Ondokuz Mayis University Faculty of Medicine Department of Endocrinology and Metabolism Samsun Turkey Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey.
Ondokuz Mayis University Faculty of Medicine Department of Internal Medicine Samsun Turkey Ondokuz Mayis University, Faculty of Medicine, Department of Internal Medicine, Samsun, Turkey.
Arch Endocrinol Metab. 2024 Jul 30;68:e230422. doi: 10.20945/2359-4292-2023-0422. eCollection 2024.
Subcentimeter papillary thyroid carcinoma (sPTC), also known as papillary thyroid microcarcinoma, is associated with a good prognosis and low mortality risk. However, some sPTCs exhibit biologically aggressive characteristics. The aim of this study was to identify factors affecting the prognosis and aggressiveness of sPTC by considering the demographic characteristics of patients with sPTC and the pathologic characteristics of the tumors.
The study included 255 patients aged ≥ 18 years who were operated on at Ondokuz Mayis University, Faculty of Medicine (Samsun, Turkey) between June 2008 and December 2021. All patients had histopathologic confirmation of sPTC (≤10 mm) and underwent regular follow-up for at least 36 months.
The tumors had a mean size of 5 mm (0.1-10 mm) and were multifocal in 53.7% of patients. Capsular invasion was observed in 9% of patients. Vascular invasion, lymphatic invasion, and extrathyroidal invasion were present in 2%, 5.5%, and 0.8% of patients, respectively. Metastatic cervical lymph nodes were observed in 9.4% of patients. On multivariate logistic regression analysis, tumor size (odds ratio [OR] 1.380, 95% confidence interval [CI] 1.106-1.722, p = 0.004) and sex (OR 4.233, 95% CI 1.355-13.226, p = 0.013) were the main predictive factors influencing lymph node metastasis. Tumors > 5 mm, compared with tumors ≤ 5 mm, had higher rates of multifocality (p = 0.009), parenchymal invasion (p = 0.008), calcifications (p = 0.001), microscopic lymphatic invasion (p = 0.002), and presence of metastatic lymph nodes (p < 0.001).
The findings of this study highlight important factors to consider in making decisions about prophylactic central compartment neck dissection in patients with sPTCs, particularly those with clinically node-negative tumors.
亚厘米级甲状腺乳头状癌（sPTC），亦称甲状腺微小乳头状癌，与良好的预后和低死亡率风险相关。然而，一些 sPTC 表现出具有侵袭性的生物学特征。本研究旨在通过考虑 sPTC 患者的人口统计学特征和肿瘤的病理学特征，确定影响 sPTC 预后和侵袭性的因素。
该研究纳入了 2008 年 6 月至 2021 年 12 月在土耳其奥登尼兹·梅伊斯大学医学院接受手术的 255 例年龄≥18 岁的患者。所有患者均经组织病理学证实患有 sPTC（≤10mm），并至少接受了 36 个月的定期随访。
肿瘤平均大小为 5mm（0.1-10mm），53.7%的患者为多灶性。9%的患者存在包膜侵犯。2%的患者存在血管侵犯，5.5%的患者存在淋巴管侵犯，0.8%的患者存在甲状腺外侵犯。9.4%的患者存在颈淋巴结转移。多因素 logistic 回归分析显示，肿瘤大小（比值比[OR] 1.380，95%置信区间[CI] 1.106-1.722，p=0.004）和性别（OR 4.233，95%CI 1.355-13.226，p=0.013）是影响淋巴结转移的主要预测因素。与肿瘤≤5mm 的患者相比，肿瘤>5mm 的患者具有更高的多灶性发生率（p=0.009）、实质侵犯发生率（p=0.008）、钙化发生率（p=0.001）、显微镜下淋巴管侵犯发生率（p=0.002）和存在转移性淋巴结的发生率（p<0.001）。
本研究结果强调了在决定对 sPTC 患者行预防性中央区颈部清扫术时需要考虑的重要因素，特别是对于临床淋巴结阴性的肿瘤患者。
