原发性甲状腺鳞状细胞癌28例临床分析  

Primary squamous cell carcinoma of the thyroid： retrospective analysis of 28 cases

作　　者：张永侠[1] 张彬[1] 吴跃煌[1] 刘文胜[1] 刘绍严[1] 高黎[2] 徐震纲[1] 唐平章[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所头颈外科,100021 [2]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放射治疗科,100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第2期143-147,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的总结分析原发性甲状腺鳞状细胞癌的临床病理特征、治疗效果及影响预后的因素。方法回顾性分析1999年1月至2012年5月期问中国医学科学院肿瘤医院头颈外科收治的28例甲状腺鳞状细胞癌患者的临床及病理资料，包括年龄、性别、首发症状、组织学分级、肿瘤临床分期、治疗方式及治疗效果。采用Kaplan—Meier法、Log—rank单因素分析和Cox回归模型多因素分析法计算生存率和预后相关因素。结果28例原发性甲状腺鳞状细胞癌占同期甲状腺恶性肿瘤的0．36％，其中男性15例，女性13例，中位发病年龄63岁。首发症状主要表现为颈部肿物26例次及声音嘶哑18例次。28例患者中，肿瘤组织学分级为高分化5例，中分化8例，低分化15例。临床分期为IVa期16例，IVb期12例。颈淋巴转移率和远处转移率分别为60．7％和25．0％。治疗方式包括手术联合术后放疗19例，单纯手术7例，单纯根治性放疗2例。全组总的1年、2年和5年生存率分别为50．4％、25．8％和19．3％，中位生存期12．2个月。经Kaplan—Meier法单因素分析，影响患者生存的因素是原发灶直径（P=0．002）、肿瘤是否侵犯食管（P=0．005）及治疗方式（P=0．030），经Cox回归模型多因素分析显示，影响患者生存的独立危险因素为原发灶直径和治疗方式（风险比分别为4．310和0．307，P值均〈0．05）。结论原发性甲状腺鳞状细胞癌发病率低，恶性程度高，侵袭性强，预后差。临床上应积极采取综合治疗方法，外科手术切除和放射线照射治疗是主要治疗手段。Objective To investigate the clinicopathological features, treatment outcomes and prognosis of patients with squamous cell carcinoma of the thyroid （SCCT）. Methods Retrospective review of 28 consecutive cases from January 1999 to May 2012. Survival rates and prognostic factors were calculated with SPSS 13.0 software using the Kaplan-Meier method and multivariate Cox model survival analysis. Results SCCT accounted for only 0. 36% of all types of thyroid malignancy. There were 15 males and 13 females, and the median age was 63 cases years. The common presenting symptoms were neck masses （26/28） and hoarse voice （18/28）. The SCCT included 15 high grade tumors, 8 intermediate grade tumors and 5 low grade tumors. Sixteen patients were at stage IVa, and 12 stage IVb; 19 underwent surgery plus postoperative radiotherapy, 7 underwent surgery alone and 2 received radiotherapy alone. The rates of lymph node metastasis and distant metastasis were 60. 7% and 25.0%, respectively. The 1-, 2- and 5-year overall survival rates were 50. 4%, 25.8% and 19.3%, respectively, and the median overall survival time was 12. 2 months. Kaplan-Meier univariate survival analyses indicated that the sizes of the tumors, esophageal invasions and treatment policies were prognostic factors, and multivariate Cox model survival analyses confirmed that the sizes of the tumors and treatment policies were independent factors for overall survival （ HR were 4. 310 and 0. 307, P 〈 0. 05 ）. Conclusions SCCT is a rare malignant tumor with strong invasive ability, high malignancy and poor prognosis. Combined modality therapy is strongly recommended, and surgical resection plus postoperative radiotherapy may be the main treatment protocol for patients with SCCT.

关 键 词：甲状腺肿瘤 癌 鳞状细胞 综合疗法 预后 

分 类 号：R736.1[医药卫生—肿瘤]