Follicular thyroid carcinoma: Histology and prognosis
Follicular thyroid carcinoma: Histology and prognosis
复制标题
DOI：
10.1002/cncr.20081
复制
发表时间：
2004-03-15
期刊：
影响因子：
6.2
通讯作者：
Clark, OH
中科院分区：
文献类型：
--
作者：
D'Avanzo, A;Treseler, P;Clark, OH
背景。滤泡性甲状腺癌是继甲状腺乳头状癌之后第二常见的甲状腺恶性肿瘤。作者对132例FTC患者的临床病程进行了研究，以确定组织学侵袭程度、肿瘤复发与患者生存之间是否存在直接关系。研究人群中的132例患者接受了182次甲状腺癌相关手术，平均随访7.5年（中位：6年，范围0-39年）。恶性滤泡性肿瘤的定义标准如下：1)微创性，肿瘤侵袭穿透肿瘤囊的整个厚度；2)中度侵袭性肿瘤伴血管浸润（伴或不伴囊膜浸润）；3)广泛侵袭性，甲状腺及甲状腺外组织的跨包膜大面积或局部侵犯。119例患者中45例（37.8%）表现为微创性FTC（仅侵犯囊膜），50例（42%）表现为中度侵入性FTC（血管侵犯伴或不伴囊膜侵犯），24例（20%）表现为广泛侵入性FTC。入院时，12例（9%）患者有远处转移，8例（6%）患者有淋巴结转移。排除12例出现远处转移的患者，21例（16%）患者在初始治疗6个月后复发转移。在45例仅有囊膜侵犯的患者中，6例（13%）出现复发或持续性疾病，5例（11%）死亡。在伴有或不伴有囊膜侵犯的50例血管侵犯患者中，10例（20%）出现复发或持续性疾病，7例（14%）死亡。血管浸润伴或不伴囊膜浸润的患者与仅伴囊膜浸润的患者相比预后较差（P < 0.0001）。在广泛侵袭性FTC患者中，24例患者中有9例（38%）复发，8例（33%）死亡；此外，其余24例患者中有7例（29%）患有持续性疾病并死亡。广泛侵袭性FTC患者的总死亡率为62%。持续性疾病患者的预后较复发性疾病患者差（P < 0.0001）。整个组中有28例（21%）患者死于ftc。在目前的回顾性研究中，作者证明微创性FTC（仅侵犯囊膜）患者的5年生存率（98%）略高于有或无囊膜侵犯血管的患者（80%），也略高于有广泛侵犯性FTC的患者（38%）。其他（但不是全部）文献报道支持以下发现：伴有血管侵犯的FTC比仅伴有囊膜侵犯的FTC更具侵袭性，但比广泛侵袭的FTC更具侵袭性。作者得出结论，FTC不应再被归类为微创或广泛侵入性；相反，他们建议将FTC分类为微创性、中度侵入性或广泛侵入性，因为这些分类的预后不同。(C) 2004年美国癌症协会。
BACKGROUND. Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy after papillary thyroid carcinoma. The authors studied the clinical course of 132 patients with FTC to determine whether there was a direct relation between the histologic degree of invasion, tumor recurrence, and patient survival.METHODS. The 132 patients in the study population underwent 182 thyroid carcinoma-related operations, and their mean follow-up was 7.5 years (median:,6 years; range, 0-39 years). The following criteria were used to define malignant follicular neoplasms: 1) minimally invasive, tumor invasion through the entire thickness of the tumor capsule; 2) moderately invasive, tumor with angioinvasion (with or without capsular invasion); and 3) widely invasive, broad area or areas of trans-capsular invasion of thyroid and extrathyroidal tissue. Forty-five of 119 patients (37.8%) presented with minimally invasive FTC (capsular invasion only), 50 patients (42%) presented with moderately invasive FTC (angioinvasion with or without capsular invasion), and 24 patients (20%) presented with widely invasive FTC. At presentation, 12 patients (9%) had distant metastases, and 8 patients (6%) had lymph node metastases.RESULTS. Excluding 12 patients who presented with distant metastases, 21 patients (16%) developed recurrent metastases 6 months after their initial treatment. Among 45 patients with capsular invasion only, 6 patients (13%) developed recurrent or persistent disease, and 5 patients (11%) died. Of the 50 patients who had angioinvasion with or without capsular invasion, 10 patients (20%) developed recurrent or persistent disease, and 7 patients (14%) died. Patients who had angioinvasion with or without capsular invasion had a less favorable prognosis compared with patients who had capsular invasion only (P < 0.0001). Among patients who had widely invasive FTC, 9 of 24 patients (38%) developed recurrent disease, and 8 patients (33%) died; in addition, 7 of the other 24 patients (29%) had persistent disease and died. The overall death rate for patients with widely invasive FTC was 62%. Patients with persistent disease had a poorer prognosis compared with patients who had recurrent disease (P < 0.0001). Twenty-eight patients (21%) in the entire group died of FTC.CONCLUSIONS. In the current retrospective investigation, the authors demonstrate that patients with minimally invasive FTC (capsular invasion only) had a slightly better survival rate at 5 years (98%) compared with patients who had angioinvasion with or without capsular invasion (80%) and had better survival compared with patients who had widely invasive FTC (38%). Other (but not all) reports in the literature support the findings that FTC with angioinvasion is more aggressive than FTC with only capsular invasion yet is less aggressive than widely invasive FTC. The authors conclude that FTC no longer should be classified as either minimally invasive or widely invasive; rather, they recommend classifying FTC as minimally invasive, moderately invasive, or widely invasive, because prognosis varies according to these groupings. (C) 2004 American Cancer Society.