Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
Am J Surg. 2023 Aug;226(2):171-175. doi: 10.1016/j.amjsurg.2023.03.023. Epub 2023 Mar 24.
Histopathologic assessment of thyroid tumors can lead to stage migration. We assessed frequency of pathologic upstaging, and associations with patient and tumor factors.
Primary thyroid cancers treated between 2013 and 2015 were included from our institutional cancer registry. For tumor, nodal, and summary stage, upstaging was present when final pathologic stage was greater than clinical staging. Multivariate logistic regression and Chi-squared tests were performed.
5,351 resected thyroid tumors were identified. Upstaging rates for tumor, nodal, and summary stage were 17.5% (n = 553/3156), 18.0% (n = 488/2705), and 10.9% (n = 285/2607), respectively. Age, Asian race, days to surgery, lymphovascular invasion, and follicular histology were significantly associated. Upstaging was significantly more common after total vs partial thyroidectomy, for tumor (19.4% vs 6.2%, p < 0.001), nodal (19.3% vs 6.4%, p < 0.001), and summary stages (12.3% vs 0.7%, p < 0.001).
Pathologic upstaging occurs in a considerable proportion of thyroid tumors, most commonly after total thyroidectomy. These findings can inform patient counseling.
甲状腺肿瘤的组织病理学评估可能导致分期迁移。我们评估了病理升级的频率，并评估了其与患者和肿瘤因素的关联。
从我们的机构癌症登记处纳入了 2013 年至 2015 年期间治疗的原发性甲状腺癌。对于肿瘤、淋巴结和总结分期，如果最终病理分期大于临床分期，则存在分期升级。进行了多变量逻辑回归和卡方检验。
确定了 5351 例切除的甲状腺肿瘤。肿瘤、淋巴结和总结分期的升级率分别为 17.5%（n=553/3156）、18.0%（n=488/2705）和 10.9%（n=285/2607）。年龄、亚洲种族、手术天数、血管淋巴管侵犯和滤泡组织学与肿瘤分期显著相关。与部分甲状腺切除术相比，甲状腺全切术后肿瘤（19.4%比 6.2%，p<0.001）、淋巴结（19.3%比 6.4%，p<0.001）和总结分期（12.3%比 0.7%，p<0.001）的升级更为常见。
相当一部分甲状腺肿瘤存在病理升级，最常见于甲状腺全切术后。这些发现可以为患者咨询提供信息。
