目的:基于seer数据库分析甲状腺未分化癌(anaplastic thyroid carcinoma,ATC)的预后,并建立Nomogram预测模型。方法:通过SEER*Stat软件收集数据库中于2004年至2015年间诊断为ATC的715例病例,运用单因素、多因素Cox回归分析、C-index评价模型及Nomogram预测模型,并绘制ROC曲线评价模型,分析关于ATC患者预后的影响因素。结果:715例ATC病例中,女性438例(61.3 %)、男性277例(38.7 %),单因素分析显示年龄、AJCC分期、手术、放疗、化疗、综合治疗、切除淋巴结个数、阳性淋巴结个数、肿瘤大小是影响ATC患者生存预后的影响因素(P＜0.05);多因素分析显示年龄≥45岁、T4b分期、M1分期、肿瘤≥65 mm及不切除淋巴结、肿瘤复发及为多发性恶性肿瘤为ATC患者预后不良的独立危险因素,接受手术、化疗、放疗治疗为独立保护因素(P＜0.05);据KM生存分析可知ATC患者预后差,晚期ATC患者生存率极低,1年生存率约2 %。结论:对于局限于甲状腺内的ATC患者,建议积极接受治疗,可延长生存期,但对于晚期ATC患者,目前治疗方案并不能有效延长生存期,因此对于此类患者重点考虑将支持性护理或临终关怀作为替代方案。
Objective: To analyze the prognosis of anaplastic thyroid carcinoma (ATC) based on seer database and establish a Nomogram prediction model. Methods: SEER * Stat software was used to collect 715 cases of ATC diagnosed from 2004 to 2015 in the database. Univariate and multivariate Cox regression analysis, C-index evaluation model and Nomogram prediction model were used to analyze the prognostic factors of ATC patients. Results: Among the 715 ATC cases, 438 cases (61.3 %) were female and 277 cases (38.7 %) were male. Univariate analysis showed that age, AJCC stage, surgery, radiotherapy, chemotherapy, comprehensive treatment, number of resected lymph nodes, number of positive lymph nodes, and tumor size were the factors affecting the survival and prognosis of patients with ATC (P＜0.05). Multivariate analysis showed that age ≥45 years old, T4b stage, M1 stage, tumor ≥65 mm, no lymph node resection, tumor recurrence and multiple malignant tumors were independent risk factors for poor prognosis in ATC patients, and surgery, chemotherapy and radiotherapy were independent protective factors (P＜0.05). According to KM survival analysis, the prognosis of ATC patients was poor, and the survival rate of patients with advanced ATC was very low, with a 1-year survival rate of about 2 %. Conclusion: For ATC patients confined to the thyroid gland, it is recommended to actively receive treatment, which can prolong the survival period, but for patients with advanced ATC, the current treatment plan does not effectively prolong the survival period, so for such patients, supportive care or hospice care is considered as an alternative.
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