Clinical Diagnosis And Treatment Of Primary Thyroid Squamous Cell Carcinoma And Its Survival Analysis

Objective To characterize clinical characteristics, ultrasonography, pathology, immunohistochemistry and analyse survival and prognostic factors of primary squamous cell carcinoma of the thyroid (PSCCT).Methods CNKI, Chinese Wanfang, Chongqing VIP databases and medical record database of Peking Union Medical College Hospital (PUMCH) were searched using keywords:" squamous", "carcinoma", " cancer", and " thyroid" from 1983-1 to 2015-11. Cases with detailed ultrasonography and pathology, immunochemistry description were included for ultrasonography and pathology analysis. Reports of PSCCT with intact clinical data and follow-up results were included for survival analysis. With SPSS version 20.0, survival rate was estimated by Kalan-Meier method and the prognostic factors by univariate analysis through Log-rank test and multivariate analysis by COX test.Results 1.8 cases of PSCCT were diagnosed and treated in PUMCH, accounting for 0.07% of thyroid cancer in 33 years. The mean age at diagnosis was 52.0 (male:female= 2:6). Main complaints included 5 rapidly enlarging neck mass and 3 thyroid nodule detected by ultrasonography. N1 ratio was 87.5% and M1 0%. Treatment includes 4 surgery alone,4 surgery plus postoperative radiotherapy,1 surgery plus postoperative chemotherapy and 1 patient gave up treatment. The 1-,2-,5-year overall survival rates were 57.1%,38.1%,38.1%.2.33 cases were included for ultrasonography analysis in mainland China. Ultrasonography characteristics include thyroid nodules (100%), solid (81.1%) or cystic-solid (18.9%) nodule, heterogenous echo (86.5%), irregular shape (92.3%), opaque boundary (71.9%), less calcification (68.8%), little blood supply (80%).3.59 cases were included for pathology analysis in mainland China. PSCCT could coexist with PTC, FTC, and thyroid abscess. Immunohistochemical positive item include CK, CK-10, CK-H, CK5/6, EMA, p63, p53, AE1/AE3, high Ki67. Tg/TTF-1 could be positive.4.66 cases were included for clinical and survival analysis. The mean age at diagnosis was 58.0 (male:female= 21:45). Rapid neck enlargement was the commonest chief compaints (84.8%).86.4% T4,25.7% Nl,9.1% Ml were detected at first diagnosis. The 1-,2-,5-year overall survival rates were 40.7%,21.6%,11.1% respectively, and median survival time was 7 months (95% 2.983-11.017). Prognostic factors were possibly age at diagnosis (P=0.024), tumor diameter(P= 0.04), radiotherapy(P=0.005) by univariate analysis and radiotherapy(P=0.011, HR=0.441) by multivariate analysis.Conclusion PSSCT is rare, rapidly-evolved with short survival time, which should be early diagnosed, and aggressively treated. Postoperative radiotherapy is possible to increase survival time.