Ito Yasuhiro, Miyauchi Akira, Hirokawa Mitsuyoshi, Yamamoto Masatoshi, Oda Hitomi, Masuoka Hiroo, Sasai Hisanori, Fukushima Mitsuhiro, Higashiyama Takuya, Kihara Minoru, Miya Akihiro
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan.
Endocr J. 2018 Jun 27;65(6):621-627. doi: 10.1507/endocrj.EJ17-0524. Epub 2018 Apr 4.
Follicular thyroid carcinoma (FTC), a form of differentiated thyroid carcinoma, is the second most common malignancy arising from thyroid follicular cells. Recently, the tumor-node-metastasis (TNM) classification for differentiated thyroid carcinoma was revised from the 7 to the 8 edition. The diagnostic criteria for poorly differentiated carcinoma (PDC) were also updated in the latest World Health Organization (WHO) classification. In this study, we investigated whether these changes are appropriate for accurately predicting prognosis. Three hundred and twenty-nine patients diagnosed with postoperative pathologically confirmed FTC, who underwent initial surgery at our hospital between 1984 and 2004, were enrolled. For this study, patients were re-evaluated and diagnosed with FTC (N = 285) or PDC (N = 44) without typical nuclear findings of papillary thyroid carcinoma. For FTC, the 8 TNM classification was a more accurate predictor of prognosis than the 7 TNM classification. In the 8 TNM classification, cause-specific survival became significantly poorer from Stage I to IVB. The cause-specific survival of PDC based on the latest WHO classification was worse than, but did not significantly differ from, that of PDC based only on the former WHO classification. For PDC, neither of the TNM classifications could accurately predict prognosis. Taken together, we conclude that (1) the 8 TNM classification more accurately reflects the prognosis of FTC than the 7 TNM classification; (2) PDC based on the former WHO classification should be retained, at least in Japan; and (3) the TNM classification may not be suitable for predicting the prognosis of PDC.
滤泡性甲状腺癌（FTC）是分化型甲状腺癌的一种，是甲状腺滤泡细胞来源的第二常见恶性肿瘤。最近，分化型甲状腺癌的肿瘤-淋巴结-转移（TNM）分类从第7版修订为第8版。世界卫生组织（WHO）最新分类中对低分化癌（PDC）的诊断标准也进行了更新。在本研究中，我们调查了这些变化是否适合准确预测预后。纳入了1984年至2004年间在我院接受初次手术、术后病理确诊为FTC的329例患者。在本研究中，对患者进行了重新评估，诊断为无典型甲状腺乳头状癌核特征的FTC（N = 285）或PDC（N = 44）。对于FTC，第8版TNM分类比第7版TNM分类更能准确预测预后。在第8版TNM分类中，从I期到IVB期，特定病因生存率显著变差。基于最新WHO分类的PDC的特定病因生存率比仅基于前一版WHO分类的PDC更差，但无显著差异。对于PDC，两种TNM分类均不能准确预测预后。综上所述，我们得出以下结论：（1）第8版TNM分类比第7版TNM分类更准确地反映了FTC的预后；（2）至少在日本，应保留基于前一版WHO分类的PDC；（3）TNM分类可能不适用于预测PDC的预后。
