Henke Lauren E, Pfeifer John D, Baranski Thomas J, DeWees Todd, Grigsby Perry W
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Pathology, Washington University School of Medicine, St. Louis, Missouri, USA.
Endocr Connect. 2018 Dec 1;7(12):1226-1235. doi: 10.1530/EC-18-0264.
The majority of papillary thyroid carcinoma (PTC) cases comprise classic papillary (C-PTC) and follicular variant (FV-PTC) histologic sub-types. Historically, clinical equivalency was assumed, but recent data suggest C-PTC may have poorer outcomes. However, large single-institution series with long-term outcomes of C-PTC and FV-PTC, using modern pathologic criteria for FV-PTC, are needed. Our objective was to compare prevalence and impact of clinicopathologic factors, including BRAF mutation status, on long-term outcomes of C-PTC and FV-PTC. We hypothesized that patients with C-PTC would have higher risk disease features and worse survival outcomes. This retrospective study included 1293 patients treated at a single, US academic institution between 1943 and 2009 with mean follow-up of 8.6 years. All patients underwent either partial or total thyroidectomy and had invasive C-PTC or FV-PTC per modern pathology criteria. Primary study measurements included differences in recurrence-free survival (RFS), disease-specific survival (DSS) and associations with clinicopathologic factors including the BRAF mutation. Compared to FV-PTC, C-PTC was associated with multiple features of high-risk disease (P < 0.05) and significantly reduced RFS and DSS. Survival differences were consistent across univariate, multivariate and Kaplan-Meier analyses. BRAF mutations were more common in C-PTC (P = 0.002). However, on Kaplan-Meier analysis, mutational status did not significantly impact RFS or DSS for patients with either histologic sub-type. C-PTC therefore indicates higher-risk disease and predicts for significantly poorer long-term outcomes when compared to FV-PTC. The nature of this difference in outcome is not explained by traditional histopathologic findings or by the BRAF mutation.
大多数甲状腺乳头状癌（PTC）病例包括经典乳头状（C-PTC）和滤泡状变异型（FV-PTC）组织学亚型。从历史上看，人们认为它们在临床上具有等效性，但最近的数据表明C-PTC的预后可能更差。然而，需要有使用现代FV-PTC病理标准的、关于C-PTC和FV-PTC长期预后的大型单机构系列研究。我们的目的是比较包括BRAF突变状态在内的临床病理因素对C-PTC和FV-PTC长期预后的患病率及影响。我们假设C-PTC患者具有更高风险的疾病特征和更差的生存结果。这项回顾性研究纳入了1943年至2009年间在美国一家学术机构接受治疗的1293例患者，平均随访8.6年。所有患者均接受了部分或全甲状腺切除术，并且根据现代病理学标准诊断为侵袭性C-PTC或FV-PTC。主要研究指标包括无复发生存期（RFS）、疾病特异性生存期（DSS）的差异以及与包括BRAF突变在内的临床病理因素的关联。与FV-PTC相比，C-PTC与多种高危疾病特征相关（P < 0.05），并且RFS和DSS显著降低。单因素、多因素和Kaplan-Meier分析的生存差异一致。BRAF突变在C-PTC中更常见（P = 0.002）。然而，在Kaplan-Meier分析中，突变状态对两种组织学亚型患者的RFS或DSS均无显著影响。因此，与FV-PTC相比，C-PTC表明疾病风险更高，并且预测长期预后明显更差。这种预后差异的本质不能用传统组织病理学发现或BRAF突变来解释。
