未分化甲状腺癌（胰岛细胞癌）的临床病程- 自身观察。

The clinical course of poorly differentiated thyroid carcinoma (insular carcinoma) - own observations.

机构信息

Department of Endocrinology and Nuclear Medicine, Hollycross, Cancer Centre, Kielce, Poland.

出版信息

Endokrynol Pol. 2010 Sep-Oct;61(5):467-73.

Abstract

INTRODUCTION

Poorly differentiated thyroid carcinoma (PDTC, insular carcinoma) occurs rarely. It is described with more aggressive behaviour, poorer prognosis, and higher mortality than well differentiated thyroid carcinoma (WDTC). The aim of this study was to evaluate the clinical course of patients with PDTC, in addition to frequency, clinical stage at the time of diagnosis and the possibility of radical surgical resection, the necessity and kind of complementary treatment, occurrence of distant metastases, and the survival of patients.

MATERIAL AND METHODS

The study involved 14 patients (9 females, 5 males) diagnosed and treated for PDTC between 2000 and 2009, aged 38 to 78 years. The medical records of patients with PDTC were analyzed to estimate assumed parameters according to the purpose of the study.

RESULTS

PDTC was diagnosed in 14 among 801 patients with thyroid carcinoma (1.75%). Clinical stages (UICC 2002) at the time of diagnosis were as follows: 3 patients - pT(₁-₂)N(o-x)M(x) (21.5%); 10 patients - pT(₃ ₄)N(x o ₁)M(x-₁)(71.4%); and 1 was unresectable - T(x)N₁M₁ (7.1%). Total thyroidectomy was achieved in 9 patients (64.3%), and 4 patients (28.6%) received non radical surgery. Complementary radioiodine treatment was given to 12 patients (85.8%). Radiation therapy of the neck was applied to 7 patients, palliative radiotherapy of the brain to 1 patient, and chemotherapy to 1 patient. Distant metastases to the lung and to the brain at diagnosis were observed in 2 patients (14.3%). During follow-up of 3-62 months lung metastases were observed in 4 patients (28.6%), three patients were observed above 5 years as disease-recurrence free (21.5%), but in one patient after 5 years and 2 months distant metastases were diagnosed. Three patients died after 2-30 months (21.5%), 2 patients were lost for control, and in the remaining 6 follow-up lasted for less than 5 years.

CONCLUSIONS

Poorly differentiated thyroid carcinoma is still a challenge both for pathologists and clinicians. Infrequent prevalence, more aggressive course, and poorer prognosis constitute major problems for the clinicians.

摘要

简介

低分化甲状腺癌（PDTC，胰岛细胞癌）罕见。其行为更具侵袭性，预后更差，死亡率高于高分化甲状腺癌（WDTC）。本研究的目的是评估 PDTC 患者的临床病程，此外还评估发病率、诊断时的临床分期和根治性手术切除的可能性、补充治疗的必要性和类型、远处转移的发生以及患者的生存情况。

材料与方法

本研究纳入了 2000 年至 2009 年间诊断和治疗的 14 例 PDTC 患者（9 名女性，5 名男性），年龄 38 至 78 岁。分析 PDTC 患者的病历，以根据研究目的评估假设参数。

结果

在 801 例甲状腺癌患者中诊断出 14 例 PDTC（1.75%）。诊断时的临床分期（2002 年 UICC）如下：3 例为 pT(₁-₂)N(o-x)M(x)（21.5%）；10 例为 pT(₃ ₄)N(x o ₁)M(x-₁)（71.4%）；1 例为不可切除的 T(x)N₁M₁（7.1%）。9 例（64.3%）患者行全甲状腺切除术，4 例（28.6%）患者行非根治性手术。12 例（85.8%）患者接受了补充放射性碘治疗。7 例患者接受了颈部放射治疗，1 例患者接受了脑姑息性放疗，1 例患者接受了化疗。2 例患者在诊断时出现肺和脑远处转移。在 3-62 个月的随访期间，4 例患者出现肺转移（28.6%），3 例患者无病生存超过 5 年（21.5%），但 1 例患者在 5 年后 2 个月时出现远处转移。3 例患者在 2-30 个月后死亡（21.5%），2 例患者失访，其余 6 例随访时间均不足 5 年。