미분화 갑상선암에서의 다병합 치료적 접근

Multimodal Therapeutic Approach in Anaplastic Thyroid Cancer

Purpose: Anaplastic thyroid cancer (ATC) is a rare but highly aggressive neoplasm with a dismal prognosis. However, a few patients survive for a long time after treatment. We tried to identify prognostic factors of this disease and analyzed treatment outcomes in patients with ATC. Methods: We reviewed the medical records of 15 patients diagnosed with ATC in our institution between 1988 and 2003. The survival was compared by the Kaplan-Meier log- rank test using SPSS program. Results: The female-to-male ratio was 1.5：1 (9 women and 6 men), and the mean age at diagnosis was 63.9 years (range, 44∼91). The mean tumor size was 6.3 cm (range, 4∼10 cm). Extrathyroidal invasion was present in 12 cases and distant metastasis at diagnosis was present in 6 cases. Surgery was performed in 8 cases. Radiotherapy was used for 10 cases and chemotherapy for 5 cases. The mean overall survival time of the 15 patients was 237 days (range, 28∼717 days). The 6∼, 12∼, 18∼ and 24∼ month survival rates were 33%, 26%, 13% and 0%. No association was found between survival and presenting symptoms, age, gender, tumor size, previous goiter history, extrathyroidal invasion, distant metastasis, surgery, radiotherapy or chemotherapy. A significantly better outcome was observed in patients received triple modality treatment (surgery, radiotherapy and chemotherapy) than in those received single or dual modality treatment (P=0.05). Conclusion: Although most patients with ATC had a poor prognosis, a multimodal approach including surgery, radiotherapy and chemotherapy, might improve survival. (Korean J Endocrine Surg 2005;5:75-80)