Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China.
Endocrine. 2018 Sep;61(3):499-505. doi: 10.1007/s12020-018-1644-y. Epub 2018 Jun 16.
Patients younger than 55 years of age with papillary thyroid carcinoma (PTC) have excellent survival. Diffuse sclerosing variant (DSV) and tall cell variant (TCV) of PTC are associated with aggressiveness; the survival of patients <55 years of age with these variants is still unclear. We aim to investigate the clinicopathological features and survival of these variants in the age group <55 years.
All adult patients (<55 years old) with DSV, TCV and conventional PTC (CPTC) came from the Surveillance, Epidemiology, and End Results program (1988-2013). Kaplan-Meier method and log-rank test were used to analyze the survival. Prognostic factors associated with survival were analyzed by Cox multivariate regression.
There were 280 DSV, 615 TCV, and 56287 CPTC in the age group <55 years. DSV and TCV were associated with multifocality, extrathyroidal extension, lymph node and distant metastasis (all p < 0.05). The 10-year disease-specific survival (DSS) of TCV was worse than CPTC (96.3 vs. 99.4%, p < 0.01), but there was no significant difference between DSV and CPTC (99.5 vs. 99.4%, p > 0.05). Cox multivariate regression showed TCV was the independent predictor of DSS (HR: 5.39, p < 0.01).
In the age group <55 years, DSV and TCV are more likely to exhibit aggressive characteristics than CPTC. Patient <55 years of age with DSV have excellent survival likewise, while patients <55 years of age with TCV carry worse survival. Further investigation for the recurrence risk of patients <55 years with these variants would contribute to optimal clinical management making.
年龄小于 55 岁的甲状腺乳头状癌（PTC）患者具有极好的生存预后。弥漫硬化型（DSV）和高细胞型（TCV）PTC 与侵袭性相关；年龄小于 55 岁的这些变体患者的生存情况仍不清楚。我们旨在研究年龄小于 55 岁的患者中这些变体的临床病理特征和生存情况。
所有来自监测、流行病学和结果计划（1988-2013 年）的 DSV、TCV 和传统 PTC（CPTC）的成年患者（年龄小于 55 岁）均纳入研究。采用 Kaplan-Meier 方法和对数秩检验分析生存情况。采用 Cox 多因素回归分析与生存相关的预后因素。
年龄小于 55 岁的患者中，DSV 为 280 例，TCV 为 615 例，CPTC 为 56287 例。DSV 和 TCV 与多灶性、甲状腺外侵犯、淋巴结和远处转移相关（均 p<0.05）。TCV 的 10 年疾病特异性生存率（DSS）差于 CPTC（96.3%比 99.4%，p<0.01），但 DSV 与 CPTC 之间无显著差异（99.5%比 99.4%，p>0.05）。Cox 多因素回归显示 TCV 是 DSS 的独立预测因子（HR：5.39，p<0.01）。
在年龄小于 55 岁的患者中，DSV 和 TCV 比 CPTC 更具侵袭性特征。同样，年龄小于 55 岁的 DSV 患者具有极好的生存预后，而年龄小于 55 岁的 TCV 患者的生存预后较差。进一步研究这些变体患者的复发风险将有助于优化临床管理。
