Keywords
risk of death
survival
mortality
prognostic factors
How to Cite
Abstract
Among malignant thyroid tumors, papillary carcinoma
(PTC) has a relatively favorable prognosis, whereas poorly differentiated
(PDTC) and anaplastic carcinoma (ATC) due to their high aggressiveness
and rapid progression are responsible for the majority
of deaths among patients with thyroid malignancies. Studying
these carcinomas as a single biological continuum of differentiation
allows for a better understanding of the evolution of the tumor
process and improved risk stratification. The aim of this study is a
comparison of the frequency and significance of clinical characteristics
that can serve as potential prognostic factors, as well as an
assessment of death risk, mortality rate and survival in patients with
PTC, PDTC and ATC of the thyroid gland, taking into account the
degree of differentiation of these tumors. Material and methods.
We retrospectively investigated the influence of gender, tumor size,
extent of its metastasis, and invasion on the mortality rate, risk
of death, and cumulative survival of patients with PTC, PDTC, and
ATC of the thyroid. Statistical analysis included the Kaplan-Meier
method, Log-rank test, Student’s t-test, and univariate regression
analysis. Results. A clear gradient in the aggressiveness of thyroid
carcinomas, varying in their degree of differentiation, has been
established. As this gradient decreases, the average tumor size, the
rate of their metastasis to lateral cervical lymph nodes and distant
sites, the breadth of invasion (into the tumor capsule, thyroid tissue,
and extra-thyroidal structures and tissues) and the patient
mortality rate increase significantly, while survival rates decrease.
For PTC, the risk of death correlates with many clinical factors, but
in PDTC and ATC, some of them lose their independent prognostic
value. The worst one-year survival was found for patients with
PTCs larger than 8 cm and patients with distant metastases. The
one-year survival rate of patients in the NDTC cohort is 76.8%, and
proven factors influencing it are large tumor size and extrathyroidal
invasion. The survival rate of patients in the cohort with ATC is 13
times lower than that of patients with PTC: only a few patients have
a chance of surviving for a year. Invasion into surrounding structures
was found to be the most significant predictor of mortality for
ATC, exceeding the influence of the presence of distant metastases.
Conclusions. The progression of thyroid carcinoma dedifferentiation
processes from PTC to ATC, accompanied by the accumulation
of genetic alterations and the loss of tumor hormonal and immune
dependence, eliminates (neutralizes) the influence of gender and
reduces the significance of some of the traditional prognostic factors for differentiated thyroid carcinomas. Their hierarchy has been
determined: tumor size is a marker of proliferation, lateral metastasis
is a marker of dissemination, and invasiveness is an indicator of
maximum malignant potential, which becomes critical in the later
stages of tumor evolution.
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