1 Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine , Seoul, Korea.
2 Department of Pathology, Seoul National University College of Medicine , Seoul, Korea.
Thyroid. 2016 Mar;26(3):404-13. doi: 10.1089/thy.2015.0316. Epub 2015 Dec 14.
This study aimed to analyze the temporal changes of the clinicopathologic characteristics, and the long-term outcomes, of various types of anaplastic thyroid cancer (ATC) and poorly differentiated thyroid cancer (PDTC).
A retrospective analysis was conducted on patients with ATC and PDTC who were treated from 1985 to 2013. The outcome measures included the clinical response to treatment and the survival rates of three separate thyroid cancer groups: ATC, PDTC, and differentiated thyroid cancer (DTC) with anaplastic foci.
The five-year disease-specific survival rate was significantly higher, both in DTC with anaplastic foci and in PTDC (81.3% and 65.8%, respectively), than it was in ATC (14.3%; p < 0.001). The proportion of cases of DTC with anaplastic foci has been increasing over time, while that of ATC has decreased. The survival rate was found to be significantly higher in resectable tumors (71.4% and 26.5%, respectively; p < 0 .001). In ATC, external beam radiation therapy showed longer survival rates than did surgery-based treatment in unresectable tumors (19.2 vs. 7.7 months, p = 0.006). Adjuvant treatment with external beam radiation or radioactive iodine increased survival duration in PDTC and in DTC with anaplastic foci. Lymphatic invasion was the most significant postoperative prognosticator in ATC (p = 0.013).
The choice of treatment of ATC and PDTC could be modified according to resectability and lymphatic invasion of the cancer.
本研究旨在分析各种类型的间变性甲状腺癌（ATC）和低分化甲状腺癌（PDTC）的临床病理特征的时间变化，以及长期预后。
对 1985 年至 2013 年间治疗的 ATC 和 PDTC 患者进行回顾性分析。结果测量包括治疗的临床反应和三组甲状腺癌的生存率：有间变灶的分化型甲状腺癌（DTC）、PDTC 和 ATC。
DTC 伴间变灶和 PDTC 的五年疾病特异性生存率明显高于 ATC（分别为 81.3%和 65.8%，14.3%；p<0.001）。DTC 伴间变灶的比例随着时间的推移而增加，而 ATC 的比例则下降。可切除肿瘤的生存率明显更高（分别为 71.4%和 26.5%；p<0.001）。在 ATC 中，对于不可切除的肿瘤，外照射放疗的生存率高于手术治疗（19.2 与 7.7 个月，p=0.006）。在 PDTC 和有间变灶的 DTC 中，辅助外照射或放射性碘治疗可延长生存时间。淋巴浸润是 ATC 术后最重要的预后预测因子（p=0.013）。
根据癌症的可切除性和淋巴浸润情况，可以对 ATC 和 PDTC 的治疗选择进行修改。
