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. 2018 May 21:2018:2383715.
doi: 10.1155/2018/2383715. eCollection 2018.

Clinicopathological and Survival Outcomes of Well-Differentiated Thyroid Carcinoma Undergoing Dedifferentiation: A Retrospective Study from FUSCC

Ben Ma  1   2 , Weibo Xu  1   2 , Wenjun Wei  1   2 , Duo Wen  1   2 , Zhongwu Lu  1   2 , Shuwen Yang  1   2 , Tongzhen Chen  1   3 , Yulong Wang  1   2 , Yu Wang  1   2 , Qinghai Ji  1   2
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Free PMC article

Clinicopathological and Survival Outcomes of Well-Differentiated Thyroid Carcinoma Undergoing Dedifferentiation: A Retrospective Study from FUSCC

Ben Ma et al. Int J Endocrinol. .
Free PMC article

Abstract

Background: Recently, several studies have reported that dedifferentiation occurs in fatal well-differentiated thyroid cancer (WDTC) cases. This study aimed at investigating the clinicopathological characteristics of WDTC undergoing dedifferentiation.

Methods: A total of 63 WDTC patients harboring dedifferentiated phenotype were enrolled in the study. The Kaplan-Meier method and Cox regression analysis were used to perform survival analyses. Harrell index of concordance (C-index) and Akaike information criterion (AIC) were calculated to compare the predictive value for prognosis among several prognostic classification systems.

Results: The median cause-specific survival (CSS) of patients was 138 months, with the CSS rate of 64.0% and 53.3% at 5 and 10 years, respectively. Presence of the anaplastic thyroid cancer (ATC) phenotype significantly increased the risk of poor CSS (P = 0.033), and age was the only independent risk factor for disease progression (P = 0.015). The C-index and AIC of the age, grade, extent, size (AGES) prognostic classification system for the CSS were 0.723 and 59.937, respectively.

Conclusions: The presence of dedifferentiated phenotypes can be responsible for the poor outcomes in WDTC patients. The AGES system demonstrates to be an optimal prognostic system for WDTC undergoing dedifferentiation.

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Figures

Figure 1
Figure 1
The flow graph of inclusion of WDTC patients harboring dedifferentiated phenotype in our study.
Figure 2
Figure 2
Kaplan-Meier plots of cause-specific survival. (a) The survival plot of all dedifferentiated patients. (b) The survival plot grouped by dedifferentiated sites indicated a significant difference between primary dedifferentiation in thyroid and metastatic region dedifferentiation (P = 0.04). (c, d) The survival plots are shown according to dedifferentiated components and distant metastasis (DM), respectively.
Figure 3
Figure 3
Kaplan-Meier plots of disease-free survival. (a) The survival plot of all dedifferentiated patients. (b–d) The survival plots are shown according to age, dedifferentiated sites, and distant metastasis (DM), respectively. The survival plot grouped by dedifferentiated sites indicated a significant difference between primary dedifferentiation in thyroid and metastatic region dedifferentiation (P = 0.011, c).
Figure 4
Figure 4
Kaplan-Meier curves of CSS for the prognostic classification systems. (a–f) The Kaplan-Meier curves of CSS according to the prognostic classification systems including EORTC, AGES, AMES, MACIS, the 7th edition TNM, and the 8th edition TNM.
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