External Validation of Three Available Grading Systems for Medullary Thyroid Carcinoma in a Single Institution Cohort
External Validation of Three Available Grading Systems for Medullary Thyroid Carcinoma in a Single Institution Cohort
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在单一机构队列中对三种可用的甲状腺髓样癌分级系统进行外部验证
DOI：
10.1007/s12022-022-09719-z
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发表时间：
2022
影响因子：
4.4
通讯作者：
M. Papotti
中科院分区：
文献类型：
--
作者：
E. Vissio;F. Maletta;Jessica Fissore;S. Osella Abate;F. Retta;M. Brizzi;A. Piovesan;R. Rossetto Giaccherino;M. Volante;M. Papotti
甲状腺髓样癌是一种罕见的甲状腺癌，临床表现多样。潜在的临床和病理预后标志物已被调查，但研究是有限的和有争议的。在各种其他部位的神经内分泌肿瘤中，坏死和增殖（有丝分裂活性和/或Ki 67指数）被整合以提供组织学分级。最近，国际甲状腺髓样癌分级系统（IMTCGS）已被设计用于通过结合增殖活性和坏死来定义高级别或低级别MTC。该提案整合了美国（2层分级，低和高等级MTC）和澳大利亚作者（3层分级，低，中，高等级MTC）先前公布的两个分级方案。为了验证这些系统的临床作用，在111个MTC的独立队列中评估了其预后影响。坏死是唯一被纳入3个分级系统的参数，被证明与肿瘤复发相关，而与增殖无关（有丝分裂计数和Ki 67指数）;然而，通过根据所有三个分级系统组合不同的参数，在所有系统中，“高级别”MTC与疾病复发显著相关（p < 0.005）。在无病生存分析中，IMTCGS分层是唯一一个在考克斯回归分析中显示出显著影响的分层（p = 0.004），Kaplan-Meier曲线进一步证实了这一点（p = 0.002）。当分析仅限于散发性MTC（68例）时，也重现了类似的结果。总之，我们的研究结果证实了IMTCGS的预后作用，支持将此信息纳入病理报告的重要性。然而，在该验证队列中，没有一个系统被证明可以预测总生存期。
Medullary thyroid carcinoma (MTC) is a rare thyroid carcinoma with a variable clinical behavior. Potential clinical and pathological prognostic markers have been investigated, but studies are limited and controversial. In neuroendocrine neoplasms of various other sites, necrosis and proliferation (mitotic activity and/or Ki67 index) are integrated to provide a histological grade. Recently, an International Medullary Thyroid Carcinoma Grading System (IMTCGS) has been designed to define high- or low-grade MTC by combining proliferative activity and necrosis. This proposal integrates two previously published grading schemes by American (2-tiered grading, low- and high-grade MTC) and Australian authors (3-tiered grading, low-, intermediate-, and high-grade MTC). To validate the clinical role of these systems, their prognostic impact was evaluated in an independent cohort of 111 MTCs. Necrosis, which was the only parameter integrated into the 3 grading systems, proved to be individually correlate with tumor relapse, while no association was found with the proliferation (mitotic count and Ki67 index); however, by combining the different parameters according to all three grading systems, “high-grade” MTCs turned out to be significantly associated with the disease recurrence (p < 0.005) in all systems. In disease-free survival analysis, the IMTCGS stratification was the only one that demonstrated a significant impact at Cox regression analysis (p = 0.004), further confirmed by the Kaplan–Meier curves (p = 0.002). Similar findings were also reproduced when analysis was restricted to sporadic MTCs (68 cases). In conclusion, our results confirm the prognostic role of IMTCGS, supporting the importance of incorporating this information into the pathology report. However, none of the systems proved to predict the overall survival in this validation cohort.
影响因子：
158.5
作者：
Wirth, L. J.;Sherman, E.;Cabanillas, M. E.
通讯作者：
Cabanillas, M. E.