Marongiu Andrea, Nuvoli Susanna, De Vito Andrea, Mura Antonio, Vargiu Sonia, Spanu Angela, Madeddu Giuseppe
Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.
Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.
J Clin Med. 2024 Sep 11;13(18):5373. doi: 10.3390/jcm13185373.
: Recurrence prediction for patients with PC and tumor sizes ranging between 1 and 4 cm, classified as T1b and T2, remains a controversial problem. We evaluated which risk factors, identified during the primary tumor surgery, might play a prognostic role in predicting disease progression. : We retrospectively enrolled 363 patients with classic PC who were in follow-up (207 T1b, 156 T2), with tissue risk factors at surgery in 209/363 cases. In all cases, an I-whole-body scan, SPECT/CT, and US were employed to detect any metastases during follow-up, and histology was used to confirm lesions. In the absence of surgery, metastases were validated by radioisotopic and radiologic procedures, eventually culminating in a needle biopsy and sequential thyroglobulin changes. : Metastases occurred in 61/363 (16.8%) patients (24 T1b, 37 T2). In 50/61 cases, the following risk factors were identified: minimal extrathyroid tumor extension (mETE) alone in 12/50 patients, neck lymph node (LN) metastases in 8/50 cases, and multifocality/multicentricity (M/M) in 6/50 cases. In the remaining 24/50 cases, the risk factors were associated with each other. From a Cox regression multivariate analysis, metastasis development was significantly ( < 0.001) influenced by only mETE and LN metastases, with a shorter disease-free survival (log-rank test). : The current study proves that mETE and neck LN metastases are associated with aggressive PC. While LN metastasis' role is known, mETE's role is still being debated, and was removed by the 's eighth edition because it was considered to not be associated with an unfavorable prognosis. However, this interpretation is not supported by the present study and, according to comparable studies, we suggest a revision of the mETE classification be considered in the next edition.
对于肿瘤大小在1至4厘米之间、分类为T1b和T2的甲状腺癌（PC）患者，复发预测仍然是一个有争议的问题。我们评估了在原发性肿瘤手术期间确定的哪些风险因素可能在预测疾病进展中发挥预后作用。我们回顾性纳入了363例接受随访的经典PC患者（207例T1b，156例T2），其中209/363例患者在手术时有组织风险因素。在所有病例中，采用全身I扫描、SPECT/CT和超声在随访期间检测任何转移灶，并通过组织学确认病变。在未进行手术的情况下，通过放射性同位素和放射学程序验证转移灶，最终以细针穿刺活检和甲状腺球蛋白的连续变化作为最终诊断。61/363（16.8%）例患者发生转移（24例T1b，37例T2）。在50/61例病例中，确定了以下风险因素：仅12/50例患者存在微小甲状腺外肿瘤侵犯（mETE），8/50例病例存在颈部淋巴结（LN）转移，6/50例病例存在多灶性/多中心性（M/M）。在其余24/50例病例中，风险因素相互关联。从Cox回归多变量分析来看，转移灶的发生仅受mETE和LN转移的显著影响（<0.001），无病生存期较短（对数秩检验）。本研究证明mETE和颈部LN转移与侵袭性PC相关。虽然LN转移的作用已为人所知，但mETE的作用仍存在争议，并且在[具体版本]的第八版中被删除，因为它被认为与不良预后无关。然而，本研究不支持这种解释，并且根据可比研究，我们建议在下一版中考虑对mETE分类进行修订。
