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Background <p>A subset of follicular thyroid cancers (FTC) can dedifferentiate into anaplastic thyroid cancer (ATC), forming composite FTC/ATC tumors. The effect of this dedifferentiation on survival outcomes remains unclear. This study aimed to characterize the clinicopathologic features of composite FTC/ATC tumors and assess their disease-specific survival (DSS).</p> Patients and Methods <p>The Surveillance, Epidemiology, and End Results (SEER) database (2000–2020) was used to identify patients with FTC, composite FTC/ATC, and ATC. Propensity score matching (PSM) was performed on the basis of age, sex, race, and histologic subtype. Clinicopathologic characteristics, DSS, and treatment outcomes were compared.</p> Results <p>A total of 60 patients with composite FTC/ATC were matched to 180 patients with FTC and 180 patients with ATC. Compared with FTC, composite tumors were associated with larger size (<i>p</i> &lt; 0.001), extra-thyroidal extension (ETE) (<i>p</i> &lt; 0.001), lymph node (<i>p</i> &lt; 0.001) and distant metastases (<i>p</i> = 0.002), more external beam radiation (<i>p</i> &lt; 0.001), and chemotherapy (<i>p</i> &lt; 0.001), but less radioactive iodine (RAI) (<i>p</i> &lt; 0.001). Compared with ATC, composite tumors showed less ETE (<i>p</i> = 0.01), fewer lymph node metastases (<i>p</i> = 0.01), less chemotherapy (<i>p</i> = 0.002), and more RAI (<i>p</i> = 0.002). The median survival of patients with co-FTC/ATC was 7 months (<i>p</i> &lt; 0.001). Advanced age (hazard ratio, HR 1.05; 95% confidence intervals, CI 1.02–1.08) and incomplete thyroidectomy (HR 2.58, 95% CI 1.20–5.56) predicted worse DSS.</p> Conclusions <p>Composite FTC/ATC tumors have survival outcomes that fall between those of FTC and ATC. Total thyroidectomy is a key component of treatment, as incomplete thyroidectomy is linked to poorer survival. Further research is needed to explore how the proportion of ATC within composite tumors influences survival outcomes.</p>

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Rare but Complex: Outcomes and Challenges in Managing Composite Follicular-Anaplastic Thyroid Cancer

  • 期刊论文

  • 发表日期：

    2025年3月25日

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  • Dilay Aykan,
  • Hala al Asadi,
  • Anjani Turaga,
  • Lutske Lodewijk,
  • Brendan M. Finnerty,
  • Thomas J. Fahey III,
  • Inne H. M. Borel Rinkes,
  • Menno R. Vriens,
  • Rasa Zarnegar

摘要

Background

A subset of follicular thyroid cancers (FTC) can dedifferentiate into anaplastic thyroid cancer (ATC), forming composite FTC/ATC tumors. The effect of this dedifferentiation on survival outcomes remains unclear. This study aimed to characterize the clinicopathologic features of composite FTC/ATC tumors and assess their disease-specific survival (DSS).

Patients and Methods

The Surveillance, Epidemiology, and End Results (SEER) database (2000–2020) was used to identify patients with FTC, composite FTC/ATC, and ATC. Propensity score matching (PSM) was performed on the basis of age, sex, race, and histologic subtype. Clinicopathologic characteristics, DSS, and treatment outcomes were compared.

Results

A total of 60 patients with composite FTC/ATC were matched to 180 patients with FTC and 180 patients with ATC. Compared with FTC, composite tumors were associated with larger size (p < 0.001), extra-thyroidal extension (ETE) (p < 0.001), lymph node (p < 0.001) and distant metastases (p = 0.002), more external beam radiation (p < 0.001), and chemotherapy (p < 0.001), but less radioactive iodine (RAI) (p < 0.001). Compared with ATC, composite tumors showed less ETE (p = 0.01), fewer lymph node metastases (p = 0.01), less chemotherapy (p = 0.002), and more RAI (p = 0.002). The median survival of patients with co-FTC/ATC was 7 months (p < 0.001). Advanced age (hazard ratio, HR 1.05; 95% confidence intervals, CI 1.02–1.08) and incomplete thyroidectomy (HR 2.58, 95% CI 1.20–5.56) predicted worse DSS.

Conclusions

Composite FTC/ATC tumors have survival outcomes that fall between those of FTC and ATC. Total thyroidectomy is a key component of treatment, as incomplete thyroidectomy is linked to poorer survival. Further research is needed to explore how the proportion of ATC within composite tumors influences survival outcomes.