Clinical and Molecular Features of Hurthle Cell Carcinoma of the Thyroid
Clinical and Molecular Features of Hurthle Cell Carcinoma of the Thyroid
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DOI：
10.1210/jc.2014-1634
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发表时间：
2015-01-01
影响因子：
5.8
通讯作者：
Smallridge, Robert C.
中科院分区：
文献类型：
--
作者：
Chindris, Ana-Maria;Casler, John D.;Smallridge, Robert C.
内容：甲状腺Hurthle细胞癌（HCC）在自然病程、治疗和随访方面仍是一个有争议的话题。目的：本研究的目的是评价HCC的临床和分子特征与预后的关系。设计：本研究回顾了马约诊所治疗的173例HCC病例，随访时间超过11年，中位时间为5.8年。结果：微创组织学患者无持续性疾病、临床复发或疾病相关死亡。男性和TNM分期与广泛浸润患者的临床复发或死亡风险增加独立相关。与TNM分期I-II的患者（女性，0%;男性，17%）相比，TNM分期III-IV的患者（女性，74%;男性，91%）的5年累积临床复发或死亡概率更高。肺转移瘤最好通过计算机断层扫描确定，而放射性碘扫描仅在27例中的2例中呈阳性。甲状腺球蛋白可检测到临床疾病的患者，与5例远处转移的患者显着的例外。常见的TERTC 228 T启动子突变在广泛侵袭性和微创肿瘤中均被检测到。TERTmRNA低于检测限，在所有samples.Conclusion：广泛浸润性肝癌与TNM分期III-IV是积极的，与无复发生存的可能性低。男性的结果比女性差。微创肝细胞癌的侵袭性要小得多。放射性碘扫描在发现远处疾病方面表现不佳。尽管肝癌中的TERT基因发生了突变，但这种突变的作用仍有待证实。
Context: Hurthle cell cancer (HCC) of the thyroid remains the subject of controversy with respect to natural course, treatment, and follow-up.Objective: The objective of the study was to evaluate the clinical and molecular features associated with outcome in HCC.Design: The study was a review of 173 HCC cases treated at Mayo Clinic over 11 years with a median 5.8-year follow-up.Results: None of the patients with minimally invasive histology had persistent disease, clinical recurrence, or disease-related death. Male gender and TNM stage were independently associated with increased risk of clinical recurrence or death in widely invasive patients. The 5-year cumulative probability of clinical recurrence or death was higher in patients with TNM stage III-IV (females, 74%; males, 91%) compared with patients with TNM stage I-II (females, 0%; males, 17%). Pulmonary metastases were best identified by computed tomography, whereas radioactive iodine scans were positive in only two of 27 cases. Thyroglobulin was detectable in patients with clinical disease, with the notable exception of five patients with distant metastases. The common TERT C228T promoter mutation was detected in both widely invasive and minimally invasive tumors. TERT mRNA was below the limit of detection in all samples.Conclusion: Widely invasive HCC with TNM stage III-IV is aggressive, with low probability of recurrence-free survival. Males have worse outcomes than females. Minimally invasive HCC appears to be considerably less aggressive. Radioactive iodine scan performs poorly in detecting distant disease. Although the TERT gene is mutated in HCC, the role of this mutation remains to be demonstrated.