Tunca F, Sormaz I C, Iscan Y, Senyurek Y G, Terzioglu T
Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, İstanbul Tıp Fakültesi Genel Cerrahi Anabilim Dalı, Turgut Özal Cad., 34390, Fatih/Istanbul, Turkey.
Department of General Surgery, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
J Endocrinol Invest. 2015 Dec;38(12):1327-34. doi: 10.1007/s40618-015-0376-6. Epub 2015 Aug 18.
To compare the histopathological features and the outcomes of the follicular variant and classical variant of papillary thyroid carcinoma.
Demographic data, histopathological features (tumor size, thyroid capsule invasion, extrathyroidal extension, vascular invasion and multicentricity), lymph node metastasis, local recurrence, distant metastasis and mortality during the follow-up of 258 C-PTC and 153 FVPTC patients who underwent total thyroidectomy were compared. The dynamic risk assessment system was used to refine postoperative risk estimates based on the assessment of response to initial treatment.
The demographic data showed no significant difference between the two groups. The mean tumor size showed no significant difference between the two groups. The rate of thyroid capsule invasion, extrathyroidal extension, and lymph node metastasis was significantly higher in C-PTC than in FVPTC group, whereas multicentricity and bilobar involvement were significantly higher in FVPTC group than in C-PTC group. Central lymph node metastasis was significantly more frequent in patients with C-PTC than in those with FVPTC (p < 0.0001). Local recurrence was found in 22 (5.3 %) patients overall and was significantly more common in C-PTC group than in FVPTC group. In patients ≥45 years, the local recurrence rate was significantly higher in patients with CPTC than in those with FVPTC. The local recurrence rate in patients <45 years was not significantly different between the two groups of patients. The multicentricity rate was significantly higher in the FVPTC group for both age groups. Dynamic risk assessment showed that the rate of intermediate- and high-risk groups showed no significant difference between C-PTC and FVPTC patients but the rate of low risk patients was higher in FVPTC group than in C-PTC group (p = 0.04). The recurrence rate in low-risk group was found higher in C-PTC compared to FVPTC patients (4.7 vs. 0.7 %, p = 0.04, respectively). The recurrence rate showed no significant difference in both intermediate- and high-risk groups in C-PTC and FVPTC patients. During the follow-up, the rate of distant metastasis and disease-specific mortality was not significantly different between the two groups (p = 0.25).
FVPTC is a common subtype of PTC and has a higher rate of multicentricity with bilobar involvement. Although aggressive histopathologic features, such as thyroid capsule invasion, extrathyroidal extension, and lymph node metastasis, are significantly more frequent in CPTC than in FVPTC, the long-term outcome is similar in both subtypes after appropriate initial surgery and postoperative RAI ablation treatment.
比较甲状腺乳头状癌滤泡变异型和经典变异型的组织病理学特征及预后。
比较258例接受全甲状腺切除术的经典型甲状腺乳头状癌（C-PTC）患者和153例滤泡型甲状腺乳头状癌（FVPTC）患者的人口统计学数据、组织病理学特征（肿瘤大小、甲状腺被膜侵犯、甲状腺外侵犯、血管侵犯和多中心性）、淋巴结转移、局部复发、远处转移及随访期间的死亡率。采用动态风险评估系统，根据对初始治疗反应的评估来优化术后风险估计。
两组的人口统计学数据无显著差异。两组的平均肿瘤大小无显著差异。C-PTC组的甲状腺被膜侵犯、甲状腺外侵犯及淋巴结转移率显著高于FVPTC组，而FVPTC组的多中心性和双侧叶受累率显著高于C-PTC组。C-PTC患者的中央区淋巴结转移明显比FVPTC患者更常见（p < 0.0001）。总体上22例（5.3%）患者出现局部复发，C-PTC组比FVPTC组更常见。在年龄≥45岁的患者中，C-PTC患者的局部复发率显著高于FVPTC患者。年龄<45岁的两组患者局部复发率无显著差异。两个年龄组中FVPTC组的多中心性率均显著更高。动态风险评估显示，C-PTC和FVPTC患者的中高危组发生率无显著差异，但FVPTC组的低风险患者发生率高于C-PTC组（p = 0.04）。C-PTC患者低风险组的复发率高于FVPTC患者（分别为4.7%和0.7%，p = 0.04）。C-PTC和FVPTC患者的中高危组复发率均无显著差异。随访期间，两组的远处转移率和疾病特异性死亡率无显著差异（p = 0.25）。
FVPTC是PTC的常见亚型，多中心性和双侧叶受累率较高。尽管C-PTC中甲状腺被膜侵犯、甲状腺外侵犯及淋巴结转移等侵袭性组织病理学特征比FVPTC显著更常见，但在进行适当的初始手术和术后放射性碘消融治疗后，两种亚型的长期预后相似。
