Chidambaranathan Nithyanand, Thiagarajan Shivakumar, Gurukeerthi B, Sathe Pranav, Samel Priyanka, Ramalingam Natarajan, Chaukar Devendra
Department of Head and Neck Oncology, Kovai Medical Hospital, Coimbatore, India.
Department of Head and Neck Oncology, Tata Memorial Centre and Homi Bhabha National Institute (HBNI), Mumbai, India.
Eur Arch Otorhinolaryngol. 2024 Apr;281(4):1923-1931. doi: 10.1007/s00405-023-08438-3. Epub 2024 Jan 8.
Multiple factors contribute to recurrences in differentiated thyroid cancers (DTC). Though the nodal size and number of positive nodes along with the presence of extranodal extension (ENE) have been mentioned in the present ATA risk stratification, the weightage given for ENE seems inadequate compared to the former two.
Factors predicting recurrences were analysed in this retrospective study of patients with DTC operated in a tertiary care centre. Based on our findings, we propose a modification in the present risk stratification. We have done so by comparing with existing risk stratification for fit and discrimination of this system.
Out of 1428 patients, 859 (60.2%) patients had pathological nodal metastases (pN +) with ENE being present in 26.8% of these. The recurrence rate was 6.4% (92 patients). Recurrence rates in patients with ≤ 5 nodes without ENE, > 5 nodes without ENE, ≤ 5 nodes with ENE and > 5 nodes with ENE were 2.7%, 1.3%, 8.3% and 10.3%, respectively. Recurrence rates in patients with 0.2-3 cm without ENE, 0.2-3 cm with ENE and > 3 cm with/without ENE were 1.8%, 8.5% and 13.4%, respectively. A modified risk stratification incorporating ENE and excluding the number of metastatic nodes was proposed. The modified risk stratification had a better fit than the present system in terms of higher C index and lower AIC.
Extranodal extension in differentiated thyroid cancer had the maximum influence on recurrence risk (recurrence-free survival) in our cohort. The prognostic impact of ENE supersedes the number of positive nodes in the risk of recurrence.
多种因素导致分化型甲状腺癌（DTC）复发。尽管目前美国甲状腺协会（ATA）风险分层中提到了淋巴结大小、阳性淋巴结数量以及存在结外侵犯（ENE），但与前两者相比，ENE的权重似乎不足。
在这项对一家三级医疗中心接受手术的DTC患者的回顾性研究中，分析了预测复发的因素。基于我们的研究结果，我们提议对目前的风险分层进行修改。我们通过与现有风险分层的拟合度和该系统的鉴别能力进行比较来做到这一点。
在1428例患者中，859例（60.2%）患者有病理淋巴结转移（pN+），其中26.8%存在ENE。复发率为6.4%（92例患者）。淋巴结≤5个且无ENE、淋巴结>5个且无ENE、淋巴结≤5个且有ENE以及淋巴结>5个且有ENE的患者复发率分别为2.7%、1.3%、8.3%和10.3%。淋巴结大小为0.2 - 3 cm且无ENE、0.2 - 3 cm且有ENE以及>3 cm且有/无ENE的患者复发率分别为1.8%、8.5%和13.4%。提出了一种纳入ENE并排除转移淋巴结数量的改良风险分层。改良后的风险分层在更高的C指数和更低的AIC方面比目前的系统具有更好的拟合度。
在我们的队列中，分化型甲状腺癌的结外侵犯对复发风险（无复发生存）影响最大。ENE在复发风险中的预后影响超过了阳性淋巴结数量。
