【摘要】 目的:探讨低分化甲状腺癌的临床生物学特征及恰当的诊疗方法。方法:回顾性分析2007年1月—2011年12月在本院接受住院治疗的35例低分化甲状腺癌患者的临床病理资料,并进行随访;选择同期收治的1485例分化型甲状腺癌患者作为对照,比较两组患者的临床生物学特征。结果:35例低分化甲状腺癌患者与1485例分化型甲状腺癌患者的原发肿瘤大小(P=0.005)、血管侵犯(P=0.001)、临床TNM分期(P=0.002)和复发(P=0.007)的差异有统计学意义。在有血管侵犯的12例低分化甲状腺癌患者中,4例有血管内癌栓,2例发生肺转移,1例发生肝转移和骨转移。35例低分化甲状腺癌患者与1485例分化型甲状腺癌患者的年龄、性别、单发还是多发、食管侵犯、喉返神经侵犯、淋巴结转移情况和初次就诊时血清促甲状腺激素水平的差异无统计学意义(P>0.05)。结论:低分化甲状腺癌的恶性程度较高,T分期和TNM分期均较高,血管侵犯明显,易于发生复发和远处转移。通过术前甲状腺细针穿刺检查以及B超引导下的临床分期和风险评估,有助于提高诊断的准确率,在治疗上应采取个体化、功能性和多学科的积极治疗措施,以改善低分化甲状腺癌患者的预后。更多还原

【Abstract】 Objective:To investigate the clinical and biological characteristics of PDTC (poorly-differentiated thyroid carcinoma) and the appropriate diagnosis and management. Methods:The clinical records of 35 hospitalized patients with PDTC (poorly-differentiated thyroid carcinoma) admitted between January 2007 and December 2011 were collected and retrospectively analyzed. The followed-up was conducted. Meanwhile, 1 485 hospitalized patients with DTC (differentiated thyroid carcinoma) were also collected as the controls. The clinical and biological characteristics between 35 PDTC patients and 1 485 DTC patients were compared. Results:The primary tumor size (P = 0.005), blood vessel invasion (P = 0.001), clinical TNM staging (P = 0.002) and recurrence (P = 0.007) were significantly different between 35 PDTC patients and 1 485 DTC patients. Of 12 PDTC patients with vessel invasion, 4 had intravascular tumor thrombi, 2 had lung metastasis, 1 had liver and bone metastases. The age, gender, multifocality, esophageal invasion, recurrent laryngeal nerve invasion, lymphatic metastasis and serum thyroid stimulating hormone level were not significantly different between 35 PDTC patients and 1 485 DTC patients (P > 0.05). Conclusion:PDTC is a highly malignant form of thyroid carcinoma which usually presents at advanced T stage and TNM stage, with high rates of blood vessel invasion, recurrence and distant metastasis. Diagnostic accuracy can be improved via preoperative fine needle aspiration of thyroid and pathology as well as clinical TNM staging and risk evaluation guided by ultrasonography. Furthermore, personalized, functional and multidisciplinary therapeutic strategies should be performed to improve the prognosis of patients with PDTC.更多还原