Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Via Palermo 636, 95122, Catania, Italy.
J Endocrinol Invest. 2017 Nov;40(11):1235-1241. doi: 10.1007/s40618-017-0688-9. Epub 2017 May 20.
Tall cell (TCV) and diffuse sclerosing (DSV) variants are aggressive variants of papillary thyroid cancer (PTC). We compared the risk of recurrent/persistent disease in patients with TCV, DSV and classical PTC (cPTC) and evaluated the prognostic accuracy of initial vs. ongoing risk stratification.
A consecutive series of DSV (n = 54), TCV (n = 72) and cPTC (n = 184) patients was retrospectively analyzed. TCV and DSV patients were first risk stratified for recurrent/persistent disease without considering the histotype as a risk factor and subsequently, 6-24 months after initial treatment, re-classified on the basis of the response to therapy (ongoing risk stratification).
Extrathyroidal extension was more frequent in DSV than in TCV and cPTC patients (p < 0.05); moreover, only DSV tumors had a higher rate of recurrent/persistent disease when compared to cPTC treated with the same protocol (total thyroidectomy followed by I treatment) (p < 0.01). After initial treatment, 54.2% of TCV and 20.4% of DSV patients were classified at low risk, while at ongoing risk stratification, the excellent response (low risk) was higher for both TCV (77.8%) and DSV (50.0%) patients relative to initial stratification (both p < 0.01). Using ongoing risk classification, positive predictive value (PPV) for persistent/recurrent disease was higher relative to initial risk stratification for both TCV (PPV = 93.8 vs. 39.4%) and DSV (PPV = 63.0 vs. 34.9%), p < 0.05 for both.
In our series DSV, but not TCV patients, had poorer outcome than cPTC treated with the same protocol. Moreover, the ongoing risk stratification predicted outcome better than the initial classification in both TCV and DSV patients.
高细胞型（TCV）和弥漫硬化型（DSV）是甲状腺乳头状癌（PTC）侵袭性变体。我们比较了 TCV、DSV 和经典型 PTC（cPTC）患者中复发性/持续性疾病的风险，并评估了初始与持续风险分层的预后准确性。
回顾性分析了连续系列的 DSV（n=54）、TCV（n=72）和 cPTC（n=184）患者。TCV 和 DSV 患者首先进行复发性/持续性疾病的风险分层，不将组织类型作为危险因素考虑在内，随后在初始治疗后 6-24 个月，根据治疗反应（持续风险分层）重新分类。
DSV 患者的甲状腺外扩展比 TCV 和 cPTC 患者更常见（p<0.05）；此外，只有 DSV 肿瘤在接受相同方案（甲状腺全切除术加 I 治疗）治疗时比 cPTC 具有更高的复发性/持续性疾病发生率（p<0.01）。初始治疗后，54.2%的 TCV 和 20.4%的 DSV 患者被归类为低危，而在持续风险分层中，TCV（77.8%）和 DSV（50.0%）患者的良好反应（低危）均高于初始分层（两者均 p<0.01）。使用持续风险分类，TCV（PPV=93.8 对 39.4%）和 DSV（PPV=63.0 对 34.9%）患者的持续性/复发性疾病的阳性预测值（PPV）均高于初始风险分层，两者均 p<0.05。
在我们的系列研究中，DSV 患者，而不是 TCV 患者，与接受相同方案治疗的 cPTC 相比，预后较差。此外，持续风险分层在 TCV 和 DSV 患者中的预后预测均优于初始分类。
