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Poorly differentiated thyroid carcinoma and poorly differentiated area in differentiated thyroid carcinoma: is there any difference?

  • Raouef Ahmed Bichoo
  • Anjali MishraEmail author
  • Niraj Kumari
  • Narendra Krishnani
  • Gyan Chand
  • Gaurav Agarwal
  • Amit Agarwal
  • Saroj Kanta Mishra
Original Article
  • 49 Downloads

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusion

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.

Keywords

Differentiated thyroid carcinoma Poorly differentiated area Aggressive thyroid carcinoma 

Notes

Authors’ contributions

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.

Funding information

No funding was received from any source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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).

Supplementary material

423_2019_1753_MOESM1_ESM.docx (183 kb)
ESM 1 (DOCX 183 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Endocrine SurgerySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of PathologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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