Skansing Daniel Bräuner, Londero Stefano Christian, Asschenfeldt Pia, Larsen Stine Rosenkilde, Godballe Christian
Department of ORL Head & Neck Surgery, Odense University Hospital, Afd. F, Odense Universitetshospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
Department of Pathology, Aalborg University Hospital, Ålborg, Denmark.
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2541-2548. doi: 10.1007/s00405-017-4527-6. Epub 2017 Mar 14.
Nonanaplastic follicular cell-derived thyroid carcinoma (NAFCTC) includes differentiated- (DTC) and poorly differentiated thyroid carcinoma (PDTC). DTC has an excellent prognosis, while PDTC is situated between DTC and anaplastic carcinomas. Short-term studies suggest that PDTC patients diagnosed only on tumor necrosis and/or mitosis have a prognosis similar to those diagnosed according to the TURIN proposal. The purpose of this study was to evaluate prognosis for NAFCTC based on long-term follow-up illuminating the significance of tumor necrosis and mitosis. A cohort of 225 patients with NAFCTC was followed more than 20 years. Age, sex, distant metastasis, histology, tumor size, extrathyroidal invasion, lymph node metastasis, tumor necrosis and mitosis were examined as possible prognostic factors. Median follow-up time for patients alive was 28 years (range 20-43 years). Age, distant metastasis, extrathyroidal invasion, tumor size, tumor necrosis and mitosis were independent prognostic factors in multivariate analysis for overall survival (OS). In disease specific survival (DSS) age was not significant. Using only necrosis and/or mitosis as criteria for PDTC the 5-, 10- and 20-year OS for DTC was 87, 79 and 69%, respectively. In DSS it was 95, 92 and 90%. For PDTC the 5-, 10- and 20-year OS was 57, 40 and 25%, respectively. In DSS it was 71, 55 and 48%. Tumor necrosis and mitosis are highly significant prognostic indicators in analysis of long time survival of nonanaplastic follicular cell-derived thyroid carcinoma indicating that a simplification of the actually used criteria for poorly differentiated carcinomas may be justified.
非间变性滤泡细胞源性甲状腺癌（NAFCTC）包括分化型甲状腺癌（DTC）和低分化甲状腺癌（PDTC）。DTC预后良好，而PDTC介于DTC和间变性癌之间。短期研究表明，仅根据肿瘤坏死和/或有丝分裂诊断的PDTC患者的预后与根据都灵提议诊断的患者相似。本研究的目的是基于长期随访评估NAFCTC的预后，以阐明肿瘤坏死和有丝分裂的意义。对225例NAFCTC患者进行了20多年的随访。将年龄、性别、远处转移、组织学、肿瘤大小、甲状腺外侵犯、淋巴结转移、肿瘤坏死和有丝分裂作为可能的预后因素进行检查。存活患者的中位随访时间为28年（范围20 - 43年）。在总生存（OS）的多因素分析中，年龄、远处转移、甲状腺外侵犯、肿瘤大小、肿瘤坏死和有丝分裂是独立的预后因素。在疾病特异性生存（DSS）中，年龄无显著意义。仅将坏死和/或有丝分裂作为PDTC的标准，DTC的5年、10年和20年总生存率分别为87%、79%和69%。在DSS中分别为95%、92%和90%。对于PDTC，5年、10年和20年总生存率分别为57%、40%和25%。在DSS中分别为71%、55%和48%。在分析非间变性滤泡细胞源性甲状腺癌的长期生存时，肿瘤坏死和有丝分裂是高度显著的预后指标，这表明简化目前用于低分化癌的标准可能是合理的。
