Poorly differentiated thyroid carcinoma and poorly differentiated area in differentiated thyroid carcinoma: is there any difference?
- 49 Downloads
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.
KeywordsDifferentiated thyroid carcinoma Poorly differentiated area Aggressive thyroid carcinoma
Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, and Narendra Krishnani participated in the study conception and design. Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, Narendra Krishnani, Gyan Chand, Gaurav Agarwal, Amit Agarwal, and Saroj Kanta Mishra participated in the acquisition of data. Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, Narendra Krishnani, Gyan Chand, Gaurav Agarwal, Amit Agarwal, and Saroj Kanta Mishra participated in the analysis and interpretation of data. Raouef Ahmed Bichoo participated in the drafting of the manuscript. Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, Narendra Krishnani, Gyan Chand, Gaurav Agarwal, Amit Agarwal, and Saroj Kanta Mishra participated in the critical revision of manuscript.
No funding was received from any source.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the Institute Ethics Committee (2016-84-MCH-EXP).
- 1.DeLellis RA, Lloyd RV, Heitz PU, Eng C (2004) World Health Organization classification of tumours: pathology and genetics of tumours of endocrine organs. IARC Press, LyonGoogle Scholar
- 4.Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, Lloyd RV, LiVolsi VA, Papotti M, Sobrinho-Simoes M, Bussolati G, Rosai J (2007) Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 31:1256–1264CrossRefGoogle Scholar
- 9.Rossi ED, Martini M, Capodimonti S, Straccia P, Revelli L, Lombardi CP, Pontecorvi A, Santeusanio G, Larocca LM, Fadda G (2015) Well-differentiated thyroid cancer with a minor poorly differentiated component: clonal heterogeneity through the prognostic role of cxcr4 and Braf analysis. Appl Immunohistochem Mol Morphol 23:196–201CrossRefGoogle Scholar
- 10.Yadav S, Gupta SK, Godbole MM et al (2009) Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India. Public Health Nutr 200913:424Google Scholar
- 12.Rosai J, Carcangiu ML, DeLellis RA (1992) Armed forces institute of pathology, atlas of tumor pathology: 3rd series. In: Tumors of the thyroid gland. Armed Forces Institute of Pathology, Washington, DCGoogle Scholar
- 13.Tuttle RM, Morris LF, Haugen BR et al (2017) Thyroid-differentiated and anaplastic carcinoma. In: Amin MB et al (eds) AJCC cancer staging manual, 8th edn. Springer International Publishing, New York City, p 873Google Scholar
- 16.Gnemmi V, Renaud F, Do Cao C, Salleron J, Lion G, Wemeau JL, Copin MC, Carnaille B, Leteurtre E, Pattou F, Aubert S (2014) Poorly differentiated thyroid carcinomas: application of the Turin proposal provides prognostic results similar to those from the assessment of high-grade features. Histopathology 64:263–273CrossRefGoogle Scholar
- 18.Bongiovanni M, Bloom L, Krane JF et al (2009) Cytomorphologic features of poorly differentiated thyroid carcinoma. A multi-institutional analysis of 40 cases. Cancer 117:185–194Google Scholar
- 21.Tanaka K, Sonoo H, Saito W et al (2011). Analysis of clinical outcome of patients with poorly differentiated thyroid carcinoma. ISRN Endocrinology ISRN Endocrinol. https://doi.org/10.5402/2011/30802
- 23.Liu L, Li D, Wang D et al (2015) Multifocality predicts poor outcome of patients with insular thyroid cancer: a clinicopathological study. Int J Clin Exp Pathol 8:11212–11217Google Scholar