Abstract
Simple SummaryThyroid cancer incidence is increasing, with overdiagnosis being the major driver of the thyroid cancer “epidemic”. Papillary thyroid carcinoma, usually with excellent prognosis, sometimes has an aggressive metastatic pattern. This heterogeneity in progression makes it difficult to tailor treatment strategies for an individual patient. We aimed to identify clinicopathological factors associated with papillary thyroid carcinoma recurrence, persistence, and specific mortality. Our study supports that both pre-surgical factors, such as male gender, presence of psammoma bodies, gross extra-thyroidal extension, and lateral compartment lymph node metastases, as well as lymph vessel invasion, venous invasion, presence of necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of PTC patients. The same is true when analysis is restricted to stage I patients. The importance of this report is to emphasize clinical and imaging pre-surgical thyroid cancer patients’ evaluation for an appropriate surgical treatment and patient prognosis.Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients’ outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients’ files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, p = 0.015), venous invasion (OR = 16.7, p = 0.022), and lateral compartment LNM (OR = 26.7, p = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, p = 0.008), lymph vessel invasion (OR = 6.9, p < 0.001), and gross ETE (OR = 16.1, p = 0.001) were predictors of structural disease status; male gender (OR = 2.9, p = 0.011), lymph vessel invasion (OR = 2.8, p = 0.006), and incomplete resection margins (OR = 4.6, p < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient’s surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.
Highlights
Thyroid cancer (TC) is the most common endocrine malignancy [1,2]
We found a significant association between increased risk of structural disease status and male gender, tumors bigger than 10mm, presence of PBs, Dystrophic calcification (DC), necrosis, lymph vessel invasion, gross ETE, incomplete surgical resection, lateral compartment lymph node metastases (LNMs), and extranodal extension of lateral LNM in the whole group (Table 3)
Our study was performed in a consecutive series of patients submitted to surgery in a single institution, in a defined period, using clinical data collected by a single medical doctor and tumors reviewed by a single pathologist
Summary
Thyroid cancer (TC) is the most common endocrine malignancy [1,2]. Cancer Institute surveillance, epidemiology, and end results (SEER), the yearly TC incidence has nearly tripled since 1975. Almost the entire change has been attributed to an increase in the incidence of papillary thyroid microcarcinoma (mPTC) [2,3]. In 2020, TC is the fifth most common cancer in women [4] and overdiagnosis is a major driver of the TC “epidemic” [5]. PTC is the most common malignancy originating from the thyroid (80–90% of all TC types [1]). PTC generally has an indolent nature and good, or even excellent, prognosis after surgery, with survival rates for adults of 92–98% at 10-year follow-up [6].
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