分化型甲状腺癌风险分类的决定因素：一项印度队列研究
Factors Determining Risk Categories in Differentiated Thyroid Carcinoma: Study of an Indian Cohort.
作者信息
Chirayath Shiga Rappai, Menon Usha V, Nair Vasantha, Kumar Harish, Praveen V P, Bhavani Nisha, Abraham Nithya
机构信息
Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
出版信息
Indian J Endocrinol Metab. 2022 May-Jun;26(3):269-274. doi: 10.4103/ijem.ijem_245_21. Epub 2022 Aug 4.
INTRODUCTION
Differentiated thyroid carcinoma/cancer (DTC) burden in developing countries could be different from that of the developed nations.
AIMS AND OBJECTIVES
To describe the clinicopathological characteristics in a cohort of DTC patients in a south Indian state of Kerala and to compare with the data from other centres.
MATERIALS AND METHODS
A retrospective analysis of the data collected on DTC patients, from January 2010 to August 2018, attending thyroid cancer clinic at a tertiary care centre.
RESULTS
mong the 944 patients (male 262; female 682; mean age 43.8 years; standard deviation, SD 13.8), types of tumour were as follows: classical papillary thyroid carcinoma (cPTC) 48.3%, follicular variants of PTC (FVPTC) 28.8%, follicular and hurthle cell carcinoma (FTC&HCC) 10.1%. Mean size of the tumour was 2.7 cm (SD 1.8) papillary thyroid micro carcinomas (PTMC) were seen in 113 patients (12%), which were detected incidentally. Metastases were present at diagnosis in 40.2% cases, most common site being cervical lymph nodes. Distant metastases were seen in 113 patients (14.5%) and commonest site was bone. The American Thyroid Association (ATA) risk stratification was possible only in 684 subjects and showed 31.3% low risk, 41.8% intermediate risk and 26.9% at high-risk category. Lymph node metastasis and distant metastasis were the commonest determining factors for intermediate and high-risk category, respectively. High-risk category was significantly higher in patients >55 years, tumour size >4 cm, FTC/HCC tumour type and extranodal extension (ENE) of lymph node metastasis. Radio active iodine ablation was given to 85.2% subjects.
CONCLUSION
In our DTC population, FVPTC formed the second most common type and PTMC were all incidentalomas. Metastasis at diagnosis was higher suggesting delayed presentation. Old age, FTC/HCC, large size of the tumour, ENE were significantly higher in high-risk patients. Rest of the features of these cohort was comparable with the United States cohort of DTC patients.
引言
发展中国家分化型甲状腺癌（DTC）的负担可能与发达国家不同。
目的
描述印度南部喀拉拉邦一组DTC患者的临床病理特征，并与其他中心的数据进行比较。
材料与方法
对2010年1月至2018年8月在一家三级医疗中心甲状腺癌门诊就诊的DTC患者收集的数据进行回顾性分析。
结果
在944例患者中（男性262例；女性682例；平均年龄43.8岁；标准差13.8），肿瘤类型如下：经典型乳头状甲状腺癌（cPTC）48.3%，PTC滤泡变异型（FVPTC）28.8%，滤泡性和许特氏细胞癌（FTC&HCC）10.1%。肿瘤平均大小为2.7cm（标准差1.8），113例患者（12%）为甲状腺微小乳头状癌（PTMC），均为偶然发现。40.2%的病例在诊断时已有转移，最常见部位为颈部淋巴结。113例患者（14.5%）出现远处转移，最常见部位为骨。仅684例患者可进行美国甲状腺协会（ATA）风险分层，结果显示低风险31.3%，中风险41.8%，高风险26.9%。淋巴结转移和远处转移分别是中风险和高风险类别的最常见决定因素。年龄>55岁、肿瘤大小>4cm、FTC/HCC肿瘤类型和淋巴结转移的结外扩展（ENE）患者的高风险类别显著更高。85.2%的患者接受了放射性碘消融治疗。
结论
在我们的DTC患者群体中，FVPTC是第二常见类型，PTMC均为偶然瘤。诊断时转移率较高，提示就诊延迟。高风险患者中，老年、FTC/HCC、肿瘤体积大、ENE显著更高。该队列的其他特征与美国DTC患者队列相当。
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