Anaplastic thyroid carcinoma: A 50-year experience at a single institution

Anaplastic thyroid carcinoma: A 50-year experience at a single institution
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DOI：
10.1067/msy.2001.118266
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发表时间：
2001-12-01
期刊：
SURGERY
影响因子：
3.8
通讯作者：
Goellner, JR
Goellner, JR
中科院分区：
医学2区
文献类型：
--
作者：
McIver, B;Hay, ID;Goellner, JR

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背景甲状腺未分化癌是人类最具侵袭性的恶性肿瘤之一。然而，很少有组织学上明确定义的ATC的大型研究。我们报告的结果，50年的经验，这种致命的恶性。我们回顾了1949年至1999年期间在该机构管理的所有ATC病例。1名病理学家（J.R.G.）回顾了所有的病理材料。从医疗记录中获得临床细节，并确定所有患者的当前状态。共有134例病例，男女比例为1.5：1，平均年龄为67岁。良性甲状腺疾病27例（20%），高分化甲状腺癌31例（23%）。62名患者（46%）在诊断时有远处转移，98%的肿瘤是局部浸润性的。96例患者（72%）的主要治疗是手术。完全切除29例（30%），“微小残留病变”25例。手术范围和切除完整性对生存率无影响（P > 0.4）。术后放疗的中位生存期稍长（5个月vs 3个月），但无显著性差异（P <0.08）。包括手术、化疗和放疗在内的综合治疗并不能提高生存率。ATC患者的前景仍然严峻。迫切需要新的ATC治疗方法。
Background. Anaplastic thyroid carcinoma (ATC) is among the most aggressive of human malignancies. However, there have been few large studies of histologically well-defined ATC. We report the results of a 50-year experience of this lethal malignancy.Methods. We reviewed all cases of ATC managed in this institution between 1949 and 1999. One pathologist (J.R.G.) reviewed all pathologic materials. Clinical details were obtained from medical records, and current status of all patients was determined.Results. There were 134 cases, with a female-to-male ratio of 1.5:1 and a mean age of 67 years. Benign thyroid disease was present in 27 cases (20%) and well-differentiated thyroid carcinoma in 31 (23%). Sixty-two patients (46%) had distant metastases at diagnosis, and 98% of the tumors were locally invasive. Primary treatment was surgical for 96 patient (72%). Complete resection was achieved in 29 cases (30%), with "minimal residual disease" in 25. Neither extent of operation nor completeness of resection affected survival (P > .4). Postoperative radiotherapy gave slightly longer median survival (5 vs 3 months), which was not significant (P < .08). Multimodal therapy, including operation, chemotherapy, and radiotherapy, did not improve survival.Conclusions. The outlook for patients with ATC remains grim. Novel treatments for ATC are desperately needed.