Extrathyroidal Extension Predicts Extranodal Extension in Patients with Positive Lymph Nodes: An Important Association That May Affect Clinical Management
Extrathyroidal Extension Predicts Extranodal Extension in Patients with Positive Lymph Nodes: An Important Association That May Affect Clinical Management
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DOI：
10.1089/thy.2013.0557
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发表时间：
2014-06-01
期刊：
影响因子：
6.6
通讯作者：
Urken, Mark L.
中科院分区：
文献类型：
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作者：
Clain, Jason B.;Scherl, Sophie;Urken, Mark L.
背景资料：虽然有共识，显着的甲状腺外扩展（埃特）（T4）应提前分化良好的甲状腺癌患者，最小的埃特（T3）的重要性仍然存在争议。此外，淋巴结转移对预后的重要性也受到了密切关注。最近的出版物强调的重要性，积极的节点的大小，数量，特别是，存在的结节延伸（ENE）作为衡量疾病的侵略性。在这项研究中，我们研究了埃特是否是ENE.Methods的预测因素：从2004年1月至2013年3月进行了回顾性分析。所有淋巴结阳性的患者进行了全面或完成甲状腺切除术。组织学特征定义的美国病理学家学会（CAP）的协议为甲状腺carcinoma.Results：共193例合格的审查。发现有埃特的患者与甲状腺内原发性肿瘤患者相比，在ENE的原发环境中有淋巴结的可能性高12倍（p < 0.000）。排除所有T4病例后（n = 6），有轻微埃特的患者发生ENE的可能性是无埃特患者的13倍（p < 0.000）。20%的微小癌与埃特表现出ENE.Conclusion：我们已经发现，原发肿瘤的生物学被赋予淋巴结的存在下，埃特导致一个显着较高的发病率ENE。在原发和复发淋巴结的处理中，应该考虑到这种关系。这项研究表明，最小的埃特是一个显着的预测ENE。虽然本系列中大多数患者的长期生存和复发随访不可用，但ENE作为更具侵袭性疾病生物学的替代物的存在及其与极轻微埃特的强相关性支持极轻微埃特患者的分期上调。
Background: While there is consensus that significant extrathyroidal extension (ETE) (T4) should upstage a patient with well-differentiated thyroid cancer, the importance of minimal ETE (T3) remains controversial. Additionally, the importance of nodal metastases on prognosis has come under scrutiny. Recent publications highlight the importance of size, number of positive nodes, and, in particular, the presence of extranodal extension (ENE) as measures of disease aggressiveness. In this study, we examined whether ETE is a predictor of ENE.Methods: A retrospective review was conducted from January 2004 to March 2013. All node-positive patients who underwent total or completion thyroidectomy were included. Histologic features defined by the College of American Pathologists (CAP) protocol for thyroid carcinoma were recorded.Results: A total of 193 patients qualified for review. Patients who were found to have ETE were 12 times more likely to have lymph nodes in the primary setting with ENE than patients with intrathyroidal primary tumors (p < 0.000). After exclusion of all T4 cases (n = 6), patients with minimal ETE were 13 times more likely to have ENE than those with no ETE (p < 0.000). Twenty percent of microcarcinomas with ETE demonstrated ENE.Conclusion: We have found that the biology of the primary tumor is conferred to the lymph node in that the presence of ETE leads to a significantly higher incidence of ENE. Awareness of this relationship should be accounted for in the management of primary and recurrent lymph nodes. This study shows that minimal ETE is a significant predictor of ENE. Although long-term survival and recurrence follow-up is not available for the majority of patients in this series, the presence of ENE as a surrogate for more aggressive disease biology and its strong association with minimal ETE supports the upstaging of patients with minimal ETE.