Okuyucu Kursat, Alagoz Engin, Ince Semra, Arslan Nuri
Gulhane Training and Research Hospital, Department of Nuclear Medicine, Etlik, Ankara, TURKEY.
Endokrynol Pol. 2017;68(6):623-630. doi: 10.5603/EP.a2017.0051. Epub 2017 Oct 12.
Papillary thyroid carcinoma (PTC) is the most common malignant thyroid tumor. A great majority of the cases live a disease-free life with quite favorable prognosis. There are lots of variants of PTC and a few of them exhibit aggressive behaviour. Typical example is the tall cell variant (TCV). Patients experience a greater incidence of recurrence, nodal and extranodal metastases, tumor associated mortality than other variants of PTC. Studies related to TCV almost always compared it with its patient population of PTC according to risk factors and clinicopathologic features. The aim of this study is to evaluate the risk factors in metastatic/recurrent TCV.
This is a retrospective cohort study of 1813 patients with differentiated thyroid carcinoma treated with radioiodine between 1992 and 2011. 56 of these patients are TCV. 34 of them developed metastasis/recurrence and 22 lived a disease-free life during the 23-year follow-up. We evaluated the risk factors in these metastatic and nonmetastatic subgroups.
We found tumor size, preablation thyroglobulin level, vascular invasion, preablation central and lateral cervical lymph node metastasis, preablation lung metastasis and stage independent risk factors. However age, preablation thyroglobulin level and stage appeared together as striking factors impacting metastasis in multivariate analysis.
Higher ablation doses up to 250-300 mCi should be administered to TCV patients having advanced stage (III,IV), pretty high preablation thyroglobulin level (over 400 ng/ml) and older age (over 52 years) especially with large tumor size (over 3.5 cm) and initial cervical lymph node metastasis.
甲状腺乳头状癌（PTC）是最常见的甲状腺恶性肿瘤。大多数病例预后良好，可无病生存。PTC有多种变体，其中少数表现出侵袭性。典型例子是高细胞变体（TCV）。与其他PTC变体相比，患者复发、淋巴结及结外转移和肿瘤相关死亡率的发生率更高。与TCV相关的研究几乎总是根据危险因素和临床病理特征将其与PTC患者群体进行比较。本研究的目的是评估转移性/复发性TCV的危险因素。
这是一项对1992年至2011年间接受放射性碘治疗的1813例分化型甲状腺癌患者的回顾性队列研究。其中56例患者为TCV。在23年的随访期间，其中34例发生转移/复发，22例无病生存。我们评估了这些转移和非转移亚组中的危险因素。
我们发现肿瘤大小、消融前甲状腺球蛋白水平、血管侵犯、消融前中央和侧颈淋巴结转移、消融前肺转移和分期是独立的危险因素。然而，在多变量分析中，年龄、消融前甲状腺球蛋白水平和分期共同作为影响转移的显著因素。
对于处于晚期（III、IV期）、消融前甲状腺球蛋白水平相当高（超过400 ng/ml）且年龄较大（超过52岁），尤其是肿瘤较大（超过3.5 cm）且有初始颈淋巴结转移的TCV患者，应给予高达250 - 300 mCi的更高消融剂量。
