Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Thyroid. 2010 Feb;20(2):153-8. doi: 10.1089/thy.2009.0352.
The tall-cell variant (TCV) of papillary thyroid carcinoma (PTC) is considered a more aggressive variant of PTC, with a poor prognosis. This is largely due to the tendency for TCV to present at an older age and with extrathyroidal extension (ETE). When these two variables are controlled for, it is unclear whether tall-cell histology alone portends a poor prognosis. Because previous studies have been underpowered to adequately answer this question, we hypothesized that TCV may have poorer prognosis than PTC. Our objective was to utilize a large cancer registry to obtain sufficient power to differentiate between outcomes in cases of TCV and PTC.
Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, we identified 278 TCV patients and 2522 classical PTC patients with sufficient information for a detailed matched-pair analysis. Each TCV patient was matched with a PTC patient for age, sex, extent of ETE, regional and distant metastases, surgical and adjuvant therapy, and year of diagnosis. The TCV cohort was then compared against all PTC cases and matched PTC cases.
Compared with classical PTC, TCV patients presented at an older age (54.3 years vs. 46.3 years, p < 0.0001) had a higher rate of ETE (53.6% vs. 30.2%, p < 0.0001) and poorer 5-year disease-specific survival (81.9% vs. 97.8%, p < 0.0001). In the matched-pair analysis comparing TCV patients to the matched PTC cohort, 5-year disease-specific survival was poorer in the TCV cohort (81.9% vs. 91.3%, p = 0.049). The number of deaths in the TCV cohort was higher than in the matched PTC cohort (p = 0.043).
TCV exhibits poorer survival than classical PTC. When the major prognostic factors for thyroid cancer are controlled for, including age and ETE, tall-cell histology alone remains a significant prognostic factor for disease-specific death.
甲状腺乳头状癌（PTC）的高细胞变异型（TCV）被认为是 PTC 的一种侵袭性更强的变异型，预后较差。这在很大程度上是由于 TCV 倾向于在年龄较大和甲状腺外扩展（ETE）时出现。当控制这两个变量时，尚不清楚高细胞组织学本身是否预示着预后不良。由于之前的研究没有足够的能力来充分回答这个问题，我们假设 TCV 可能比 PTC 预后更差。我们的目的是利用一个大型癌症登记处获得足够的权力来区分 TCV 和 PTC 病例的结果。
使用美国国家癌症研究所的监测、流行病学和最终结果数据库，我们确定了 278 例 TCV 患者和 2522 例有详细配对分析所需信息的经典 PTC 患者。每位 TCV 患者均与 PTC 患者进行年龄、性别、ETE 程度、局部和远处转移、手术和辅助治疗以及诊断年份的匹配。然后将 TCV 队列与所有 PTC 病例和匹配的 PTC 病例进行比较。
与经典 PTC 相比，TCV 患者的年龄较大（54.3 岁比 46.3 岁，p < 0.0001），ETE 发生率较高（53.6%比 30.2%，p < 0.0001），5 年疾病特异性生存率较差（81.9%比 97.8%，p < 0.0001）。在比较 TCV 患者与匹配的 PTC 队列的配对分析中，TCV 队列的 5 年疾病特异性生存率较差（81.9%比 91.3%，p = 0.049）。TCV 队列的死亡人数高于匹配的 PTC 队列（p = 0.043）。
TCV 的生存情况不如经典 PTC。当控制甲状腺癌的主要预后因素，包括年龄和 ETE 时，高细胞组织学本身仍然是疾病特异性死亡的重要预后因素。
