Department of Nuclear Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
Department of Pathology, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2024 Aug;39(4):590-602. doi: 10.3803/EnM.2024.1927. Epub 2024 Jun 27.
Poorly differentiated thyroid carcinoma (PDTC) accounts for a small portion of thyroid carcinomas but contributes to a significant proportion of thyroid carcinoma-associated deaths. The clinicopathological prognostic factors and clinical outcomes of PDTC remain unclear. We aimed to evaluate the clinical outcomes of patients with PDTC after curative treatment.
A comprehensive search was performed up to September 2023. We included studies investigating treatment outcomes in patients with PDTC who underwent initial surgery. The 5-year disease-free survival (DFS) and overall survival (OS) were extracted. In this meta-analysis, the enrolled PDTC histological criteria included 3rd, 4th, and 5th World Health Organization (WHO) and Memorial Sloan Kettering Cancer Center (MSKCC) classification. A random-effects model was used for the pooled proportion analysis. Meta-regression analysis was conducted to evaluate the prognostic factors.
Twenty retrospective studies published between 2007 and 2023, including 1,294 patients, met all inclusion criteria. Studies that diagnosed PDTC based on various histological criteria including 3rd WHO (n=5), 4th WHO (n=12), 5th WHO (n=2), and MSKCC (n=1) were included. Overall, 5-year DFS and 5-year OS were 49.4% (95% confidence interval [CI], 42.3 to 56.4) and 73.8% (95% CI, 66.5 to 79.9), with moderate heterogeneity of 58% and 55%, respectively. In meta-regression analysis, extrathyroidal extension (ETE) was a prognostic factor for OS.
The meta-analysis of DFS and OS in patients with PDTC show the moderate heterogeneity with a variety of histological criteria. ETE appears to have a significant impact on OS, regardless of histological criteria.
低分化甲状腺癌（PDTC）在甲状腺癌中占比较小，但在甲状腺癌相关死亡中占比较大。PDTC 的临床病理预后因素和临床结果仍不清楚。我们旨在评估接受根治性治疗后 PDTC 患者的临床结局。
系统检索至 2023 年 9 月，纳入接受初始手术治疗的 PDTC 患者治疗结局的研究。提取 PDTC 患者的 5 年无病生存率（DFS）和总生存率（OS）。本荟萃分析纳入的 PDTC 组织学标准包括第 3、4 和 5 版世界卫生组织（WHO）和纪念斯隆凯特琳癌症中心（MSKCC）分类。采用随机效应模型进行汇总比例分析。进行荟萃回归分析以评估预后因素。
2007 年至 2023 年期间发表的 20 项回顾性研究，共纳入 1294 例患者，均符合所有纳入标准。纳入的研究基于包括第 3 版 WHO（n=5）、第 4 版 WHO（n=12）、第 5 版 WHO（n=2）和 MSKCC（n=1）在内的各种组织学标准诊断 PDTC。总体而言，5 年 DFS 和 5 年 OS 分别为 49.4%（95%置信区间 [CI]，42.3 至 56.4）和 73.8%（95% CI，66.5 至 79.9），异质性分别为 58%和 55%。在荟萃回归分析中，甲状腺外侵犯（ETE）是 OS 的预后因素。
基于不同组织学标准的 PDTC 患者 DFS 和 OS 的荟萃分析显示存在中度异质性。ETE 似乎对 OS 有显著影响，与组织学标准无关。
