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目的:探讨低分化甲状腺癌的临床生物学特征及恰当的诊疗方法。方法:回顾性分析2007年1月—2011年12月在本院接受住院治疗的35例低分化甲状腺癌患者的临床病理资料,并进行随访;选择同期收治的1485例分化型甲状腺癌患者作为对照,比较两组患者的临床生物学特征。结果:35例低分化甲状腺癌患者与1485例分化型甲状腺癌患者的原发肿瘤大小(P=0.005)、血管侵犯(P=0.001)、临床TNM分期(P=0.002)和复发(P=0.007)的差异有统计学意义。在有血管侵犯的12例低分化甲状腺癌患者中,4例有血管内癌栓,2例发生肺转移,1例发生肝转移和骨转移。35例低分化甲状腺癌患者与1485例分化型甲状腺癌患者的年龄、性别、单发还是多发、食管侵犯、喉返神经侵犯、淋巴结转移情况和初次就诊时血清促甲状腺激素水平的差异无统计学意义(P>0.05)。结论:低分化甲状腺癌的恶性程度较高,T分期和TNM分期均较高,血管侵犯明显,易于发生复发和远处转移。通过术前甲状腺细针穿刺检查以及B超引导下的临床分期和风险评估,有助于提高诊断的准确率,在治疗上应采取个体化、功能性和多学科的积极治疗措施,以改善低分化甲状腺癌患者的预后。
Objective: To investigate the clinical biological characteristics of poorly differentiated thyroid cancer and the appropriate diagnosis and treatment methods. Methods: The clinical and pathological data of 35 patients with poorly-differentiated thyroid cancer admitted to our hospital from January 2007 to December 2011 were retrospectively analyzed. The data of 1485 patients with differentiated thyroid carcinoma treated at the same period were selected as control The clinical biological characteristics of two groups were compared. Results: The primary tumor size (P = 0.005), vascular invasion (P = 0.001), clinical TNM stage (P = 0.002) and relapse (P = 0.007) in 35 patients with poorly differentiated thyroid cancer and 1485 patients with differentiated thyroid cancer ) Difference was statistically significant. Of the 12 patients with poorly differentiated thyroid cancer who had vascular invasion, 4 had intravascular thrombus, 2 had lung metastases, and 1 had liver metastases and bone metastases. 35 cases of poorly differentiated thyroid cancer and 1485 cases of differentiated thyroid cancer patients with age, sex, single or multiple, esophageal invasion, recurrent laryngeal nerve, lymph node metastasis and initial treatment serum thyroid hormone levels were not statistically different Significance (P> 0.05). Conclusions: The poorly differentiated thyroid carcinoma has higher malignancy, higher T stage and TNM stage, and obvious vascular invasion, which is prone to relapse and distant metastasis. Preoperative thyroid fine needle aspiration examination and B-guided clinical staging and risk assessment help to improve the diagnostic accuracy, the treatment should take individual, functional and multidisciplinary positive treatment measures to improve the low Prognosis of patients with differentiated thyroid cancer.