Thyroid Cancer Coverage from Every Angle
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Aggressive Papillary Thyroid Carcinoma: Update on Incidence and Survival Outcomes

By: Kayci Reyer
Posted: Thursday, April 30, 2020

Research conducted by Allen S. Ho, MD, of Samuel Oschin Comprehensive Cancer Institute, Los Angeles, and colleagues reported a significant increase in the incidence of aggressive papillary thyroid carcinoma, resulting in a wide variety of survival outcomes. The study, published in JAMA Oncology, found that increasing prevalence of aggressive papillary thyroid carcinoma variants was greater than that of well-differentiated or anaplastic papillary thyroid carcinoma.

“Given the disproportionately rising prevalence of aggressive papillary thyroid carcinoma variants and their wide range of outcomes, greater emphasis on tailored treatment approaches is needed for these histologically and prognostically distinct subtypes,” concluded the authors.

Using hospital-based and population-based U.S cancer registries between 2000 and 2016, the study identified 5,447 different variants of papillary thyroid carcinoma. The most common variant was tall cell (n = 3,339), followed by poorly differentiated (n = 1,331), diffuse sclerosing (n = 415), and insular (n = 362). A total of 35,812 well-differentiated and 2,249 anaplastic cases were also noted. Between 2000 and 2016, the occurrence of aggressive variants rose significantly (annual percentage chance [APC] =  9.1; P < .001), outpacing increases in both well-differentiated (APC = 5.1; P < .001) and anaplastic variants (APC = 1.9; P = .003).

Survival outcomes were linked to histologic subtype and varied widely, even once adjusted for “inherent differences in baseline characteristics.” The 10-year overall survival rate was highest for patients with well-differentiated variants at 85.4%, followed by those with diffuse sclerosing variants at 79.2%, tall cell at 71.9%, poorly differentiated at 45.1%, insular at 27.9%, and anaplastic at 8.9%.”

Of note, the study authors acknowledged that “individual cancers will contain a blend of variants or tumor grade components that may defy categorization. However, they added, “The breadth and scale of these results represent convincing evidence backing substratification.”

Disclosure: For full disclosures of the study authors, please visit jamanetwork.com.

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