在不具有侵袭性特征的 PTC 中，单纯高细胞百分比不应指导患者的临床管理。
Tall cell percentage alone in PTC without aggressive features should not guide patients' clinical management.
机构信息
Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy.
Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
出版信息
J Clin Endocrinol Metab. 2021 Sep 27;106(10):e4109-e4117. doi: 10.1210/clinem/dgab388.
CONTEXT
Recent diagnostic criteria updates of the tall cell variant of papillary thyroid carcinoma (TCPTC) by the World Health Organization (WHO) have determined the inclusion of tumors with 30% to 49% of tall cells. However, the impact of tall cell percentage on papillary thyroid carcinoma (PTC) patients' prognosis is still debated.
OBJECTIVE
We aimed to evaluate whether tall cell percentage affects patient outcome in the absence of aggressive features.
METHODS
Rates of aggressive features, recurrence-free survival (RFS), and distant RFS (5-year median follow-up) were compared among tumors with less than 30%, 30% to 49% and at least 50% tall cells. We also evaluated the impact of the new tall cell cutoff on patient management.
RESULTS
Overall, 3092 tumors (15.7% of all PTCs) were collected: A total of 792 PTCs had less than 30%, 503 had 30% to 49%, and 1797 had 50% or more tall cell areas. With the new WHO definition, the number of TCPTCs increased by 28%. There were no differences in recurrence rates according to tall cell percentage. The coexistence of BRAF and TERT promoter mutations predicted a worse RFS. Considering the new definition of TCPTC, the level of risk according to the American Thyroid Association increased from low to intermediate in 4.2% of cases. However, the recurrence rate within this subgroup was comparable to low risk.
CONCLUSION
TCPTC and PTC with tall cell areas can be considered as a unique group with similar recurrence risk. However, whenever aggressive features are absent, tumors have a low risk of recurrence independently of tall cell percentage.
背景
世界卫生组织（WHO）最近更新了甲状腺滤泡细胞癌（TCPTC）的诊断标准，将包含 30%至 49%高柱状细胞的肿瘤纳入其中。然而，高柱状细胞比例对甲状腺乳头状癌（PTC）患者预后的影响仍存在争议。
目的
我们旨在评估在没有侵袭性特征的情况下，高柱状细胞比例是否影响患者的结局。
方法
比较低至 30%、30%至 49%和至少 50%高柱状细胞的肿瘤中侵袭性特征、无复发生存率（RFS）和远处 RFS（5 年中位随访）的发生率。我们还评估了新的高柱状细胞截止值对患者管理的影响。
结果
共收集了 3092 例肿瘤（所有 PTC 的 15.7%）：792 例 PTC 低至 30%、503 例 30%至 49%、1797 例 50%或更多高柱状细胞区域。根据新的 WHO 定义，TCPTC 的数量增加了 28%。根据高柱状细胞比例，复发率无差异。BRAF 和 TERT 启动子突变的共存预测 RFS 更差。考虑到 TCPTC 的新定义，根据美国甲状腺协会的标准，4.2%的病例风险级别从低危变为中危。然而，该亚组的复发率与低危相似。
结论
TCPTC 和高柱状细胞区域的 PTC 可被视为具有相似复发风险的独特群体。然而，只要没有侵袭性特征，肿瘤无论高柱状细胞比例如何，复发风险均较低。
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