International Medullary Thyroid Carcinoma Grading System: A Validated Grading System for Medullary Thyroid Carcinoma
| Autor: | Ian Ganly, Fedaa Najdawi, Angela Chou, Antonio De Leo, Justine A. Barletta, Philip M. Spanheimer, Abir Al Ghuzlan, Alex Papachristos, Dana M. Hartl, Mohammed Alghamdi, Aradhya Nigam, Bayan Alzumaili, Christina Kanaan, Anthony J. Gill, James A. Fagin, Bin Xu, Eric Baudin, Erica Solaroli, Brian R. Untch, Sara Ahmadi, Andrea Repaci, Mohamed-Amine Bani, Anthony Glover, Ronald Ghossein, Giovanni Tallini, Talia L Fuchs, Pierre Khneisser |
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| Přispěvatelé: | Xu, Bin, Fuchs, Talia L, Ahmadi, Sara, Alghamdi, Mohammed, Alzumaili, Bayan, Bani, Mohamed-Amine, Baudin, Eric, Chou, Angela, De Leo, Antonio, Fagin, James A, Ganly, Ian, Glover, Anthony, Hartl, Dana, Kanaan, Christina, Khneisser, Pierre, Najdawi, Fedaa, Nigam, Aradhya, Papachristos, Alex, Repaci, Andrea, Spanheimer, Philip M, Solaroli, Erica, Untch, Brian R, Barletta, Justine A, Tallini, Giovanni, Al Ghuzlan, Abir, Gill, Anthony J, Ghossein, Ronald A |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Cancer Research Pathology medicine.medical_specialty Consensus Proliferation index Medullary cavity Adolescent Biopsy Risk Assessment Thyroid carcinoma Necrosis Young Adult Predictive Value of Tests Risk Factors Mitotic Index Medicine Humans Thyroid Neoplasms Grading (education) Child Aged Cell Proliferation Retrospective Studies Aged 80 and over business.industry Reproducibility of Results Middle Aged United States Carcinoma Neuroendocrine Europe Ki-67 Antigen Oncology Child Preschool medullary thyroid carcinoma grading prognosis survival ki67 proliferation index tumor necrosis neuroendocrine tumor thyroid carcinoma Female Neoplasm Grading New South Wales business |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 40(1) |
| ISSN: | 1527-7755 |
| Popis: | PURPOSE Medullary thyroid carcinoma (MTC) is an aggressive neuroendocrine tumor (NET) arising from the calcitonin-producing C cells. Unlike other NETs, there is no widely accepted pathologic grading scheme. In 2020, two groups separately developed slightly different schemes (the Memorial Sloan Kettering Cancer Center and Sydney grade) on the basis of proliferative activity (mitotic index and/or Ki67 proliferative index) and tumor necrosis. Building on this work, we sought to unify and validate an internationally accepted grading scheme for MTC. PATIENTS AND METHODS Tumor tissue from 327 patients with MTC from five centers across the United States, Europe, and Australia were reviewed for mitotic activity, Ki67 proliferative index, and necrosis using uniform criteria and blinded to other clinicopathologic features. After reviewing different cutoffs, a two-tiered consensus grading system was developed. High-grade MTCs were defined as tumors with at least one of the following features: mitotic index ≥ 5 per 2 mm2, Ki67 proliferative index ≥ 5%, or tumor necrosis. RESULTS Eighty-one (24.8%) MTCs were high-grade using this scheme. In multivariate analysis, these patients demonstrated decreased overall (hazard ratio [HR] = 11.490; 95% CI, 3.118 to 32.333; P < .001), disease-specific (HR = 8.491; 95% CI, 1.461 to 49.327; P = .017), distant metastasis-free (HR = 2.489; 95% CI, 1.178 to 5.261; P = .017), and locoregional recurrence-free (HR = 2.114; 95% CI, 1.065 to 4.193; P = .032) survivals. This prognostic power was maintained in subgroup analyses of cohorts from each of the five centers. CONCLUSION This simple two-tiered international grading system is a powerful predictor of adverse outcomes in MTC. As it is based solely on morphologic assessment in conjunction with Ki67 immunohistochemistry, it brings the grading of MTCs in line with other NETs and can be readily applied in routine practice. We therefore recommend grading of MTCs on the basis of mitotic count, Ki67 proliferative index, and tumor necrosis. |
| Databáze: | OpenAIRE |
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