以骨转移为首发症状的分化型甲状腺癌的临床特征与生存分析  

Differentiated thyroid carcinoma patients with bone metastasis as the initial presentation:clinical characteristics and survival analysis

作　　者：许艳红[1,2] 宋红俊[2] 邱忠领[2] 陈立波[2] 罗全勇[2] 

机构地区：[1]苏州大学研究生部,苏州215006 [2]上海交通大学附属第六人民医院核医学科,上海200233

出　　处：《肿瘤》2011年第6期538-541,共4页Tumor

摘　　要：目的:探讨以骨转移为首发症状的分化型甲状腺癌(differentiated thyroid carcinoma,DTC)的临床特征,并进行生存分析。方法:对拟行131I治疗的1546例DTC患者的临床资料进行回顾性分析,收集以骨转移为首发症状的DTC患者的资料,分析骨转移情况,并进行生存分析。结果:DTC骨转移患者共120例,其中以骨转移为首发症状的DTC患者28例(23.3%,28/120),其中滤泡状癌20例、乳头状癌6例、乳头状癌滤泡亚型2例。临床症状表现为骨骼疼痛者26例(92.9%),其中腰椎病理性骨折1例,股骨病理性骨折2例。无骨痛者2例,分别为体检时发现枕骨和肋骨DTC转移。28例患者骨转移灶共73处,以骨盆和椎体转移最多见(63.0,46/73),其中12例患者伴有其他部位的远处转移(42.9%)。本组以骨转移为首发症状的DTC患者的5年和10年生存率分别为93.0%和71.0%;与甲状腺癌术后诊断为骨转移的DTC患者(92例)相比,以骨转移为首发症状诊断为DTC患者的20年生存率更高(P=0.012)。结论:部分DTC发病较为隐匿,当临床发现原因不明的局部骨骼疼痛、病理学骨折或骨质破坏时,应排除DTC骨转移可能。以骨转移为首发症状诊断为DTC患者的预后要优于甲状腺癌术后诊断为骨转移的DTC患者。Objective：To evaluate the clinical characteristics and survival of differentiated thyroid carcinoma（DTC） patients with bone metastasis as the initial presentation.Methods：The clinical data from 1 546 DTC patients undergoing ^131I treatment were retrospectively analyzed,and the clinical characteristics of DTC patients with bone metastasis as the initial presentation were collected.The distribution of bone metastasis was analyzed,and the survival rate was calculated.Results：A total of 120 DTC patients had bone metastasis,28（23.3%） of whom had bone metastasis as the initial presentation.Of these 28 patients,20 had follicular carcinoma,6 had papillary carcinoma,and 2 had follicular variant of papillary carcinoma.The most clinical manifestation was bone pain（n=26,92.9%）：one patient had a lumbar fracture and two patients had femur fractures.Two patients presented with no symptoms,and however,occipital metastasis and rib lesions were found by physical examination.These 28 patients had 73 bone metastatic lesions which were frequently found in the pelvis and vertebrae（63.0%,46/73）.There were 12 patients presented with other distant metastases（42.9%）.The 5-year and 10-year survival rates in these 28 patients were 93.0% and 71.0%,respectively.The 20-year survival rate of these 28 patients was higher than the remaining 92 patients with post-operatively proved bone metastasis（P=0.012）.Conclusion：The occurrence of DTC is occult in some patients.Once local bone pain,pathological fracture and bone destruction in the absence of known causes,further examinations should be needed to exclude bone metastasis from DTC.The prognosis of DTC patients with bone metastasis as the initial presentation is superior to the DTC patients with post-operatively proven bone metastasis.

关 键 词：甲状腺癌 骨转移 首发症状 临床特征 

分 类 号：R736.1[医药卫生—肿瘤]