Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor‐Node‐Metastasis Staging System (eighth edition)

Abstract

Summary Objective Poorly differentiated thyroid cancer (PDTC) is a rare, but aggressive thyroid cancer (TC) and a main cause of death from non‐anaplastic follicular cell‐derived TC. Assessing the risk of PDTC‐related death and the risk of recurrence is important for clinicians. The recent American Thyroid Association (ATA) 2015 guidelines and the updated 8th edition of the American Joint Committee on Cancer/Tumor‐Node‐Metastasis (AJCC/TNM) staging system should support clinicians in the management approach to PDTC patients. Patients Forty‐six consecutive PDTC patients treated in a single oncologic centre, 2000‐2017. Measurements Retrospective analysis of TNM stage, initial risk, response‐to‐therapy categories, follow‐up and final disease status incorporating the ATA 2015 criteria and the 8th AJCC/TNM staging system. Disease‐specific survival (DSS) using the Kaplan‐Meier method. Results Of the 46 PDTC 21 (45.6%) were ATA high risk (HR), 22 (47.8%), 17 (37%) and seven (15.2%) were TNM stages I, II, and III‐IV, respectively. During a median follow‐up of 55.5 months, two (4.3%) patients were recurrent, 18 (39.1%) died of PDTC. The 5‐/10‐year DSS were 65/57%, respectively. According to the AJCC/TNM, the 5‐/10‐year DSS of I, II, and III‐IV stage were 83/83%; 77/55%, and 0/0%, respectively. According to the 2015 ATA initial risk, the 5‐/10‐year DSS were 91/72% for ATA intermediate risk and 38/38% for ATA HR patients. Conclusions In PDTC patients, the updated AJCC/TNM staging system accurately predicts a high risk of death in stage III‐IV, whereas it seems to be inadequate for predicting a very low or low risk of death expected for differentiated TC in stage I‐II. The ATA initial HR may be also used to predict a high risk of PDTC‐related death.

Histopathology and immunohistochemistry as prognostic factors for poorly differentiated thyroid cancer in a series of Polish patients

“…The retrospective study was performed at Holycross Cancer Center (HCC), Kielce, a tertiary referral oncologic center in Poland, that provides comprehensive care for patients with TC and includes surgery, endocrinology, nuclear medicine, and radiation oncology departments, with similar characteristic as described in a previous study site [15]. The recruitment procedure resulting in a study group of 46 consecutive PDTC patients who underwent primary surgery between 2000 and 2017 was reported in details previously in the study with other objectives [15]. Subsequently, three PDTC cases were identified among 234 newly diagnosed TCs at HCC in 2018.…”

“…The staging of all cases was re-classified according to the 8 th edition of the American Joint Committee on Cancer/Tumor-Node-Metastases (AJCC/TNM) staging system [17]. All details of the management protocols, including indications for postoperative treatment such as radioiodine (RAI) therapy, external beam radiation therapy (EBRT), or subsequent-line therapies [conventional chemotherapy (CHTH) and tyrosine kinase inhibitor (TKI) therapy], and follow-up protocols, were described previously [15]. Death of the patient was considered disease-related when hospital conclusions were unequivocal or a TC death certificate was available.…”

Update on current diagnosis and management of anaplastic thyroid carcinoma

“…Early diagnosis and treatment yield the best outcome and prognosis[ 100 - 102 ]. A study from the United States including 719 patients found that racial, ethical and socioeconomic status seems to influence survival and prognosis.…”

Commentary on the study of Walczyk et al. Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor‐Node‐Metastasis Staging System (eighth edition).

“…The Walczyk retrospective study of 46 patients with PDTC treated in a single tertiary referral centre from 2000 to 2017 focused on the clinical usefulness of the recent 2015 American Thyroid Association (ATA) guidelines and the updated 8th edition of AJCC staging system in patients with this rare and aggressive endocrine malignancy . This Polish study emphasized a comprehensive approach to management of PDTC including clinical and pathological factors, initial risk stratification, response to therapy, and follow‐up data including re‐evaluation of initial risk estimates.…”

“…The 8th edition of the AJCC staging system underestimates the mortality due to PDTC, and the clinical course of patients with PDTC is distinctly worse than predicted by the ATA risk stratification criteria. The current study suggests that the PDTC patients need more appropriate guidelines that distinguish PDTC patients from patients with differentiated thyroid cancer (DTC) …”