Endocrinology, Department of Clinical and Molecular Medicine of the University of Catania, Garibaldi-Nesima Hospital, Catania, Italy.
Thyroid. 2011 Apr;21(4):383-9. doi: 10.1089/thy.2010.0331.
The diffuse sclerosing variant of papillary thyroid carcinoma (DSPC) is a relatively rare variant of papillary thyroid cancer. Large studies of patients with DSPC have been infrequently performed, and controversy still exists concerning some DSPC features and outcomes. The aim of the present study was to retrospectively evaluate the clinicopathologic features and outcomes in a series of 34 consecutive patients with DSPC and to compare them with a larger group of 245 consecutive patients with the classic variant of papillary thyroid carcinoma (cPTC) that were evaluated in the same period.
Clinical and histological features (sex, age, tumor size,multifocality, bilaterality, extra thyroid extension, and local and distant metastases) were recorded in all patients, as well as any persistent or recurrent disease and the patients' disease status at last observation. Patients with cPTC were classified as either low (122) or high risk (123). DSPC and high-risk patients were all treated with the same protocol, including ¹³¹I treatment. All patients were included in a Cox regression model analysis to investigate the effect of each variable on the hazard ratio.
As expected, multifocality, bilaterality, and extra thyroid extension were more frequently noted at presentation, and the pT1 category of TNM classification was less frequently noted in DSPC and high-risk patients with cPTC compared with low-risk patients with cPTC. No significant difference was found between patients with DSPC and those with high-risk cPTC, except that extra thyroid extension was found more frequently in the patients with DSPC. Using multivariate analysis, diffuse sclerosing variant was an independent variable for predicting a high risk of persistent and recurrent disease during initial follow-up. However, at a later time, and after further treatment, the disease status was not different between patients with DSPC and those with high-risk cPTC, and only the presence of distant metastases affected the final outcome.
DSPC is a thyroid papillary carcinoma variant characterized by high aggressiveness. In patients with DSPC, the outcome is worse than in patients with low-risk cPTC; and, at presentation, characteristics are somewhat worse than for patients with high-risk cPTC.At medium term, the outcome is similar to that observed in patients with high-risk cPTC, provided aggressive treatment is used (additional surgical intervention, when required, and/or ¹³¹I radiotherapy).
弥漫硬化型甲状腺乳头状癌（DSPC）是一种相对罕见的甲状腺乳头状癌变体。对 DSPC 患者进行的大型研究很少，关于 DSPC 的一些特征和结果仍存在争议。本研究的目的是回顾性评估 34 例连续 DSPC 患者的临床病理特征和结果，并将其与同期评估的 245 例经典型甲状腺乳头状癌（cPTC）患者的更大组进行比较。
记录所有患者的临床和组织学特征（性别、年龄、肿瘤大小、多灶性、双侧性、甲状腺外延伸以及局部和远处转移），以及任何持续性或复发性疾病以及患者最后一次观察时的疾病状态。cPTC 患者分为低危（122 例）和高危（123 例）。DSPC 和高危患者均采用相同的治疗方案，包括 ¹³¹I 治疗。所有患者均纳入 Cox 回归模型分析，以研究每个变量对危险比的影响。
正如预期的那样，多灶性、双侧性和甲状腺外延伸在发病时更为常见，与低危 cPTC 患者相比，DSPC 和高危 cPTC 患者的 TNM 分类 pT1 类别更为少见。DSPC 患者与高危 cPTC 患者之间无显著差异，除了 DSPC 患者更常发生甲状腺外延伸。使用多变量分析，弥漫性硬化型是预测初始随访期间持续性和复发性疾病高风险的独立变量。然而，在以后的时间里，在进一步治疗后，DSPC 患者与高危 cPTC 患者之间的疾病状态没有差异，只有远处转移的存在会影响最终结果。
DSPC 是一种侵袭性较高的甲状腺乳头状癌变体。在 DSPC 患者中，预后比低危 cPTC 患者差；并且，在发病时，其特征比高危 cPTC 患者稍差。在中期，只要使用积极的治疗（必要时进行额外的手术干预和/或 ¹³¹I 放疗），其预后与高危 cPTC 患者相似。
