Lin Jen-Der, Chao Tzu-Chieh, Hsueh Chuen
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, ROC.
Clin Endocrinol (Oxf). 2007 Feb;66(2):224-8. doi: 10.1111/j.1365-2265.2006.02712.x.
The aim of this study was to compare the clinical presentation and prognosis of poorly differentiated thyroid carcinoma (PDTC) with those of classical papillary thyroid carcinoma (PTC) to identify the appropriate surgical modalities for use in conjunction with radioactive iodide ((131)I) therapy and external radiotherapy for treating PDTC.
Sixty-seven PDTC patients (mean age 50.3 +/- 18.1 years, range 14-82 years) underwent surgery at the Chang Gung Medical Centre (CGMC), Linkou. To compare clinical presentations and treatment outcomes, 134 age- and gender-matched patients with classical PTC were selected randomly from the patient database at CGMC.
Of the 67 PDTC patients, 53 underwent near-total thyroidectomy. Following surgery, 45 were administered (131)I for remnant ablation and treatment of distant metastatic disease. Forty-one of the 67 (61.2%) patients with PDTC and 26/134 (19.4%) with classical PTC failed to achieve disease-free status. Twenty-four of the 67 (34.3%) PDTC patients eventually died of thyroid cancer after a mean follow-up of 5.9 +/- 0.6 years. Age and TNM staging at surgery were significant indicators of PDTC patient survival and mortality.
As the prognosis for PDTC patients is poorer than that for classical PTC patients, (131)I treatment following surgery is useful. To improve the survival rate, early diagnosis is crucial for PDTC.
本研究旨在比较低分化甲状腺癌（PDTC）与经典乳头状甲状腺癌（PTC）的临床表现和预后，以确定与放射性碘（（131）I）治疗及外照射放疗联合使用的适合治疗PDTC的手术方式。
67例PDTC患者（平均年龄50.3±18.1岁，范围14 - 82岁）在林口长庚医学中心（CGMC）接受手术。为比较临床表现和治疗结果，从CGMC患者数据库中随机选取134例年龄和性别匹配的经典PTC患者。
67例PDTC患者中，53例行近全甲状腺切除术。术后，45例接受（131）I治疗以消融残余甲状腺组织及治疗远处转移疾病。67例PDTC患者中有41例（61.2%）、134例经典PTC患者中有26例（19.4%）未达到无病状态。67例PDTC患者中有24例（34.3%）在平均随访5.9±0.6年后最终死于甲状腺癌。手术时的年龄和TNM分期是PDTC患者生存和死亡的重要指标。
由于PDTC患者的预后比经典PTC患者差，术后（131）I治疗是有用的。为提高生存率，早期诊断对PDTC至关重要。
