分化型甲状腺癌的间变转化。

Anaplastic Transformation of Differentiated Thyroid Carcinoma.

机构信息

Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), Los Angeles, California, U.S.A.

University of California Los Angeles, Los Angeles (UCLA) Head and Neck Cancer Program, Los Angeles, California, U.S.A.

出版信息

Laryngoscope. 2023 Feb;133(2):437-442. doi: 10.1002/lary.30277. Epub 2022 Jul 2.

DOI:10.1002/lary.30277

PMID:35779253

Abstract

OBJECTIVES

Anaplastic thyroid carcinoma (ATC) is a rare but highly aggressive form of thyroid cancer. Increasingly, patients with ATC present with concurrent foci of well-differentiated thyroid carcinoma (WDTC); however, the significance of these pathologic findings remains unclear. The objective of this study is to determine whether the presence of WDTC within anaplastic tumors is a prognosticator of survival.

METHODS

A retrospective cohort study of all cases of biopsy-proven ATC managed at a tertiary care academic medical center from 2002 to 2020 was performed. Mean age at diagnosis, median survival time, and locations of distant metastases were assessed. The impact of clinical markers such as presence of differentiation, demographic variables, and oncologic information on overall survival was also determined via univariate and multivariate analysis.

RESULTS

Forty-five patients were included in this study. The mean age at diagnosis was 69.1 years. Median survival time was 6.1 months after diagnosis. The most common location of distant metastases was the lung (40%). The presence of limited areas of WDTC in patients with predominantly anaplastic thyroid tumors was not significantly associated with improved outcomes (p = 0.509). Smaller tumor size and use of chemotherapy in ATC patients were significantly associated with prolonged survival (p = 0.026 and 0.010, respectively).

CONCLUSIONS

Clinical outcomes for ATC remain poor. The presence of foci of differentiation within anaplastic thyroid tumors does not appear to improve overall survival-the anaplastic component evidently drives outcomes. Further studies into novel therapies are needed to improve survival in ATC.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:437-442, 2023.

摘要

目的

间变性甲状腺癌（ATC）是一种罕见但高度侵袭性的甲状腺癌。越来越多的 ATC 患者同时存在分化良好的甲状腺癌（WDTC）病灶；然而，这些病理发现的意义尚不清楚。本研究的目的是确定在间变性肿瘤中存在 WDTC 是否是生存的预后因素。

方法

对 2002 年至 2020 年间在一家三级保健学术医疗中心经活检证实的所有 ATC 病例进行了回顾性队列研究。评估诊断时的平均年龄、中位生存时间和远处转移的部位。还通过单变量和多变量分析确定了临床标志物（如分化的存在、人口统计学变量和肿瘤学信息）对总生存的影响。

结果

本研究共纳入 45 例患者。诊断时的平均年龄为 69.1 岁。诊断后中位生存时间为 6.1 个月。远处转移最常见的部位是肺（40%）。在主要为间变性甲状腺肿瘤的患者中存在有限区域的 WDTC 与改善的结果没有显著相关性（p=0.509）。较小的肿瘤大小和在 ATC 患者中使用化疗与延长生存时间显著相关（p=0.026 和 0.010）。