Bichoo Raouef Ahmed, Mishra Anjali, Kumari Niraj, Krishnani Narendra, Chand Gyan, Agarwal Gaurav, Agarwal Amit, Mishra Saroj Kanta
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Langenbecks Arch Surg. 2019 Feb;404(1):45-53. doi: 10.1007/s00423-019-01753-6. Epub 2019 Jan 23.
Poorly differentiated thyroid carcinoma (PDTC) patients have worse outcomes than patients with differentiated thyroid carcinoma (DTC), but the implication of poorly differentiated areas (PDAs) noted in DTC is not very well understood. The aim of the present study was to compare the clinicopathologic profiles and outcomes of PDTC and DTC with PDA.
A total of 142 patients, managed at out center between September 1989 and June 2016, were enrolled in this retrospective study. Histology was reviewed, and the patients were divided in the following three groups: poorly differentiated carcinoma [PDTC; group 1 (n = 27)]; papillary thyroid carcinoma with PDA [PTC with PDA; group 2 (n = 27)]; and follicular thyroid carcinoma with PDA [FTC with PDA; group 3 (n = 88)]. Clinico-pathologic profiles and outcomes were compared between the three groups. The Kaplan-Meier method was used for survival analysis. The log-rank test and Cox regression model were used to perform univariate and multivariate analyses of the factors affecting the overall survival (OS).
The clinical profiles of the three groups were comparable except for significantly less incidence of lymph node involvement (p = 0.002) and extra-thyroidal invasion (p = 0.002) and higher incidence of distant metastases (p = 0.01) in group 3. Median follow-up period was 47.5 months, and 5- and 10-year OS were 57 and 14%, respectively. There was no difference between OS of PDTC and DTC (group 2 + 3), but group 3 patients had significantly better OS than group 2 patients. Univariate analysis revealed that tumor size (p = 0.04), extra-thyroidal invasion (p = 0.05), lateral compartment lymphadenopathy (p = 0.002), distant metastases (p = < 0.001), absence of encapsulation (p = 0.03), and > 75% PDA (p = 0.001) were associated with worse OS. Multivariate analysis revealed tumor size (p = 0.005), distant metastases (p = 0.012), lymphadenopathy (p = 0.017), TNM staging (p = < 0.001), and PDA > 75% (p = < 0.001) to be significantly associated with OS.
There is no difference in the outcomes of PDTC and DTC with PDA. However, PTC patients with PDA have worse outcomes than FTC patients with PDA. Irrespective of tumor type, the presence of more than 75% PDA in DTC is associated with adverse outcomes.
低分化甲状腺癌（PDTC）患者的预后比分化型甲状腺癌（DTC）患者更差，但DTC中出现的低分化区域（PDA）的意义尚未完全明确。本研究的目的是比较PDTC与伴有PDA的DTC的临床病理特征及预后。
本回顾性研究纳入了1989年9月至2016年6月在我院接受治疗的142例患者。对组织学进行复查，并将患者分为以下三组：低分化癌[PDTC；第1组（n = 27）]；伴有PDA的乳头状甲状腺癌[伴有PDA的PTC；第2组（n = 27）]；伴有PDA的滤泡状甲状腺癌[伴有PDA的FTC；第3组（n = 88）]。比较三组的临床病理特征及预后。采用Kaplan-Meier法进行生存分析。采用对数秩检验和Cox回归模型对影响总生存（OS）的因素进行单因素和多因素分析。
三组的临床特征具有可比性，但第3组的淋巴结受累发生率（p = 0.002）和甲状腺外侵犯发生率（p = 0.002）显著更低，远处转移发生率更高（p = 0.01）。中位随访期为47.5个月，5年和10年OS分别为57%和14%。PDTC与DTC（第2组 + 第3组）的OS无差异，但第3组患者的OS显著优于第2组患者。单因素分析显示，肿瘤大小（p = 0.04）、甲状腺外侵犯（p = 0.05）、侧方淋巴结肿大（p = 0.002）、远处转移（p = < 0.001）、无包膜（p = 0.03）以及PDA > 75%（p = 0.001）与较差的OS相关。多因素分析显示，肿瘤大小（p = 0.005）、远处转移（p = 0.012）、淋巴结肿大（p = 0.017）、TNM分期（p = < 0.001）以及PDA > 75%（p = < 0.001）与OS显著相关。
PDTC与伴有PDA的DTC的预后无差异。然而，伴有PDA的PTC患者的预后比伴有PDA的FTC患者更差。无论肿瘤类型如何，DTC中PDA超过75%与不良预后相关。
