经病理证实的甲状腺良性滤泡结节的远处转移：临床病理特征及长期生存的预测因素

Distant metastases from pathologically proven benign follicular nodules of the thyroid: clinicopathological features and predictors of long-term survival.

作者信息

Qiu Zhong-Ling, Shen Chen-Tian, Sun Zhen-Kui, Tang Juan, Song Hong-Jun, Zhang Guo-Qiang, Luo Quan-Yong

机构信息

Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233, Shanghai, China.

Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233, Shanghai, China.

出版信息

Endocrine. 2020 Jul;69(1):113-125. doi: 10.1007/s12020-020-02237-0. Epub 2020 Mar 18.

DOI:10.1007/s12020-020-02237-0

PMID:32189188

Abstract

OBJECTIVE

Distant metastases are rarely observed in patients with initial pathologically proven benign follicular nodules of the thyroid. This study aimed to evaluate the clinicopathological features and independent variables associated with survival in such patients with distant metastases.

METHODS

In total, 10,992 consecutive differentiated thyroid cancer (DTC) patients treated with I after total or near-total thyroidectomy from 2000 to 2018 were retrospectively reviewed.

RESULTS

Thirty-nine patients with initial pathologically proven benign follicular nodules of the thyroid were enrolled. Among them, 26 were pathologically diagnosed as thyroid adenoma, 8 as benign nodular goiter, 4 as thyroid adenoma combined with benign nodular goiter, and 1 as normal thyroid tissue. Of 26 patients with the initial pathological slides obtained, eight cases were rediagnosed as minimally invasive thyroid carcinoma (MI-FTC), 10 as follicular tumor of uncertain malignant potential (FT-UMP), and five as well-differentiated tumor of UMP (WDT-UMP). Monitoring of thyroglobulin (Tg) changes after initial thyroidectomy and preablation-stimulated Tg (psTg) level were significantly associated with 5-year OS rate (P = 0.007 and P = 0.005, respectively). The presence of radioactive-refractory DTC (RR-DTC), monitoring of Tg changes after initial thyroidectomy, and psTg level had significant effects on 10-year OS rate (P = 0.002, P < 0.001, and P = 0.005, respectively). Lack of monitoring of Tg changes after initial thyroidectomy and RR-DTC were independent factors associated with poor prognosis (P = 0.003 and P = 0.008, respectively).

CONCLUSIONS

MI-FTC, FT-UMP, and WDT-UMP tended to be ignored and/or misdiagnosed as benign follicular lesions. Lack of monitoring of Tg changes after initial thyroidectomy and the presence of RR-DTC were identified as independent factors associated with poor survival.

摘要

目的

在最初经病理证实为甲状腺良性滤泡性结节的患者中，远处转移很少见。本研究旨在评估此类发生远处转移患者的临床病理特征及与生存相关的独立变量。

方法

回顾性分析了2000年至2018年期间10992例接受全甲状腺或近全甲状腺切除术后接受碘治疗的连续分化型甲状腺癌（DTC）患者。

结果

纳入39例最初经病理证实为甲状腺良性滤泡性结节的患者。其中，26例经病理诊断为甲状腺腺瘤，8例为良性结节性甲状腺肿，4例为甲状腺腺瘤合并良性结节性甲状腺肿，1例为正常甲状腺组织。在获取了初始病理切片的26例患者中，8例被重新诊断为微侵袭性甲状腺癌（MI-FTC），10例为恶性潜能不确定的滤泡性肿瘤（FT-UMP），5例为高分化的UMP肿瘤（WDT-UMP）。初次甲状腺切除术后甲状腺球蛋白（Tg）变化的监测及消融前刺激Tg（psTg）水平与5年总生存率显著相关（分别为P = 0.007和P = 0.005）。放射性难治性DTC（RR-DTC）的存在、初次甲状腺切除术后Tg变化的监测及psTg水平对10年总生存率有显著影响（分别为P = 0.002、P < 0.001和P = 0.005）。初次甲状腺切除术后缺乏Tg变化监测及RR-DTC是与预后不良相关的独立因素（分别为P = 0.003和P = 0.008）。