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

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.