Axelsson Tomas A, Hrafnkelsson Jon, Olafsdottir Elinborg J, Jonasson Jon G
1 Faculty of Medicine, University of Iceland , Reykjavik, Iceland .
Thyroid. 2015 Feb;25(2):216-20. doi: 10.1089/thy.2014.0075. Epub 2014 Nov 19.
The tall cell variant (TCV) of papillary thyroid carcinoma (PTC) is an aggressive variant of PTC that is believed to have worse outcomes than classical PTC. The objective of this study was to investigate the incidence, survival, and disease recurrence of patients with TCV and compare them with other PTC in a whole population.
Information on all thyroid carcinomas diagnosed in Iceland from 1990 to 2009 was obtained from the Icelandic Cancer Registry. PTC diagnosed postmortem was excluded. The date of diagnosis, sex, and age at diagnosis were registered. All histopathology material was re-evaluated, and papillary thyroid tumors classified as either TCV or other types of PTC. Tumors were classified as TCV if >50% of cells were tall (height > twice the width). TNM stage was determined for all the cases. Endpoints were thyroid cancer-specific death and thyroid cancer recurrence.
Out of 376 patients diagnosed with PTC in the study period, 49 (13%) were classified as TCV. Patients with TCV were older (66 years vs. 49 years, p<0.001), more often had pT4 tumors (71% vs. 15%, p<0.001), had higher rates of nodal metastasis (51% vs. 22%, p<0.001), and more often distant metastasis (14% vs. 2%, p<0.001). The age-adjusted incidence of TCV for men was 0.5/100,000 [confidence interval (CI) 0.3-0.7] and for women 0.7/100,000 [CI 0.4-1.0] between 1990 and 2009. The five-year disease-specific survival for TCV was 83% [CI 68-91] compared to 98% [CI 96-99] for other PTC respectively (p<0.001). In multivariate analysis, TCV histology was an independent risk factor for recurrence (hazard ratio (HR) 3.18 [CI 1.48-6.84]) but not for disease specific survival (HR 1.86 [CI 0.77-4.73]).
TCV comprises 13% of all diagnosed PTC in Iceland with an incidence of 0.5/100,000 for men and 0.7/100,000 for women. Patients diagnosed with TCV have worse five-year disease-specific survival than patients with other PTC. TCV histology is an independent risk factor for disease recurrence but not for disease-specific survival.
甲状腺乳头状癌（PTC）的高细胞变异型（TCV）是PTC的一种侵袭性变异型，据信其预后比经典PTC更差。本研究的目的是调查TCV患者的发病率、生存率和疾病复发情况，并在整个人口中将其与其他PTC进行比较。
从冰岛癌症登记处获取1990年至2009年在冰岛诊断的所有甲状腺癌的信息。排除尸检诊断的PTC。记录诊断日期、性别和诊断时的年龄。对所有组织病理学材料进行重新评估，将甲状腺乳头状肿瘤分为TCV或其他类型的PTC。如果超过50%的细胞为高细胞（高度>宽度的两倍），则肿瘤分类为TCV。确定所有病例的TNM分期。终点为甲状腺癌特异性死亡和甲状腺癌复发。
在研究期间诊断为PTC的376例患者中，49例（13%）被分类为TCV。TCV患者年龄更大（66岁对49岁，p<0.001），更常出现pT4肿瘤（71%对15%，p<0.001），淋巴结转移率更高（51%对22%，p<0.001），远处转移更常见（14%对2%，p<0.001）。1990年至2009年期间，男性TCV的年龄调整发病率为0.5/100,000[置信区间（CI）0.3 - 0.7]，女性为0.7/100,000[CI 0.4 - 1.0]。TCV的五年疾病特异性生存率为83%[CI 68 - 91]，而其他PTC分别为98%[CI 96 - 99]（p<0.001）。在多变量分析中，TCV组织学是复发的独立危险因素（风险比（HR）3.18[CI 1.48 - 6.84]），但不是疾病特异性生存的危险因素（HR 1.86[CI 0.77 - 4.73]）。
TCV占冰岛所有诊断出的PTC的13%，男性发病率为0.5/100,000，女性为0.7/100,000。诊断为TCV的患者五年疾病特异性生存率比其他PTC患者更差。TCV组织学是疾病复发的独立危险因素，但不是疾病特异性生存的危险因素。
