Englum Brian R, Pura John, Reed Shelby D, Roman Sanziana A, Sosa Julie A, Scheri Randall P
Department of Surgery, Duke University Medical Center, Duke University School of Medicine, DUMC Box #3513, Durham, NC, 27710, USA.
Duke Clinical Research Institute, Durham, NC, 27705, USA.
World J Surg. 2015 Dec;39(12):2928-34. doi: 10.1007/s00268-015-3192-4.
Follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FV-PTC) are difficult entities to distinguish based on cytology prior to pathologic evaluation of surgical specimens but may have different treatment algorithms. The current study describes trends in rates of FTC versus FV-PTC in the U.S. and develops a risk assessment tool to aid clinicians in predicting final diagnosis and shaping treatment plans.
Relative rates of FTC and FV-PTC in the surveillance, epidemiology, and end results (SEER) database were evaluated for temporal trends from 1988 to 2011. Using multivariable logistic regression, a simplified scoring system was developed to estimate the risk of FTC versus FV-PTC using patient and tumor characteristics. The National Cancer Data Base was used for model validation.
Of 115,091 thyroid cancer cases in the SEER database from 1988 to 2011, 23,980 involved FTC (n = 5056; 21 %) or FV-PTC (n = 18,924; 79 %). In 1988, half of follicular cases were FV-PTC; however, FV-PTC accounted for over 85 % of these lesions by 2010. Increasing age >45 years, male gender, black race, increasing tumor size, and distant metastases were strongly associated with increased risk of FTC, while lymph node disease and extrathyroidal extension were associated with FV-PTC. A bedside risk assessment nomogram using these preoperative variables classified patient risk of FTC from 2 to 70 %. FV-PTC has become the dominant malignancy with follicular cytology, accounting for >85 % of these cases. A simple bedside risk assessment tool can risk stratify patients with follicular lesions and inform patient and clinician discussions and decision making.
滤泡状甲状腺癌（FTC）和乳头状甲状腺癌滤泡变体（FV-PTC）在手术标本进行病理评估之前，很难通过细胞学进行区分，但它们可能具有不同的治疗方案。本研究描述了美国FTC与FV-PTC发病率的变化趋势，并开发了一种风险评估工具，以帮助临床医生预测最终诊断并制定治疗方案。
评估监测、流行病学和最终结果（SEER）数据库中1988年至2011年FTC和FV-PTC的相对发病率的时间趋势。使用多变量逻辑回归，开发了一个简化的评分系统，根据患者和肿瘤特征来估计FTC与FV-PTC的风险。使用国家癌症数据库进行模型验证。
在1988年至2011年SEER数据库中的115,091例甲状腺癌病例中，23,980例涉及FTC（n = 5056；21%）或FV-PTC（n = 18,924；79%）。1988年，滤泡状病例中有一半是FV-PTC；然而，到2010年，FV-PTC占这些病变的85%以上。年龄>45岁、男性、黑人种族、肿瘤大小增加和远处转移与FTC风险增加密切相关，而淋巴结疾病和甲状腺外侵犯与FV-PTC相关。使用这些术前变量的床边风险评估列线图将患者FTC风险分类为2%至70%。FV-PTC已成为具有滤泡状细胞学特征的主要恶性肿瘤，占这些病例的85%以上。一个简单的床边风险评估工具可以对滤泡状病变患者进行风险分层，并为患者和临床医生的讨论及决策提供参考。
