Yoshida Akira, Sugino Kiminori, Sugitani Iwao, Miyauchi Akira
Division of Breast and Endocrine Surgery, Kanagwa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Japan,
World J Surg. 2014 Sep;38(9):2311-6. doi: 10.1007/s00268-014-2536-9.
Anaplastic thyroid carcinoma (ATC) is occasionally found on postoperative pathological examination of patients with differentiated thyroid carcinoma (DTC). There is no general consensus on how we should treat these incidentally diagnosed ATC (incidental ATC).
A total of 675 patients with ATC were registered with the ATC Research Consortium of Japan. These patients were treated between 1995 and 2008 in 38 registered institutions. About 81 % of the ATC patients had common-type ATC and about 14 % had ATC co-existing with a metastatic DTC lesion. The remaining 5 % had incidental ATC. Among the patients with incidental ATC, we investigated 25 patients whose clinical data were fully available. We examined the clinical profile of incidental ATC, and the relationships between treatment and outcome in patients with incidental ATC.
The tumor size was clearly smaller, and patients with extrathyroid invasion or distant metastasis were significantly fewer in incidental ATC than in common-type ATC. Most incidental ATC coexisted with papillary carcinoma. While the clinical course of incidental ATC was favorable compared with common-type ATC, half of the patients had disease-related deaths. The prognostic factors of incidental ATC were nearly the same as those of common-type ATC, but the tumor size alone was an independent factor on multivariate analysis. Regarding treatments, the outcome was more favorable in those who underwent curative resection, and the clinical course showed a slight improvement by the addition of external beam radiotherapy and/or chemotherapy after curative resection, but it did not reach statistical significance.
Incidental ATC is the only curable type of ATC, and further studies are needed to establish the effectiveness of additional postoperative radiotherapy and/or chemotherapy in incidental ATC.
间变性甲状腺癌（ATC）偶尔在分化型甲状腺癌（DTC）患者的术后病理检查中被发现。对于如何治疗这些偶然诊断出的ATC（偶发性ATC），目前尚无普遍共识。
共有675例ATC患者在日本ATC研究联盟登记。这些患者于1995年至2008年期间在38家登记机构接受治疗。约81%的ATC患者为普通型ATC，约14%的患者ATC与转移性DTC病灶共存。其余5%为偶发性ATC。在偶发性ATC患者中，我们调查了25例临床资料完整的患者。我们研究了偶发性ATC的临床特征，以及偶发性ATC患者的治疗与预后之间的关系。
偶发性ATC的肿瘤大小明显较小，甲状腺外侵犯或远处转移的患者明显少于普通型ATC。大多数偶发性ATC与乳头状癌共存。虽然偶发性ATC的临床病程与普通型ATC相比有利，但仍有一半的患者死于与疾病相关的原因。偶发性ATC的预后因素与普通型ATC几乎相同，但在多变量分析中，仅肿瘤大小是一个独立因素。关于治疗，接受根治性切除的患者预后更有利，根治性切除后加用外照射放疗和/或化疗，临床病程有轻微改善，但未达到统计学意义。
偶发性ATC是ATC中唯一可治愈的类型，需要进一步研究以确定术后额外放疗和/或化疗在偶发性ATC中的有效性。
