Gunalp Bengul, Okuyucu Kursat, Ince Semra, Ayan Aslı, Alagoz Engin
Department of Nuclear Medicine, Gulhane Training and Research Hospital, Ankara, Turkey.
Hell J Nucl Med. 2017 May-Aug;20(2):122-127. doi: 10.1967/s002449910552. Epub 2017 Jul 12.
There has been much discussion recently about the risk category of tall cell variant (TVC) histology and its effects on the management of papillary thyroid carcinoma (PTC). We, therefore, undertook a retrospective study to compare stage-matched risk factors and recurrence rates between classical PTC (cPTC) patients and patients with TCV histology.
A total of 3128 well-differentiated thyroid carcinoma patients who were treated and followed-up for more than 5 years in our clinic from 1995 to 2016 were included in this study. There were 2783 PTC (89%) patients, 1113 (40%) of them were cPTC and 56 (2%) of them were TCV patients.
In all stages, the stage-matched incidence of extrathyroidal extension (ETE), lymphovascular invasion and initial lymph node metastases were significantly higher in TCV patients than in cPTC patients (P<0.001). Recurrence was in 10 of 27 patients (37%) with TCV and in 91 of 890 (10%) patients with cPTC diagnosed in stage I (odds ratio (OR)=5.16); in 4 of 6 patients with TCV and 18 of 84 (21%) patients with cPTC in stage II (OR=7.33); in 5 of 6 patients with TCV and 11 of 46 (23%) patients with cPTC in stage III (OR=15.90); and in 13 of 17 patients with TCV and 31 of 93 (33%) patients with cPTC in stage IV (OR=6.50). Stage-matched recurrence rates were found significantly higher in all stages of TCV patients than in cPTC patients (OR=8.49, P<0.001). Recurrence with distant metastases was seen more frequently in TCV patients than in cPTC patients (P<0.001) and treatment of metastatic disease was more difficult in TCV patients.
Tall cell variant was an independent poor prognostic factor in papillary thyroid carcinoma patients even if they were diagnosed at early stages of the disease. Patients with tall cell variant histology required more aggressive therapeutic approach and closer follow-up than classical patients.
近期关于高细胞变异型（TVC）组织学的风险类别及其对乳头状甲状腺癌（PTC）治疗的影响存在诸多讨论。因此，我们进行了一项回顾性研究，以比较经典型PTC（cPTC）患者与具有TVC组织学特征患者之间分期匹配的风险因素及复发率。
本研究纳入了1995年至2016年在我院接受治疗并随访超过5年的3128例分化型甲状腺癌患者。其中有2783例PTC患者（占89%），其中1113例（占40%）为cPTC患者，56例（占2%）为TVC患者。
在所有分期中，TVC患者甲状腺外侵犯（ETE）、脉管侵犯及初始淋巴结转移的分期匹配发生率均显著高于cPTC患者（P<0.001）。I期诊断的27例TVC患者中有10例（37%）复发，890例cPTC患者中有91例（10%）复发（比值比（OR）=5.16）；II期6例TVC患者中有4例复发，84例cPTC患者中有18例（21%）复发（OR=7.33）；III期6例TVC患者中有5例复发，46例cPTC患者中有11例（23%）复发（OR=15.90）；IV期17例TVC患者中有13例复发，93例cPTC患者中有31例（33%）复发（OR=6.50）。各分期中TVC患者的分期匹配复发率均显著高于cPTC患者（OR=8.49，P<0.001）。TVC患者远处转移复发的情况比cPTC患者更常见（P<0.001），且TVC患者转移性疾病的治疗更困难。
即使在疾病早期诊断，高细胞变异型仍是乳头状甲状腺癌患者独立的不良预后因素。具有高细胞变异型组织学特征的患者比经典型患者需要更积极的治疗方法及更密切的随访。
