Abstract：
BACKGROUND: Poorly differentiated thyroid carcinoma (PDTC) is a distinct entity with intermediate prognosis between indolent follicular thyroid cancers and anaplastic carcinoma. The management guidelines are not standardized for these cancers due its low prevalence and limited available literature. Therefore, we did this systematic review with emphasis on current evidence on diagnosis, imaging, molecular markers, and management of these carcinomas.
METHODS: We searched four databases, PubMed, Medline, EMBASE, and Emcare to identify studies published till October 2023. All studies reporting diagnostic tests, imaging, molecular marker expression and management of PDTC were included in the review. The meta-analysis was conducted on expression of molecular markers in these cancers following recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects meta-analysis was used to calculate pooled estimated prevalence with 95% confidence intervals. Based on the inclusion criteria, 62 articles were selected to be incorporated for the review. Differences in pathological diagnostic criteria of PDTC was noted in literature which was addressed in WHO 2022 diagnostic terminologies with expansion of the definition. Surgical management is uniformly recommended for early stage PDTC. However, literature is divided and anecdotal for recommendations on radioactive iodine (RAI), extent of neck dissection and adjuvant treatment in PDTC. Evidence for Next Generation Sequencing (NGS), novel theragnostic approaches, immunotherapy targets are evolving. Based on the subset analysis for expression of molecular markers, we found the most common markers expressed were TERT (41%), BRAF (28%) and P 53 (25%).
CONCLUSIONS: Poorly differentiated thyroid carcinomas have a high case fatality rate (up to 31%). Eighty-five % of the patients who succumb to the disease have distant metastasis. Even though under-represented in literature, evidence-based management of these aggressive tumors can help personalize the treatment for optimal outcomes.
METHODS: We searched four databases, PubMed, Medline, EMBASE, and Emcare to identify studies published till October 2023. All studies reporting diagnostic tests, imaging, molecular marker expression and management of PDTC were included in the review. The meta-analysis was conducted on expression of molecular markers in these cancers following recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects meta-analysis was used to calculate pooled estimated prevalence with 95% confidence intervals. Based on the inclusion criteria, 62 articles were selected to be incorporated for the review. Differences in pathological diagnostic criteria of PDTC was noted in literature which was addressed in WHO 2022 diagnostic terminologies with expansion of the definition. Surgical management is uniformly recommended for early stage PDTC. However, literature is divided and anecdotal for recommendations on radioactive iodine (RAI), extent of neck dissection and adjuvant treatment in PDTC. Evidence for Next Generation Sequencing (NGS), novel theragnostic approaches, immunotherapy targets are evolving. Based on the subset analysis for expression of molecular markers, we found the most common markers expressed were TERT (41%), BRAF (28%) and P 53 (25%).
CONCLUSIONS: Poorly differentiated thyroid carcinomas have a high case fatality rate (up to 31%). Eighty-five % of the patients who succumb to the disease have distant metastasis. Even though under-represented in literature, evidence-based management of these aggressive tumors can help personalize the treatment for optimal outcomes.
摘要：
背景：低分化甲状腺癌（PDTC）是一种独特的实体，在惰性滤泡性甲状腺癌和间变性癌之间具有中等预后。由于这些癌症的低患病率和有限的可用文献，管理指南没有标准化。因此,我们做了这个系统综述，重点是当前的诊断证据，成像,分子标记,和这些癌症的管理。
方法：我们搜索了四个数据库，PubMed,Medline,EMBASE,和Emcare来确定直到2023年10月发表的研究。所有报告诊断测试的研究，成像,PDTC的分子标记表达和管理被纳入综述。根据系统评价和荟萃分析(PRISMA)的优选报告项目的建议,对这些癌症中的分子标志物的表达进行荟萃分析。使用随机效应荟萃分析以95%置信区间计算合并估计患病率。根据纳入标准，选择了62篇文章进行审查。文献中指出了PDTC病理诊断标准的差异，WHO2022诊断术语中对其定义进行了扩展。早期PDTC统一推荐手术治疗。然而,关于放射性碘（RAI）的建议的文献是分开的和轶事的，PDTC的颈清扫程度和辅助治疗。下一代测序（NGS）的证据，新的治疗方法，免疫治疗的目标正在演变。基于分子标记表达的子集分析，我们发现表达的最常见的标记是TERT(41%)，BRAF(28%)和P53(25%)。
结论：低分化甲状腺癌的病死率高（高达31%）。85%死于该疾病的患者具有远处转移。尽管在文学中代表性不足，这些侵袭性肿瘤的循证管理有助于个性化治疗以获得最佳结果.
方法：我们搜索了四个数据库，PubMed,Medline,EMBASE,和Emcare来确定直到2023年10月发表的研究。所有报告诊断测试的研究，成像,PDTC的分子标记表达和管理被纳入综述。根据系统评价和荟萃分析(PRISMA)的优选报告项目的建议,对这些癌症中的分子标志物的表达进行荟萃分析。使用随机效应荟萃分析以95%置信区间计算合并估计患病率。根据纳入标准，选择了62篇文章进行审查。文献中指出了PDTC病理诊断标准的差异，WHO2022诊断术语中对其定义进行了扩展。早期PDTC统一推荐手术治疗。然而,关于放射性碘（RAI）的建议的文献是分开的和轶事的，PDTC的颈清扫程度和辅助治疗。下一代测序（NGS）的证据，新的治疗方法，免疫治疗的目标正在演变。基于分子标记表达的子集分析，我们发现表达的最常见的标记是TERT(41%)，BRAF(28%)和P53(25%)。
结论：低分化甲状腺癌的病死率高（高达31%）。85%死于该疾病的患者具有远处转移。尽管在文学中代表性不足，这些侵袭性肿瘤的循证管理有助于个性化治疗以获得最佳结果.
