title: Nonanaplastic follicular cell-derived thyroid carcinoma: mitosis and necrosis in long-term follow-up.
abstract: Nonanaplastic follicular cell-derived thyroid carcinoma (NAFCTC) includes differentiated- (DTC) and poorly differentiated thyroid carcinoma (PDTC). DTC has an excellent prognosis, while PDTC is situated between DTC and anaplastic carcinomas. Short-term studies suggest that PDTC patients diagnosed only on tumor necrosis and/or mitosis have a prognosis similar to those diagnosed according to the TURIN proposal. The purpose of this study was to evaluate prognosis for NAFCTC based on long-term follow-up illuminating the significance of tumor necrosis and mitosis. A cohort of 225 patients with NAFCTC was followed more than 20 years. Age, sex, distant metastasis, histology, tumor size, extrathyroidal invasion, lymph node metastasis, tumor necrosis and mitosis were examined as possible prognostic factors. Median follow-up time for patients alive was 28 years (range 20-43 years). Age, distant metastasis, extrathyroidal invasion, tumor size, tumor necrosis and mitosis were independent prognostic factors in multivariate analysis for overall survival (OS). In disease specific survival (DSS) age was not significant. Using only necrosis and/or mitosis as criteria for PDTC the 5-, 10- and 20-year OS for DTC was 87, 79 and 69%, respectively. In DSS it was 95, 92 and 90%. For PDTC the 5-, 10- and 20-year OS was 57, 40 and 25%, respectively. In DSS it was 71, 55 and 48%. Tumor necrosis and mitosis are highly significant prognostic indicators in analysis of long time survival of nonanaplastic follicular cell-derived thyroid carcinoma indicating that a simplification of the actually used criteria for poorly differentiated carcinomas may be justified.
authors.affiliation: Department of ORL Head & Neck Surgery, Odense University Hospital, Afd. F, Odense Universitetshospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. skansing@dadlnet.dk.
authors.forename: Daniel Bräuner
authors.identifier: http://orcid.org/0000-0003-3945-7617
authors.initials: DB
authors.lastname: Skansing
authors.affiliation: Department of ORL Head & Neck Surgery, Odense University Hospital, Afd. F, Odense Universitetshospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Stefano Christian
authors.initials: SC
authors.lastname: Londero
authors.affiliation: Department of Pathology, Aalborg University Hospital, Ålborg, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Asschenfeldt
authors.affiliation: Department of Pathology, Odense University Hospital, Odense C, Denmark.
authors.forename: Stine Rosenkilde
authors.initials: SR
authors.lastname: Larsen
authors.affiliation: Department of ORL Head & Neck Surgery, Odense University Hospital, Afd. F, Odense Universitetshospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Godballe
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D008938:Mitosis; D015999:Multivariate Analysis; D009336:Necrosis; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Long-term survival; Mitosis; Prognostic factors; Thyroid carcinoma; Tumor necrosis