Trimboli Pierpaolo, Bongiovanni Massimo, Rossi Fabio, Guidobaldi Leo, Crescenzi Anna, Ceriani Luca, Nigri Giuseppe, Valabrega Stefano, Romanelli Francesco, Giovanella Luca
Section of Endocrinology and Diabetology, Ospedale Israelitico, Via Fulda, 14, 00148, Rome, Italy,
Endocrine. 2015 May;49(1):191-5. doi: 10.1007/s12020-014-0453-1. Epub 2014 Oct 17.
The prognosis of differentiated thyroid cancers (DTC) read at cytology as indeterminate and classified as Thy 3 according to the British Thyroid Association has recently been suggested to be good. To obtain robust information about this potential novelty, in this study we retrospectively reviewed DTC with a prior fine-needle aspiration cytology (FNAC) of Thy 3, Thy 4 or Thy 5 presently followed up at two institutes. Patients with no FNAC before surgery were excluded and a series of 284 DTC was enrolled in the study. Of these, 53 had Thy 3, 108 Thy 4, and 123 had Thy 5 prior to surgery. At histology, 280 (98.6 %) papillary and 4 follicular (1.4 %) cancers were found. Overall, the less aggressive cancer forms were prevalent in all three groups. The lower TNM stages (I and II) were more frequent in the Thy 3 group (96.2 %) than in the other cases (76.6 %) (p < 0.001). Neck lymph node metastasis at diagnosis was found in 3.8 % of Thy 3, 18.5 % of Thy 4, and 26 % of Thy 5 cases. At follow-up, a 16.2 % recurrence rate was recorded, ranging from 1.9 % in Thy 3 group to 19.5 % for Thy 4 and Thy 5 (p < 0.001). According to the Kaplan-Meier curve, Thy 3 was thus a favorable prognostic factor compared with Thy 4 and Thy 5 (OR = 0.079, p < 0.001, 95 %CI 0.01-0.59). At multivariate analysis, Thy 3 was an independent predictor of good prognosis (OR = 0.06, p = 0.03, 95 %CI 0.01-0.80). In conclusion, DTC with a preoperative Thy 3 cytology have a better prognosis than those with Thy 4 and Thy 5 due to less aggressive tumor types and lower TNM stage at diagnosis.
根据英国甲状腺协会的分类，细针穿刺细胞学检查结果为不确定且分类为Thy 3的分化型甲状腺癌（DTC），其预后最近被认为良好。为了获取有关这一潜在新情况的可靠信息，在本研究中，我们回顾性分析了两所机构目前正在随访的术前细针穿刺细胞学检查（FNAC）结果为Thy 3、Thy 4或Thy 5的DTC患者。排除术前未进行FNAC的患者，共纳入284例DTC患者进行研究。其中，53例术前为Thy 3，108例为Thy 4，123例为Thy 5。组织学检查发现，280例（98.6%）为乳头状癌，4例（1.4%）为滤泡状癌。总体而言，侵袭性较低的癌型在所有三组中均占主导。Thy 3组中较低的TNM分期（I期和II期）比其他病例（76.6%）更为常见（p < 0.001）。诊断时，Thy 3组有3.8%的患者出现颈部淋巴结转移，Thy 4组为18.5%，Thy 5组为26%。随访时，记录的复发率为16.2%，Thy 3组为1.9%，Thy 4组和Thy 5组为19.5%（p < 0.001）。根据Kaplan-Meier曲线，与Thy 4和Thy 5相比，Thy 3是一个有利的预后因素（OR = 0.079，p < 0.001，95%CI 0.01 - 0.59）。多因素分析显示，Thy 3是良好预后的独立预测因素（OR = 0.06，p = 0.03，95%CI 0.01 - 0.80）。总之，术前细胞学检查为Thy 3的DTC患者，因其肿瘤类型侵袭性较低且诊断时TNM分期较低，故预后优于Thy 4和Thy 5的患者。
