摘要
目的 探讨甲状腺未分化癌（ATC）的临床病理特征、诊治策略及预后影响因素。方法 回顾性分析2012年1月至2025年1月郑州大学第一附属医院收治的64例经病理检查结果确诊ATC病人的临床资料，包括年龄、性别、临床症状、实验室检查、肿瘤特征、转移情况、免疫组化指标及治疗方式等。采用Kaplan-Meier法分析生存率，Log-rank检验比较不同因素组间生存差异，Cox比例风险回归模型分析预后独立危险因素。结果 共纳入64例ATC病人，男性23例（35.9%），女性41例（64.1%），中位年龄69岁，中位生存期为6.0个月。6个月、1年及2年生存率分别为45.4%、26.2%和18.7%。单因素分析显示：年龄 ≥ 60岁、白细胞计数 ≥ 10×10⁹/L、肿瘤最大径 ≥ 6 cm、腺体外侵犯、颈部及颈侧区淋巴结转移、远处转移、晚期肿瘤分期、手术治疗、放疗、化疗及综合治疗方式与病人预后相关（P＜0.05）。多因素分析发现：年龄 ≥ 60岁（HR=2.724，95%CI：1.155～6.425，P=0.022）、颈侧区淋巴结转移（HR=3.630，95%CI：1.619～8.136，P=0.002）和远处转移（HR=3.902，95%CI：1.969～7.732，P＜0.001）是独立危险因素；接受放疗（HR =0.307，95%CI：0.134～0.703，P=0.005）、化疗（HR=0.435，95%CI：0.214～0.887，P=0.022）和积极综合治疗（HR=0.240，95%CI：0.120～0.481，P＜0.001）是独立保护因素。结论 ATC预后极差，年龄 ≥ 60岁、颈侧区淋巴结转移及远处转移是影响预后的独立危险因素。多学科综合治疗，特别是包含放疗和化疗的治疗方案，可显著改善病人预后，为临床决策提供依据。
Abstract
To investigate the clinicopathological features, therapeutic strategies, and prognostic factors of anaplastic thyroid carcinoma (ATC). Methods A retrospective analysis was conducted on 64 patients with pathologically confirmed ATC treated at The First Affiliated Hospital of Zhengzhou University between January 2012 and January 2025. Clinical data included age, sex, symptoms, laboratory tests, tumor characteristics, metastasis, immunohistochemical markers, and treatment modalities. Survival was estimated by the Kaplan-Meier method, group differences were compared using the log-rank test, and independent prognostic factors were identified by the Cox proportional hazards regression model. Results A total of 64 patients were enrolled, including 23 males (35.9%) and 41 females (64.1%), with a median age of 69 years and a median survival of 6.0 months. The 6-month, 1-year, and 2-year survival rates were 45.4%, 26.2%, and 18.7%, respectively. Univariate analysis showed that age ≥60 years, white blood cell count ≥10×10⁹/L, maximum tumor diameter ≥6 cm, extrathyroidal invasion, cervical and lateral neck lymph node metastasis, distant metastasis, advanced tumor stage, surgical treatment, radiotherapy, chemotherapy, and multimodal therapy were significantly associated with prognosis (P＜0.05). Multivariate analysis revealed that age ≥60 years (HR=2.724, 95%CI: 1.155-6.425, P=0.022), lateral neck lymph node metastasis (HR=3.630, 95%CI: 1.619-8.136, P=0.002), and distant metastasis (HR=3.902, 95%CI: 1.969-7.732, P＜0.001) were independent risk factors. Radiotherapy (HR=0.307, 95%CI: 0.134-0.703, P=0.005), chemotherapy (HR=0.435, 95%CI: 0.214-0.887, P=0.022), and aggressive multimodal therapy (HR=0.240, 95%CI: 0.120-0.481, P＜0.001) were independent protective factors. Conclusion ATC carries an extremely poor prognosis. Age ≥60 years, lateral neck lymph node metastasis, and distant metastasis are independent adverse prognostic factors. Multidisciplinary multimodal treatment, particularly regimens including radiotherapy and chemotherapy, can significantly improve prognosis and provide important guidance for clinical decision-making.
关键词
甲状腺未分化癌 /
预后 /
生存分析 /
综合治疗 /
放疗 /
化疗
Key words
anaplastic thyroid carcinoma /
prognosis /
survival analysis /
multimodal therapy /
radiotherapy /
chemotherapy
李红强, 高天龙, 陈 宇, 马润声, 殷德涛.
甲状腺未分化癌临床诊治及预后因素研究[J]. 中国实用外科杂志. 2025, 45(09): 1021-1026 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.09.11
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