Stegenga Merel T, Oudijk Lindsey, van Velsen Evert F S, Peeters Robin P, Medici Marco, Verburg Frederik A, van Ginhoven Tessa M, van Kemenade Folkert J, Visser W Edward
Erasmus MC Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, 3015GDThe Netherlands.
Erasmus MC Academic Center for Thyroid Diseases, Department of Pathology, Erasmus Medical Center, Rotterdam, 3015GDThe Netherlands.
J Clin Endocrinol Metab. 2025 Apr 22;110(5):e1343-e1350. doi: 10.1210/clinem/dgae581.
The 2022 WHO Classification categorizes oncocytic (OTC) and follicular thyroid carcinoma (FTC), based on the degree of capsular and vascular invasion, into minimally invasive (MI), encapsulated angio-invasive (EA), and widely invasive tumors (WI). While associations with clinical outcomes have been studied extensively in FTC, robust clinical data are lacking for OTC. We aimed to investigate the impact of the reclassification of OTC and FTC by the 2022 WHO Classification on clinical outcomes.
All adult OTC and FTC patients treated at the Erasmus MC (the Netherlands) between 2000 and 2016 were retrospectively included. All tumors were extensively revised by 2 independent pathologists, facilitated by Palga: Dutch Pathology Databank. Kaplan-Meier curves were used to study the association of the 2004 and 2022 WHO Classification with overall survival, disease-specific survival (DSS), recurrence-free survival, and radioactive iodine (RAI)-refractory disease.
Among 52 OTC and 89 FTC patients, 15 (28.8%) OTC and 34 (38.2%) FTC tumors were reclassified as EAOTC or EAFTC. The 2022 WHO Classification substantially improved risk stratification in both subtypes for DSS, compared to the 2004 edition. Ten-year DSS rates were 100% for MIOTC, 92.9% for EAOTC, and 56.5% for WIOTC, compared to 100% (MIOTC) and 64.2% (WIOTC) following the 2004 WHO Classification. For FTC and RAI-refractory disease, similar trends were observed.
Classification of OTC and FTC into 3 subcategories as defined by the 2022 WHO Classification substantially improves discrimination between low-, intermediate-, and high-risk patients, especially for DSS and RAI-refractory disease.
2022年世界卫生组织（WHO）分类根据包膜和血管侵犯程度，将嗜酸细胞性甲状腺癌（OTC）和滤泡状甲状腺癌（FTC）分为微侵袭性（MI）、包膜血管侵袭性（EA）和广泛侵袭性肿瘤（WI）。虽然FTC与临床结局的关联已得到广泛研究，但OTC缺乏有力的临床数据。我们旨在研究2022年WHO分类对OTC和FTC重新分类对临床结局的影响。
回顾性纳入2000年至2016年在伊拉斯姆斯医学中心（荷兰）接受治疗的所有成年OTC和FTC患者。所有肿瘤均由2名独立病理学家进行广泛复查，借助Palga：荷兰病理数据库进行。采用Kaplan-Meier曲线研究2004年和2022年WHO分类与总生存期、疾病特异性生存期（DSS）、无复发生存期和放射性碘（RAI）难治性疾病的关联。
在52例OTC患者和89例FTC患者中，15例（28.8%）OTC肿瘤和34例（38.2%）FTC肿瘤被重新分类为EAOTC或EAFTC。与2004年版相比，2022年WHO分类在两种亚型中均显著改善了DSS的风险分层。MIOTC的10年DSS率为100%，EAOTC为92.9%，WIOTC为56.5%，而2004年WHO分类后分别为100%（MIOTC）和64.2%（WIOTC）。对于FTC和RAI难治性疾病，观察到类似趋势。
按照2022年WHO分类定义将OTC和FTC分为3个亚类，可显著改善低、中、高风险患者之间的区分，尤其是对于DSS和RAI难治性疾病。
