Abstract
Simple SummaryPoorly differentiated thyroid carcinoma (PDTC) represents a rare but aggressive variant of thyroid carcinoma and contributes to a significant proportion of thyroid carcinoma-associated deaths. Studies on PDTC are rare; therefore, we aim to assess the clinical course of these patients, evaluate the prognostic value of response to initial radioiodine therapy and identify risk factors for poor prognosis to optimize the clinical management of patients with PDCT.Background: In patients with poorly differentiated thyroid carcinoma, the clinical course and prognostic value of response to initial radioiodine therapy is evaluated. Methods: In 47 patients, clinical and imaging features were analyzed. Patients were stratified in no (NED), biochemical (B-ED) and structural evidence of disease (S-ED) assessed at the first diagnostic control and its impact on survival was evaluated. Further, possible risk factors for a shorter disease-specific survival rate (DSS) were analyzed. Results: In total, 17/47 patients consisted of NED, 10/47 were B-ED and 20/47 S-ED patients. At the last follow-up, 18/47 patients were NED, 2/47 patients B-ED and 27/47 patients S-ED. The median survival time was only reached for the S-ED group (median 3.9 years, 95%CI 2.8–5.1 years) and was not reached in the B-ED and NED groups. Metastases were diagnosed by a 18F-FDG-PET/CT scan in all cases and a multivariate analysis showed that the PET-positivity of metastases was the only significant predictor of DSS (p = 0.036). Conclusion: The response to initial surgery and radioiodine therapy in PDTC patients can achieve an excellent outcome and a further follow-up should be refined based on findings at the first diagnostic control. However, patients with an incomplete response and metastatic patients who become mostly radioiodine refractory show a significantly shorter survival, which makes accurate staging by 18F-FDG-PET/CT imaging crucial.
Highlights
Differentiated thyroid carcinoma (PDTC) represents a rare (2–15%) but aggressive variant of thyroid carcinoma and contributes to a significant proportion of thyroid carcinoma-associated deaths [1]
Poorly differentiated thyroid carcinoma (PDTC) shows the morphological and biological characteristics that lie between the well-differentiated (DTC) and undifferentiated anaplastic thyroid carcinoma (ATC), which results in a corresponding clinical course and prognosis that can vary between fairly mild courses up to very aggressive behavior [6]
We evaluate the prognostic value of the response to initial radioactive iodine (RAI) therapy and opted to find the best clinical management of PDTC patients
Summary
Differentiated thyroid carcinoma (PDTC) represents a rare (2–15%) but aggressive variant of thyroid carcinoma and contributes to a significant proportion of thyroid carcinoma-associated deaths [1]. PDTC shows the morphological and biological characteristics that lie between the well-differentiated (DTC) and undifferentiated anaplastic thyroid carcinoma (ATC), which results in a corresponding clinical course and prognosis that can vary between fairly mild courses up to very aggressive behavior [6]. In DTC, due to the preserved differentiation of tumor cells and, their ability to accumulate I-131, the established therapeutic approach includes a primary surgical tumor resection followed by a risk-adapted application of radioactive iodine (RAI) therapy to eliminate residual thyroid tissue and undetectable microscopic tumor lesions [8]. We evaluate the prognostic value of the response to initial RAI therapy and opted to find the best clinical management of PDTC patients. In patients with poorly differentiated thyroid carcinoma, the clinical course and prognostic value of response to initial radioiodine therapy is evaluated. At the last follow-up, 18/47 patients were NED, 2/47 patients B-ED and 27/47 patients
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