it poses particular problems with regard to diagnosis and management. Case reports to date support a first-line surgical approach alone or in combination with radiation therapy. Despite the use of these treatment modalities, the presence of thyroid metastasis is associated with a very poor prognosis and significant morbidity. Herein, we review the literature and report on 2 cases of rectal carcinoma metastatic to the thyroid gland that were treated with oxaliplatin-containing chemotherapy regimens. In both cases, the patients responded well to combination chemotherapy up front or after previous surgery and chemoradiation. The favorable survival and symptom benefits observed in these patients suggest that combination chemotherapy should be considered in the management of these very rare cases.     

Malignant transformation of thyroid cancer; poorly differentiated cancer and anaplastic cancer transformation

The prognosis of thyroid cancer depends largely on histological differentiation and clinical stage. The prognosis in anaplastic cancer is worst, in well differentiated cancer it is best; poorly differentiated cancer takes a middle position. The prognosis of patients with differentiated cancer is generally good, however, there are cases with malignant transformation such as poorly differentiated, anaplastic and squamous-cell cancer transformation. We studied the frequency and the inducement factors of malignant transformation in patients with thyroid cancer. The frequency of poorly differentiated, anaplastic and squamous-cell cancer transformation was 13.6%, 6.4% and 0.7%, respectively. In anaplastic cancer transformation, irradiation is an important factor.     

Phase II evaluation of high dose accelerated radiotherapy for anaplastic thyroid carcinoma.

BACKGROUND AND PURPOSE: Anaplastic thyroid cancer responds poorly to conventional radiotherapy and prognosis in the absence of effective chemotherapy is dismal. The median survival following diagnosis is only 4 months and the majority of patients die with uncontrolled local disease. This study describes the use of accelerated radiotherapy aiming to improve local response in patients with anaplastic thyroid carcinoma. Toxicity was assessed prospectively. PATIENTS AND METHODS: Seventeen patients with anaplastic thyroid carcinoma were treated and assessed for both outcome and treatment toxicity. Eight further patients with primary carcinomas arising in the neck were also treated with this protocol but were assessed for treatment toxicity only. Patients were treated twice daily, 5 days a week, to a total dose of 60.8 Gy in 32 fractions over 20-24 days in two or three phases. RESULTS: Three patients with anaplastic carcinoma demonstrated a complete clinical response and seven patients achieved a partial response. Five patients had stable disease and two patients died before radiotherapy was completed. Toxicity from oesophagitis and dysphagia was high with 10 patients requiring intravenous fluids or nasogastric tube feeding. CONCLUSION: This approach improved the response rate to radiotherapy but toxicity was unacceptable. A modified accelerated radiotherapy protocol is being explored.     

The management of advanced thyroid cancer

Although the prognosis of the majority of patients with thyroid cancer is excellent there are some patients with advanced thyroid cancer in whom the prognosis is poor. Such patients include: patients with locally invasive or recurrent differentiated thyroid cancer and medullary thyroid cancer, and all patients with anaplastic cancer. The management of patients with advanced thyroid cancer is reviewed with emphasis on the role of external beam radiotherapy.     

Anaplastic thyroid cancer and primary thyroid lymphoma: a review of these rare thyroid malignancies

BACKGROUND: To review the current literature on the treatment of anaplastic thyroid cancer (ATC) and thyroid lymphoma (TL). RESULTS: Both anaplastic carcinoma (ATC) and TL represent rare forms of thyroid cancer. ATC behaves in a highly aggressive manner, resulting in significant morbidity and mortality. Multimodality therapy consisting of both radiotherapy (RT) and chemotherapy is essential in obtaining local/regional control. Although ATC has been relatively chemo resistant, newer agents such like taxotere show promise. The role of surgery in the treatment of ATC continues to evolve, presently it should be reserved for patients who have shown an initial response to multimodality therapy and in patients in whom a complete macroscopic resection can be achieved with minimal morbidity. The successful treatment of TL currently lies in accurately diagnosing the histological subtype. Both large B-cell and mixed lymphomas are best treated with multimodality therapy consisting of CHOP combined with hyper-fractioned RT. MALT lymphomas with there more indolent course may be amenable to single modality RT or total thyroidectomy if diagnosed at an early stage IE. DISCUSSION: Although both ATC and TL are rare, it is important for surgeons to be aware of the need for multimodality therapy when treating these patients and to understand the limited role surgery plays in diagnosis and treatment.