利用动态风险分层评估高细胞型甲状腺滤泡癌患者的风险。

Utilizing Dynamic Risk Stratification in Patients With Tall Cell Variant Papillary Thyroid Cancer.

机构信息

Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.

出版信息

Laryngoscope. 2023 Sep;133(9):2430-2438. doi: 10.1002/lary.30725. Epub 2023 May 9.

DOI:10.1002/lary.30725

PMID:37159105

Abstract

OBJECTIVES

Tall cell variant (TCV) papillary thyroid cancer (PTC) is a subtype of PTC associated with aggressive tumor behavior, advanced stage, and higher rates of recurrence and mortality. The present study aimed to test an established dynamic risk stratification tool in the TCV population, with the goal of better predicting the postoperative course of these patients.

STUDY DESIGN

Retrospective chart review.

METHODS

A total of 94 patients with TCV who underwent total thyroidectomy with radioactive iodine ablation were retrospectively reviewed from 1998 through 2020. Biochemical, structural, and overall response to treatment was determined for each patient, based on postoperative thyroglobulin levels and imaging findings. Primary outcomes were locoregional and distant recurrence, presence of disease at final follow-up, need for additional intervention, and disease-specific mortality.

RESULTS

Patients with TCV who were stratified as having an excellent overall response to treatment had lower rates of locoregional recurrence than indeterminate, biochemical incomplete, and structural incomplete responses (2.0%, 33.3%, 55.0%, and 85.7% at 5 years respectively, p < 0.001). The same was true for distant recurrence as well (2.0%, 9.0%, 35.1%, and 42.9%, p < 0.001). An excellent response was also associated with lower rates of presence of disease at final follow-up, need for additional intervention, and disease-specific mortality.

CONCLUSIONS

Although TCV is an aggressive subtype associated with worse clinical outcomes than classical PTC, patients with an excellent overall response to treatment have significantly improved outcomes when compared to indeterminate, biochemical incomplete, and structural incomplete responses.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:2430-2438, 2023.

摘要

目的

高细胞型（TCV）甲状腺乳头状癌（PTC）是一种与侵袭性肿瘤行为、晚期、更高的复发率和死亡率相关的 PTC 亚型。本研究旨在对 TCV 人群中一种已建立的动态风险分层工具进行测试，以更好地预测这些患者的术后病程。

研究设计

回顾性图表回顾。

方法

回顾性分析了 1998 年至 2020 年间接受全甲状腺切除术和放射性碘消融术的 94 例 TCV 患者。根据术后甲状腺球蛋白水平和影像学发现，确定每位患者的生化、结构和整体治疗反应。主要结局是局部和远处复发、最终随访时的疾病存在、需要额外干预和疾病特异性死亡率。

结果

TCV 患者被分层为治疗后总体反应良好者，其局部复发率低于不确定、生化不完全和结构不完全反应者（分别为 5 年时的 2.0%、33.3%、55.0%和 85.7%，p<0.001）。远处复发也是如此（分别为 2.0%、9.0%、35.1%和 42.9%，p<0.001）。良好的反应也与最终随访时疾病的存在、需要额外干预和疾病特异性死亡率较低相关。