Outcomes in Patients With Poorly Differentiated Thyroid Carcinoma

Ibrahimpašić, Tihana; Ghossein, Ronald; Carlson, Diane L.; Nixon, Iain J.; Palmer, Frank L.; Shaha, Ashok R.; Patel, Snehal G.; Tuttle, R. Michael; Shah, Jatin P.; Ganly, Ian

doi:10.1210/jc.2013-3842

Cited by 121 publications

(134 citation statements)

References 27 publications

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“…In contrast, in the present study, locoregional disease was the immediate cause of death in <10% of non-ANA FCDC. Such a difference could be explained in part by the advances in locoregional control in recent years (18).…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic Features of Fatal Non-Anaplastic Follicular Cell–Derived Thyroid Carcinomas

Ibrahimpašić

Wang

et al. 2016

Thyroid

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Background: The vast majority of thyroid cancers, in particular the non-anaplastic follicular cell-derived thyroid carcinomas (non-ANA FCDC), are considered indolent tumors with very low mortality. Hence, it is crucial to analyze the subgroup of these patients who die of disease (DOD) in order to identify clinicopathologic features predictive of disease-specific mortality. Methods: All non-ANA FCDC operated at a tertiary cancer center between 1985 and 2010 who were DOD were identified and submitted to a meticulous clinicopathologic analysis. Results: Out of 3750 non-ANA FCDC, 58 (1.5%) DOD cases were identified. The DOD group was composed of 33 (57%) poorly differentiated carcinomas (PDTC), 14 (24%) tall-cell variant papillary thyroid carcinomas (TCVPTC), four (7%) Hürthle cell carcinomas, three (5%) papillary microcarcinomas, two (3%) classical variant PTC, and two (3%) follicular variant PTC. Twenty-seven (47%) patients presented with distant metastases (DM), 28 (48%) developed DM during follow-up, while the remaining three (5%) had locally advanced non-resectable recurrence. Gross extension beyond the thyroid (GET) was present in 36 (62%) and extensive vascular invasion (VI) in 21 (36%) of cases. All microcarcinomas had PDTC in their clinically apparent cervical lymph nodes at presentation. Encapsulated thyroid carcinomas were responsible for 17% of DOD cases, and all had extensive VI and/or DM at presentation. All patients had at least one of these high-risk features at diagnosis: DM at presentation, PDTC, GET, and/or extensive VI. The majority of patients died from DM (n = 51; 88%), three (5%) from locoregional disease, three (5%) from both, and one (2%) from unknown cause. Conclusions: PDTC and TCVPTC are responsible for the vast majority of deaths in differentiated thyroid carcinomas, while the few fatal classical, follicular variant PTC and microcarcinomas all harbor a PDTC component, DM, or GET. Encapsulated differentiated thyroid carcinoma with focal capsular and/or VI without DM at presentation does not seem to cause death. Lack of DM at presentation, PDTC, GET, and extensive VI identify thyroid carcinomas that are at almost no risk of DOD. The vast majority of patients die of DM rather than locoregional invasion, prompting the need for effective systemic treatment.

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Section: Discussionmentioning

confidence: 99%

“…diagnosed solely by MSKCC criteria), these PDTC display additional genetic events (18). When compared with PTC, PDTC are associated with a higher mutation burden and a higher rate (40%) of telomerase reverse transcriptase (TERT) promoter mutations (19).…”

Section: Controversy Surrounding Pdtcmentioning

confidence: 99%

Clinicopathologic Features of Fatal Non-Anaplastic Follicular Cell–Derived Thyroid Carcinomas

Ibrahimpašić

Wang

et al. 2016

Thyroid

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“…This definition differs from the most recent Turin proposal that requires the presence of a solid/trabecular/insular growth pattern in addition to proliferative grading (12). In a recent study, both classifications were found to be comparable in predicting intermediate prognosis of thyroid cancer (13).…”

Section: Histopathologic Analysismentioning

confidence: 80%

Time Course and Predictors of Structural Disease Progression in Pulmonary Metastases Arising from Follicular Cell–Derived Thyroid Cancer

Sabra

Ghossein

Tuttle

2016

Thyroid

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Background: With the advent of molecular targeted therapy for the management of radioactive iodine (RAI) refractory, progressive metastatic thyroid cancer, it becomes important to define the time course and risk factors for structural disease progression in follicular cell-derived thyroid cancer (FCDTC) patients. This will help in defining the optimal time to start these therapies and better define their impact on structural disease progression. Objectives: This retrospective review of 199 consecutive patients with FCDTC presenting with lung metastasis examined the progression-free survival (PFS) in thyroid cancer patients with lung metastasis treated with surgery and RAI, and who had not received molecular targeted therapy or chemotherapy. Results: The median overall survival (OS) was 10.45 years, while the median PFS was 3.65 years. A strong correlation was found between OS and PFS. PFS is shorter in patients with RAI refractory disease, poorly differentiated/Hürthle cell histologies, male sex, fluorodeoxyglucose-avid metastatic foci, older age (>45 years), and pulmonary metastases >1 cm. At final follow-up (a median of 6.9 years from lung metastasis diagnosis), 68% of the patients had progressed and 46% had died. Conclusions: With the exception of younger patients with low disease burden, most patients presenting with lung metastasis from FCDTC (RAI avid and RAI refractory) using standard-of-care approaches will have disease progression on long-term follow-up. Additional studies are needed to identify novel therapies that would improve the PFS of such patients.

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“…This thyroid carcinoma subtype has a propensity to metastasize to regional lymph nodes (50%-85%), as well as distantly (36%-85%), most commonly to the lungs and bones (11). Another study reported that distant metastases and local recurrences to be quite variable in patients with PDTC (12).…”

Section: Discussionmentioning

confidence: 99%

Submucosal Esophageal Metastasis in a Patient with Poorly Differentiated Thyroid Carcinoma: a Case Report

Kim

Park

et al. 2017

J Endocr Surg

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We report an unusual case of esophageal metastasis protruding through the submucosa from a poorly differentiated thyroid carcinoma (PDTC). A PDTC is a very rare thyroid carcinoma subtype. A 68-year-old woman with PDTC exhibited recurrence at the thyroidectomy site and esophageal metastatic mass despite finishing the first treatment and undergoing regular follow-up. She received additional resective treatment with modified radical neck dissection for the recurrent neck nodes and endoscopic submucosal resection for the esophageal protruding mass. To our knowledge, no case of esophageal metastasis protruding through the submucosa from a PDTC has been previously reported.

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Outcomes in Patients With Poorly Differentiated Thyroid Carcinoma

Abstract: With appropriate surgery and adjuvant therapy, excellent locoregional control can be achieved in PDTC. Disease-specific deaths occurred due to distant metastases and rarely due to uncontrolled locoregional recurrence in this series.

Cited by 121 publications

References 27 publications

Clinicopathologic Features of Fatal Non-Anaplastic Follicular Cell–Derived Thyroid Carcinomas

Clinicopathologic Features of Fatal Non-Anaplastic Follicular Cell–Derived Thyroid Carcinomas

Time Course and Predictors of Structural Disease Progression in Pulmonary Metastases Arising from Follicular Cell–Derived Thyroid Cancer

Submucosal Esophageal Metastasis in a Patient with Poorly Differentiated Thyroid Carcinoma: a Case Report

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