Distant metastases from pathologically proven benign follicular nodules of the thyroid: clinicopathological features and predictors of long-term survival
Distant metastases from pathologically proven benign follicular nodules of the thyroid: clinicopathological features and predictors of long-term survival
复制标题
病理证实的甲状腺良性滤泡结节的远处转移：临床病理学特征和长期生存的预测因素
DOI：
10.1007/s12020-020-02237-0
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发表时间：
2020-03-18
期刊：
影响因子：
3.7
通讯作者：
Luo，Quan-Yong
中科院分区：
文献类型：
--
作者：
Qiu，Zhong-Ling;Shen，Chen-Tian;Luo，Quan-Yong
目的早期病理证实的良性甲状腺滤泡结节很少发生远处转移。本研究旨在评估这类远处转移患者的临床病理特征和与生存相关的独立变量。方法回顾性分析2000年至2018年共10992例连续分化型甲状腺癌（DTC）患者在全甲状腺或近全甲状腺切除术后接受131i治疗。结果39例经病理证实为良性甲状腺滤泡结节的患者入组。其中病理诊断为甲状腺腺瘤26例，良性结节性甲状腺肿8例，甲状腺腺瘤合并良性结节性甲状腺肿4例，甲状腺正常组织1例。在26例患者的初始病理切片中，8例再次诊断为微创性甲状腺癌（MI-FTC）， 10例为恶性潜能不确定的滤泡性肿瘤（FT-UMP）， 5例为高分化甲状腺癌（WDT-UMP）。初始甲状腺切除术后甲状腺球蛋白（Tg）变化和消融前刺激Tg （psTg）水平监测与5年OS率显著相关（P= 0.007和P= 0.005）。放射性难治性DTC （RR-DTC）的存在、初始甲状腺切除术后Tg变化监测和psTg水平对10年OS率有显著影响（P= 0.002、P< 0.001和P= 0.005）。初始甲状腺切除术后缺乏Tg变化监测和RR-DTC是预后不良的独立因素（P= 0.003和P= 0.008）。结论smi - ftc、FT-UMP、WDT-UMP易被忽视或误诊为良性滤泡病变。缺乏对初始甲状腺切除术后Tg变化的监测和RR-DTC的存在被认为是与生存率低相关的独立因素。
ObjectiveDistant metastases are rarely observed in patients with initial pathologically proven benign follicular nodules of the thyroid. This study aimed to evaluate the clinicopathological features and independent variables associated with survival in such patients with distant metastases.MethodsIn total, 10,992 consecutive differentiated thyroid cancer (DTC) patients treated with131I after total or near-total thyroidectomy from 2000 to 2018 were retrospectively reviewed.ResultsThirty-nine patients with initial pathologically proven benign follicular nodules of the thyroid were enrolled. Among them, 26 were pathologically diagnosed as thyroid adenoma, 8 as benign nodular goiter, 4 as thyroid adenoma combined with benign nodular goiter, and 1 as normal thyroid tissue. Of 26 patients with the initial pathological slides obtained, eight cases were rediagnosed as minimally invasive thyroid carcinoma (MI-FTC), 10 as follicular tumor of uncertain malignant potential (FT-UMP), and five as well-differentiated tumor of UMP (WDT-UMP). Monitoring of thyroglobulin (Tg) changes after initial thyroidectomy and preablation-stimulated Tg (psTg) level were significantly associated with 5-year OS rate (P= 0.007 andP= 0.005, respectively). The presence of radioactive-refractory DTC (RR-DTC), monitoring of Tg changes after initial thyroidectomy, and psTg level had significant effects on 10-year OS rate (P= 0.002,P< 0.001, andP= 0.005, respectively). Lack of monitoring of Tg changes after initial thyroidectomy and RR-DTC were independent factors associated with poor prognosis (P= 0.003 andP= 0.008, respectively).ConclusionsMI-FTC, FT-UMP, and WDT-UMP tended to be ignored and/or misdiagnosed as benign follicular lesions. Lack of monitoring of Tg changes after initial thyroidectomy and the presence of RR-DTC were identified as independent factors associated with poor survival.