Tall cell variant papillary thyroid carcinoma impacts disease-free survival at the 10 % cut-point on multivariate analysis.

Autor: Samankan S; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pathology, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: shsamakan@mfa.gwu.edu., Militello L; Department of Pathology, University at Buffalo, Jacobs School of Medicine, Buffalo, NY, USA., Seo G; THANC (Thyroid and Head and Neck Cancer) Foundation, New York, NY, USA., Everest S; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., O'Malley Q; THANC (Thyroid and Head and Neck Cancer) Foundation, New York, NY, USA., Spaulding SL; THANC (Thyroid and Head and Neck Cancer) Foundation, New York, NY, USA., Xing M; THANC (Thyroid and Head and Neck Cancer) Foundation, New York, NY, USA., Matloob A; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Beute J; THANC (Thyroid and Head and Neck Cancer) Foundation, New York, NY, USA., Chai R; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Doyle S; Department of Pathology, University at Buffalo, Jacobs School of Medicine, Buffalo, NY, USA., Urken ML; THANC (Thyroid and Head and Neck Cancer) Foundation, New York, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Brandwein-Weber M; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Jazyk: angličtina
Zdroj: Pathology, research and practice [Pathol Res Pract] 2022 Aug; Vol. 236, pp. 154012. Date of Electronic Publication: 2022 Jul 02.
DOI: 10.1016/j.prp.2022.154012
Abstrakt: Introduction: The diagnosis of tall cell variant papillary thyroid carcinoma (TCV-PTC) corresponds to the feature of "aggressive histology" within the framework of the American Thyroid Association (ATA) Risk of Recurrence (ROR) guidelines. Using the current World Health Organization (WHO) definition for TCV-PTC (tall cells with height at least twice the width, distribution ≥ 30 %), we examined the impact of this diagnosis on disease-free survival (DFS).
Methods: The study cohort consisted of 347 patients treated for primary papillary thyroid carcinoma (PTC). Current ATA guidelines were followed for the extent of surgery and the administration of adjuvant radioiodine therapy. Clinical surveillance included ultrasound examination and biochemical parameters according to ATA standards. The outcome was measured as time from surgery to first disease recurrence (DR) versus time from surgery until the last documented disease-free encounter (no evidence of disease, NED). Disease-free patients with fewer than 6 months of follow-up were excluded from this cohort. Structural recurrences are documented by histology or cytology whereas biochemical recurrences are documented by rising serum thyroglobulin in the absence of structural disease. All slides on all patients were examined by two pathologists with the substantial interobserver agreement (Kappa = 73 %). The primary tumors are categorically classified either as (1) TCV-PTC (definition above), (2) Papillary thyroid carcinoma with tall cell features (PTC-TCF) (≥ 10 % < 30 % tall cells), or (3) Control (< 10 % tall cells). Tumor size is categorized as either (1) ≤ 10 mm, (2) 11-29 mm, or (3) ≥ 30 mm. Degree of ETE is categorized as either intrathyroidal, microscopic ETE, histologic spread to strap muscles, or pT4 disease.
Results: 185 patients are classified as TCV-PTC (≥ 30 % tall cells), 62 as PTC-TCF (≥ 10 % < 30 % tall cells), and 100 as control group (< 10 % tall cells). TCV-PTC is associated with ≥ 30 mm size (p = .0246) and invasion of strap muscles and/or pT4 (p = .0325). There was no relationship between TCV-PTC and aggressive lymph node (ALN) status defined by ATA. Overall follow-up ranged from two months (one patient death) to 203 months (mean 40.8, median 33.0). DR occurred in 61 patients (mean 31.4 months, range 0 -184, 59 structural recurrences, 2 biochemical recurrences). Three models for TCV-PTC were examined: Model 1 - Tall cells ≥ 10% versus control, Model 2 - TCV-PTC versus TCF-PTC versus control, and Model 3 - TCV-PTC versus control. Kaplan Meier curves demonstrated decreased DFS with ALN status (p = .0001), ETE (p = .0295), and TCV-PTC (Model 1, p = .041). On multivariate analysis, TCV-PTC (Model 1) remained significantly predictive when adjusted for ALN (p = .0059). ETE dropped out of the model.
Conclusion: TCV-PTC is significantly associated with larger tumors and a greater degree of ETE. The diagnosis of TCV-PTC significantly impacts DFS at the 10 % cut-point on multivariate analysis.
(Copyright © 2022 Elsevier GmbH. All rights reserved.)
Databáze: MEDLINE
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